key: cord-0816616-m46hwnu5
authors: Chen, Qinghong; Lan, Xing; Zhao, Zhenghua; Hu, Shaofei; Tan, Fang; Gui, Ping; Yao, Shanglong
title: Role of anesthesia nurses in the treatment and management of patients with COVID-19
date: 2020-05-30
journal: J Perianesth Nurs
DOI: 10.1016/j.jopan.2020.05.007
sha: 154430671510477d7d3907390e4b8128e8a306d6
doc_id: 816616
cord_uid: m46hwnu5

Abstract As the backbone for the treatment of patients with coronavirus disease 2019 (COVID-19), nurses have been actively playing key roles in cabin hospitals, isolation wards, and intensive care units (ICUs) for critical cases. Anesthesia nurses have their own professional specialties, such as airway management, the use and maintenance of life support equipment, including ventilators, and the use of high-flow oxygen equipment. With rich experience in emergency responses and nursing, anesthesia nurses, along with emergency nurses and critical care nurses, play important roles during the treatment of COVID-19 patients. In our hospital, 27 of 34 anesthesia nurses participated in the front-line fight against COVID-19 and did an excellent job. Anesthesia care by nurses is relatively new in China, and the role of anesthesia nurses during a disaster response has not been fully appreciated. Given their specialty, anesthesia nurses have played important roles in the treatment of COVID-19 patients. We hope that authorities will consider including anesthesia nurses in national disaster response medical rescue teams.

In the month before New Year's Day 2020, the coronavirus disease 2019 (COVID-19) outbreak began in Wuhan, Hubei Province, China, and quickly spread throughout China.

COVID-19 is an acute respiratory infection that is mainly transmitted via respiratory droplets and contact. All age groups are susceptible. The disease is highly contagious with a short onset period and a long incubation period [1] . COVID-19 poses severe challenges to the public health emergency response system in China and is a serious threat to public health and life. In the wake of the epidemic, the Chinese government responded quickly by sending medical rescue teams across China to Hubei. Most of the team members were from respiratory medicine, infectious disease medicine, critical care medicine, and emergency medicine. In particular, anesthesia nurses played an important role in the treatment of COVID-19 patients thanks to their specialties in airway management. In this paper, we discuss the specialties and roles of anesthesia nurses in front-line work.

Nurses are the backbone of the medical emergency response system. They work with other healthcare professionals on the front lines and play key roles during emergency responses [2] . On Mechanism of the State Council that more than 42 000 healthcare professionals around China had been dispatched to Hubei, of whom 28 600 (68%) were nurses (Table 1) . During the treatment of COVID-19 patients, nurses provided meticulous care, treatment, monitoring, and mental support, thereby playing key roles in COVID-19 prevention and control. Nurses worked closely with doctors to promote patient recovery and improve treatment outcomes [3] .

Severe COVID-19 is associated with a critical and rapidly evolving condition and includes multiple organ failure and multiple complications. The treatments are often complex, involving a very high workload for nurses and high requirements for technical skills. During treatment, careful monitoring, close cooperation between doctors and nurses, and attention to the holistic care of patients with critical disease are essential for improving patient outcomes. COVID-19 patients face severe mental challenges. In addition to nursing and treatment, nurses are able to promptly ease a patient's psychological concerns while enhancing courage to overcome COVID-19.

Anesthesia care by nurses is relatively new in China and was established to align with the development of modern anesthesiology [4] . The title "anesthesia nurse" was officially proposed internationally in 1861 to adapt to the rapid development of anesthesiology [5] . Anesthesia care by nurses is relatively new in China and the education program is only 20 years old and still in its infancy [6] . 3.6 Skin care should be performed, and stress injuries should be prevented.

As medical centers strive to treat as many COVID-19 patients as possible in China, front-line nurses in respiratory medicine and infectious disease medicine faced high workload and stress levels. Proper shifts and support from nurses from other departments have helped alleviate the stress experienced by front-line nurses. Of the 34 anesthesia nurses at our hospital, 27 experienced nurses supported front-line work at some point and worked at fever clinics, isolation wards, ICUs and cabin hospitals to provide medical treatment and care and mental support for COVID-19 patients ( Table 2 ). The few nurses who did not participate were responsible for the normal operation of the anesthesiology department. Cabin hospitals (Figure 2 ) , also called makeshift hospitals(Fangcang in Chinese), are large, temporary hospitals built by converting public venues, such as stadiums and exhibition centers, into health-care facilities to isolate patients with mild to moderate symptoms of an infectious disease from their families and communities, while providing medical care, disease monitoring, food, shelter and social activities [10] .

In general, anesthesia nurses primarily work in the PACU for postoperative care. They monitor patient breathing, circulation, consciousness, muscle strength, and blood oxygen saturation; prevent common complications; manage respiratory emergencies; and transfer patients to his/her ward after a patient is fully awake. They have extensive clinical experience in airway management, monitoring patient conditions, emergency response, mental care, and safe transfer, all of which give them unique advantages in the treatment and management of COVID-19 patients.

Anesthesia nurses are experienced in patient transport. The transport of critically ill patients is a high-risk procedure. It is challenging to ensure the safety of critically ill patients during transport. Studies have shown that up to 71 % of patients endure mild to severe complications during transport or examination [11] . However, the transport of critically ill patients during a crisis is an important task. In particular, life support and monitoring during transport requires senior medical staff with transport experience; notably, the transport of critically ill patients is a daily task in the PACU. Anesthesia nurses are better equipped than other nurses to handle this task.

Anesthesia nurses have more experience in personal protection. They routinely work in an operating room and are familiar with surgical gowns, gloves, eye protection, surgical caps, masks, and even barrier gowns. They are superior to other nurses with respect to the acceptance of and adaptability to PPE. During the severe acute respiratory syndrome (SARS) epidemic in 2003, personal protection was the main source of stress for nurses. COVID-19 is more contagious than SARS. Nurses must wear multilayer PPE, including multilayer protective clothing, masks, gloves, foot covers, and eye protection, which can cause breathing problems and hypoxia. Eye protection and caps block vision and hearing; gloves reduce the hand's tactile sensation and increase the difficulty of nursing procedures. As a result, the difficulty of completing work tasks is greatly increased, with high stress and workload levels. Moreover, nurses unfamiliar with isolation and protection and intensive care are prone to mental stress, physical burnout, and even other complications.

Anesthesia nurses have extensive experience in emergency response. COVID-19 mainly targets the lungs. Symptoms include dry cough, fever, acute respiratory distress syndrome, and even respiratory failure, multiple organ failure, and cardiac arrest. As a result, nurses face high levels of stress. During the postanesthesia stage, postoperative patients are prone to hypoxemia due to respiratory tract obstruction and respiratory depression and subsequently hypoxic agitation [12] , blood pressure fluctuations and insufficient perfusion of major organs, delayed 

Anesthesia nurses have unique airway and respiratory management skills and experience and can quickly adapt to the treatment and management of patients with COVID-19. However, anesthesia nurses lack experience in the prevention and control of infectious diseases, which is also the case for most nurses from noninfectious disease departments. Anesthesia nurses routinely work in operating rooms and, thus, may lack experience in the nursing procedures in regular wards and in patient communication, which are two shortcomings. Therefore, anesthesia nurses require training in emotional management and communication. 

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