key: cord-348038-9v16k6gi authors: Bagnasco, Annamaria; Zanini, Milko; Hayter, Mark; Catania, Gianluca; Sasso, Loredana title: COVID 19—A message from Italy to the global nursing community date: 2020-05-08 journal: J Adv Nurs DOI: 10.1111/jan.14407 sha: doc_id: 348038 cord_uid: 9v16k6gi During these difficult times, it is not easy to learn all the nursing lessons from the COVID-19 epidemic in Italy. It is not easy because - at the time of writing - Italian nurses are in the middle of this emergency that shows no sign of diminishing. Whatever is said today can change completely after only 24 hours. As a global community we have only known about this virus for a few months, but it has invaded lives, hospitals and homes, subverting habits, practices, and protocols. Some of the lessons learned will emerge later - after reflection and retrospective analysis. However, some things are now so evident that sharing them now is vital to help prepare those who are getting ready to face this emergency. dent that sharing them now is vital to help prepare those who are getting ready to face this emergency. The first lesson is the vital importance of personal protective equipment (PPE)-both in terms of amount and suitability. In Italy the lack of suitable PPE, in particular, appropriate masks-as the ordinary surgical masks are of no use-has played a key role in spreading the infection among health workers. This lack of appropriate protection for those working on the front lines translates into a drastic daily loss of health professionals. It has been estimated that one tenth of those in Italy who are COVID-19 positive are physicians and nurses, but this could be underestimated due to the presence of infected professionals who are without symptoms (Anelli et al., 2020; Sorbello et al., 2020) . It is to their enormous credit that many nurses continue to provide care conscious that the minimum levels of protection cannot be guaranteed. With the global pandemic now accelerating in areas of the world yet to see Italian levels of infection, it is vital that PPE equipment is procured and delivered to the COVID-19 front-line critical care environments. Protecting staff-as well as being an ethical duty of healthcare providers-is also essential to prevent reductions in skilled staff due to illness when they are needed more than ever. Time is precious in this pandemic-Italy did not see it coming-many other areas of the world can. The importance of PPE for staff cannot be emphasized enough. Learn also from Italian nurses' experiences of the harm long-term use of PPE: facial lesions and sores produced by the pressure and sweat caused by masks and goggles worn far beyond the usual time frame in normal clinical practice. Further research will be needed on this-with the manufacturers of PPE being involved. But in the immediate situation healthcare providers can advise on self-care for those staff having to wear PPE for protracted periods (Suen et al., 2020) . To help limit face lesions caused by the pressure of masks and goggles, the Italian National Institute of Health (Istituto Superiore di Sanità) organized online courses for health professionals to help them deal with this issue, among others related to keeping safe against Covid-19. More ergonomic masks, goggles and PPE will need to be available in the future. Another very challenging issue, especially at the beginning of the outbreak, has been the antigen or viral testing of front-line staff, unfortunately in most cases this was not possible due to the very rapid spread of COVID-19 infections, because there were not enough testing kits available and places where these analyses could be conducted (Paterlini, 2020) . We also recognize that the lack of antibody testing resulted in an inability to tell who had had the infection but now had immunity-and could therefore safely return to work. More recently, some Italian Regions are starting to conduct tests on all front-line staff and on the entire population, but it has taken several precious weeks of time to implement this. So, this is another important lesson for the global community. An additional emotional burden facing nurses is the fear of introducing the virus into their own homes and exposing family members to COVID-19. It is important that nurses and other health professionals are trained in the correct procedures to manage uniforms and other belongings to minimize such a risk. If possible, staff should be encouraged and supported to use alternative accommodation to reduce the risk of family transmission. Policy makers need to ensure they provide appropriate logistic and financial support to help with this course of action. This also creates a sense of isolation for healthcare workers who are already highly stressed. It highlights that this epidemic is wreaking a huge emotional toll on all healthcare professionals in Italy. The long-term support needs of these staff can be planned later-but the importance of trying to provide some psychological support for staff-including the opportunity to speak about their experiences and fears-if only briefly-should be an important part of the acute response to COVID-19. Front-line COVID-19 care giving is exhausting-especially over long hours-at some point replacement staff will be needed to enable others to take some rest and restore their energy. Many of these replacements may be returning to practice or unfamiliar with critical care environments-the importance of training and providing PPE for these staff should not be neglected due to the urgency of the need to plug gaps in the care teams. To healthcare providers and policy makers in areas at the start of their COVID-19 epidemic, our message is to plan for the replacement of staff in critical care areasthink about how this will be done, how they can be prepared and how you plan to recall recently retired nurses back to the hospitals. The peer review history for this article is available at https://publo ns.com/publo n/10.1111/jan.14407 and encouragement, to ensure that such choices are solidly rooted in noble values. One last but very important lesson from the epidemic is the need to plan for the possibility of caring for patients in their own homes. We have learnt that hospitalization is not necessary for everyone and can even be harmful. Home care may be a more viable option. Moreover, this would enable to reduce hospital stay and facilitate the fast discharge of recovering patients, thus increasing the availability of beds and other hospital resources. However, to take care of patients at home community nurses and general practitioners must have all the equipment and instruments they need in order to be able to do their job properly. Therefore, it is important to educate large numbers of primary and community-based health professionals who, with all the necessary equipment and means, and in collaboration with general practitioners, can take care of patients directly in their own homes. It is also vital that this also included ensuring the infection control measures are in place to protect others living in the same dwelling. To conclude, 2020 is the Year of the Nurse, celebrating the bicentenary of the birth of our colleague Florence Nightingale, but it will surely be remembered also as the year of the COVID-19 pan- We thank Dr Giuseppe Aleo, PhD and Lecturer of Scientific English from the Department of Health Sciences of the University of Genoa for translating this editorial into English. Covid-19: Over 300 Italian doctors and scientists call for more testing Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) Airway Research Group, and The European Airway Management Society Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures