Jing ZHANG, Jian?Hua DENG, Ling TANG,Xiao?Jia WANG

1School of Nursing, Beijing University of Chinese Medicine,Beijing, China; 2Department of Urology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China;3Department of Nursing, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China; 4Intensive Care Unit, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China

ABSTRACT

Nursing work is an integral part of hospital work. Under the challenge of the COVID?19 epidemic, it is particularly important to establish a timely and efficient nursing management system. The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills. The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions, rational allocation of human resources, and strengthening personnel training, so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

Keywords: COVID?19, nursing emergency system, nursing management, personnel allocation, traditional Chinese medicine hospital

INTRODUCTION

COVID-19 is an acute respiratory infectious disease with rapid transmission and wide infection range, which seriously threatens social stability and human safety.[1]Emergency outbreaks lead to serious challenges and tests in nursing management.[2]In order to cope with the new outbreak of COVID-19, under the unified deployment of the leading group of hospital epidemic prevention and control, the department of nursing established a COVID-19 epidemic prevention and control nursing management system based on the feedforward control theory. Feedforward control,also known as pre-event control, is a kind of control method which can effectively reduce the loss and has preventive effect. It refers to predicting the consequences of management activities and taking preventive measures before the management work starts, so that the possible deviation can be avoided in advance. Feedforward control is a part of control theory. The application of feedforward control in hospital infection management can control various unsafe factors in the budding state before a variety of operations. A study[3]applied the theory and method of feedforward control to the nursing management in response to influenza A H1N1 epidemic and achieved good clinical results. The application of feedforward preventive and control nursing management system has greatly improved our hospital’s emergency response-ability to cope with the outbreak of COVID-19. Now, the nursing prevention and control experience is reported as follows.

NURSING PREVENTION AND CONTROL EXPERIENCE

Establishing an efficient epidemic nursing management system

Formulating emergency plan for epidemic prevention and control

In order to strengthen the leadership and management of the emergency response to the COVID-19 epidemic and improve the emergency response capacity, on the basis of the hospital emergency response plan, the department of nursing formulated the corresponding emergency response plan according to the work characteristics of each department and in accordance with the Technical Guidelines for the Prevention and Control of New Coronavirus Infection, which is formulated by experts of the National Health Organization. Key departments such as dialysis room, emergency room, and outpatient clinic have carried out simulation exercises of prevention and control scenarios for many times, refined each process, and improved various rules and regulations.

Establishing three?level management system

Successful feedforward control is a requirement of scientific management during an epidemic. Nursing work has a strong professional uniqueness, and it is necessary to establish and improve a top–down, graded division of labor, layers of responsibility, and relatively independent command system of nursing business. As a functional department of hospital management, the nursing department is responsible for organizing and managing the nursing work of the hospital.In the overall epidemic prevention and control system of the hospital, a three-level management system of the hospital’s nursing epidemic was established for the leadership of the director of the nursing department: the director of the nursing department → the general head nurse → the clinical head nurse (clinical nursing specialist). The original block nursing management was reformed into strip vertical management,and the unified management of nurses was implemented.[4]In the vertical management system, the nursing department controlled the allocation of nurses in the whole hospital.According to the actual situation of the hospital, nursing staff can be allocated reasonably to maximize the use of limited resources. Establishing a three-level nursing management system can mobilize the work enthusiasm of all nurses,establish awareness of prevention and control, and ensure that all preventive management measures are implemented in place through a nursing management system with clear hierarchy and clear responsibilities.[5]

Implementation of three?level supervision of epidemic prevention and control

Epidemic prevention and control measures should be implemented, and the epidemic prevention and control supervision group should strictly implement the three-level supervision of problem rectification: issuing a list of first-level problems, discussing with head nurses for second-level problems, and clinical assistance docking by head nurses (clinical nursing specialist) for third-level problems. The closed-loop system of establishment of rules, hierarchical training, supervision and inspection, and continuous improvement of epidemic scientific prevention and control management has been realized. The inspection and supervision group supervises the key links of personal protection, object surface wiping and air disinfection,disinfection and isolation, preinspection registration, ward closure management, knowledge training, nursing operation,etc., These include: (1) strictly require nurses to dress. Nurses must dress as per the requirements of post and work area and can take appropriate protective measures according to risk level. There are no cases of inadequate protection and excessive protection; (2) for disinfection of articles and air in the ward, the required disinfectant concentration and wiping frequency should be used, and ultraviolet disinfection should be carried out regularly and registered on time; (3)in terms of disinfection and isolation, medical staff strictly implement hand hygiene and the classification and disposal of medical waste, equip patients with special pens, and have a clear division of work areas, and take correct protective measures in each area; (4) strictly carry out preexamination and triage, and the registered patient information meets the requirements; (5) strictly enforce the closed management system of the ward, such as access control management,visiting and escorting system, transfer of articles, protection of nursing workers, and use of isolation wards; (6) effectively implement the knowledge training on the prevention and control of COVID-19; and (7) strengthen the standard of nursing operation, especially the standard of disinfection,isolation, and operation process protection.

Establishing prevention and control position in epidemic nursing management system

In the prevention and control position established in the emergency system of epidemic nursing, body temperature screening and epidemiological examination are carried out at the entrance to the hospital; patients are guided to keep a safe distance at the outpatient clinic of the hospital; the dynamic working mode of “l(fā)ooking, listening, questioning,and feeling the pulse” is carried out in the emergency preexamination and triage office, so the suspected patients could be screened quickly; the closed management is implemented in the inpatient area; the emergency buffer ward is started. These five main prevention and control positions not only ensure the daily operation of the hospital but also reduce the risk of the transmission of COVID-19 in the hospital.

Reasonable allocation of human resources

The goal of human resource management team is to make the organization play an active role in crisis management,and reasonable staffing is the basic guarantee for effective work.[6]How to rationally allocate nursing human resources and how to improve the utilization rate of existing nursing human resources during the outbreak of COVID-19 is an urgent problem for current nursing managers.

Deployment of frontline personnel in Wuhan

The emergency prevention and control group of the nursing department selected 12 nurses with professional backgrounds of severe illness, respiration, and cardiology based on the comprehensive consideration of their political quality, severe experience, and stress resistance. They and the doctors formed a national medical team of traditional Chinese medicine to go to a designated hospital of Wuhan and quickly carried out the first-line treatment of the epidemic in the local area. Up to completion of emergency rescue task, there has been no medical staff being infected.

Allocation of nursing staff in hospital

It is necessary to sort out the key epidemic prevention and control posts and reasonably allocate reserve personnel according to the post demand. The following are the key prevention and control posts and personnel reserves: (1)isolation ward: the nursing department uses the nursing information management system to query the existing nursing staff resources of the whole hospital. The first batch of first-line nurses was selected according to age and professional and technical level. After the first batch of nurses entered the isolation ward for 1 week, the nursing department continued to deploy the second and third echelons as alternates. Fourteen days is a work cycle. The first batch of personnel has rested after working 14 days into the isolation, supplemented by the second echelon; (2) preinspection and triage department: the preinspection and triage system of infectious diseases refers to the screening, inspection, and triage of infectious diseases in advance for the patients who visit the hospital for diagnosis and treatment according to the relevant provisions of the Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases in order to effectively control the epidemic situation of infectious diseases and prevent cross infection in medical institutions. The nursing emergency prevention and control group sets up full-time nursing staff at the entrance to the hospital, the emergency department, and the dialysis room to take the body temperature, and all persons coming to the hospital need to cooperate to complete the epidemiological investigation; (3) outpatient: the part of outpatient clinics in our hospital is concentrated, with the majority of elderly patients who are anxious to see a doctor. These elderly patients are prone to irritability, tension, and anxiety. The emergency prevention and control group of nursing arranged the head nurse to make the deploy and control at a fixed point, defined the responsibilities, divided the regional management, and guided the outpatient nurses to ease the patients’ negative emotions with standard language and clear signs, which reduced the risk of cross infection in the hospital and greatly improved the satisfaction of the patients; and (4) combined ward: due to the spring festival coinciding with the epidemic period, the number of patients in each inpatient ward decreased. Under the unified deployment of hospital leaders and medical department, some ward areas were reorganized and merged. After the merger, the nursing department reasonably allocated human resources in the ward according to the number of patients and the nature of work posts. The rest of the staff will be managed by the nursing department.After the unified training of the nursing department, they will be added to the intensive care unit, emergency department,and other departments as required.

Flexible management of human resource allocation

Human resource management is a key point in scientific prevention and control. The implementation of flexible management makes the human resource management of nursing team realize the overall deployment, flexible scheduling, and dynamic cross-regional management. Under the leadership of the director of the nursing department,more than 30 heads of nurses stuck to the front line of epidemic prevention and control, and 505 nurses were in a dynamic deployment state.

Strengthening nursing staff training

The training quality of medical staff is directly related to the quality of clinical medical team, medical level and the quality of health-care service, and also to the ability of medical staff to cope with public health emergencies.[7]We should attach importance to the training, education, and management of nurses and improve their work enthusiasm and sense of responsibility. Let nurses actively carry out various nursing operations in accordance with the regulations, improve the quality of nursing, and prevent the occurrence of nosocomial infections.[8,9]The nursing department has carried out training related to the knowledge of prevention and control of COVID-19 and has asked head nurses of all departments to strengthen the training of nursing technology operation for nurses in the ward. Through theoretical and technical operation training,nurses are skilled in grasping the basic theoretical knowledge of COVID-19 and are fully prepared for emergency in terms of operation technology, consciousness, and psychology.

Multichannel training for nursing staff

The epidemic documents are updated every day. The content and form of epidemic training are followed up in real time.The nursing department adopts online and offline training channels. The training objects include nurses at all levels,nursing workers and cleaners. Especially, it strengthens the management of key personnel (junior nurses, nursing workers, etc.). The contents include personal prevention and control and skills drills to achieve comprehensive epidemic prevention and control training.

Carrying out strict examination for nursing staff at all levels

Nursing workers in the hospital include nurses and nursing assistants. Their educational level is very different. Therefore, different training and assessment methods should be adopted to enable them to master the knowledge of prevention and control of COVID-19. The head nurses interpreted the key contents of the hospital’s COVID-19 epidemic documents and adopted face-to-face or videoconferencing training in departments. The department of nursing conducts a unified assessment every day in the form of daily questions. Nurses complete the day's questions through WeChat. The department of nursing conducts a unified score statistics and analysis of the reasons for the wrong answers. The results were fed back to the departments to complete the feedback of learning effect on the day. For nursing assistants, due to their low cultural level and weak awareness of epidemic prevention,the nursing department has adopted the form of one-to-one training for nursing assistants by head nurses and the use of photographs and short videos, so that the nursing assistants complete the rapid memory. In order to strengthen the knowledge of epidemic prevention, the assessment forms of nursing assistants have been diversified, which include face-to-face questioning, on-site demonstration, and the form of “nursing assistants ten questions and answers.”These forms make the passing rate of nursing assistants at different levels of knowledge reach 100%.

CONCLUSION

The outbreak of COVID-19 belongs to public health emergencies. Nosocomial infection management is an important work in the emergency mechanism of public health emergencies. Nursing involves all aspects of nosocomial infection management, and its responsibility runs through the whole process of coping with the outbreak of COVID-19. The scientific application of nursing emergency management system in the treatment of new infectious diseases is the guarantee to successfully complete the prevention and control of new infectious diseases.[10]

Scenario drill of emergency plan plays an important role in nursing guidance, which can reduce various deficiencies,help to improve the comprehensive ability of nursing staff, and reduce nursing errors.[11]The establishment of three-level management and three-level supervision system can accurately find the key points of prevention and control and achieve scientific management. The prevention and control positions should be established in the emergency management system of epidemic nursing, and the key gates of hospitals should be controlled by nurses themselves to reduce the risk of epidemic prevention and control in hospitals. Strict theoretical and technical operation training of nursing staff,rational allocation of human resources, and implementation of flexible management can effectively retain the backbone of the fight against the epidemic.

Nurses have played an important role in combating the enormous challenges of the epidemic. The implementation of nursing management can ensure that nurses strictly implement the isolation and disinfection steps and daily operations. Effective standardization of nursing staff operation details can improve the quality and level of care and reduce the incidence of nosocomial infection.[12]Nursing work infiltrates all aspects of hospital infection management.Nurses with professional knowledge and technical literacy directly undertake the prevention and supervision of fighting epidemic situation to ensure the smooth implementation of nosocomial infection prevention and control.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.