-Introduction:

From last year the pandemic has been a central topic in our lives and many of our activities have been affected by the pandemic situation. It is perfectly understandable

Covid 3 Hospital of Casal Palocco Rome, Italy intensive care.

: Sars-Covid II is a deadly and extremely infective pathogen that our society has had to fight with all its strength. Obviously hospitals are on the frontline in fighting the worst effect of covid: people’s illness and death. Medical staff have been in this war to save us and our cares now for over a year  and many of us see news about their extraordinary work under hard and stressful work conditions. This is the burden that has fallen most heavily on the shoulders of nurses, the protagonists of my project. They are the “hospitals’ manpower”: every day nurses do many jobs, from basic care, transport, preparing the patients to talk with parents and relatives or offering the patients themselves comfort, reassurance or explaining any kind of situation, even the bad ones. The objective of this project is to show how their work life changed with the pandemic and the challenge they had to face to fight for us and with, “The fear to take home this invisible thing”. This fight is worth remembering and that’s why I chose this topic: Don’t let the works of our saviours be forgotten, understand their challenges and fatigue to heal us, and the importance to have done our duty as society members in the pandemic (wear a mask, keep distance,…) to help them to save lives. All reasons that push me to go on with this project and I hope you will appreciate and understand better my project and what the nurses have done.

To set up the project I had the help of my mother, an operating room technician, that introduced me all the interviewees. All the interviews were online, so there were connection problems and so a few parts were missing but not so much as to compromise the sense. I used “Audacity” as the recording software.

That’s all about “how and why” of  this project and I wish you good reading.

 

-Nurses and their many responsibilities:

Talking about what is a nurse isn’t so simple because they have many things to face, as we can see in the quote from the nurse Charlie Joseph Charles Beetman:

Nurse in their equipment.

“You can have 6 beds with 6 patients but with different pathologies so everyone must have different managements so it is never boring because you can have polytrauma, heart failure, kidney failure and others so there are techniques and things, constantly updated, even the machines are more and more sophisticated and also protections need to be continuously upgraded to stay a step ahead”

These words are the core about nursing jobs: a medical operator who has many tasks inside of a hospital, some we already know very well from the idea that society has about them: a person, in many cases a woman, who cares for injured people lying

In beds . That’s true, but there is more.  To start with, half of the nursing staff are men and they do paediatric assistance, prepare hospital rooms for every kind of work especially the surgery rooms which must be sterilized and ready with all instruments and tools, also shifting things around the hospital or ordering all kind of equipment (even the printer paper!) All of this is the work that nurses do every day as Nurse Alessandro Vitucci says:

I have done paediatric cardiac surgery assistance in intensive care for 6 years, so I’m working in a hospital intensive care and I take care of direct assistance to the patient in the nursing field, in team with medics, surgeons and physiotherapists,….. also psychologists and others, that’s my job”.

Also some of their job are under the human sphere as the relationship with patients’ parents and relatives, and it’s hard to deal with people’s worry for their care, above all in surgery or intensive care. The nurses have the task to explain the situation, even the worst case scenario, while keeping themselves calm even in critical scenarios and telling the parents if something went wrong, so a very hard work, especially in a paediatric hospital: it’s heart-breaking to say to a parent “your child died”.  On the other hand they also share the joy when all thing wind up in a good way and they will see their loved one soon. All these are human experiences that helps you grow, but also a sphere that became more difficult with the pandemic’s arrival as the next chapter topic relates.

Another important thing is the length of a nurses working shift, they are very long: Alessandro says:

7 hour for a sun shift and 10 for a night shift”. Nurse Tiziana Satta  reflected the same, “We live 50% at home and 50% at work”,  These long hours create a strong bond among the nursing staff: they live half of their lives together, they became a second family and a close-knit team. This helps them team up with medics and technicians, they stay and work many hours together and know each other which helps their work corporation a lot”.

In the end, nurses have to deal with technology, rules and protocols. With improvements in scientific knowledge these things need to be constantly upgraded: new technological tools and change, abolition, new rules or protocols are routine and nurses have to study all about them: a nurse’s work never ends!

 

-The Covid pandemic: what changed in a nurse’s job:

A visit under covid time.

Many things changed in our lives with the pandemic, from our social life to our work, and the nurse’s reality wasn’t different, in hospitals new protocols and rules was adopt already in February 2020 but the real change started even for them with the lockdown, as Valerio Confalone says:

“Maybe we didn’t notice it yet, it looked like a thing far from our region, our workplace, and at that moment we understand that it was a national problem, we are all in this problem. That day, March 8th 2020, we understood what had happened and the pandemic started to change our job”.

The pandemic set a new challenge for sanitary operators, starting with increased control: hospitals became a critical place where Covid could easily infect many people, many with compromised immunity due to other illnesses. To avoid spreading Covid the sanitary director of the interviewees’ hospital launched new rules and protocols to check everybody who entered, from visitor to patient and all sanitary operators. Above all, the sanitary operators had, and this arrangement still lasts, to take a Covid test every 15 days. Everyone who did this test knew very well how annoying it was, and for the nurses other things were added.

One of the most important changes were masks, as we have to wear them all day outside home, nurse and other medical staff have to wear them all day inside the hospital, and as we have seen their shift are 7/10 hours long.  It is really hard wear a mask for so much time without taking it off ever for few second. The masks used were in many cases ffp1, but after were added ffp2 and ffp3, to be worm according to the protocol case.

Other rules ordered frequent hand washing, prohibition of staying in some rooms for too long, heavy equipment for Covid cases (I will deepen into this topic in the next chapter) and new protocols to learn as we discovered new things about Covid.

Another great change was the visit schedule change on pandemic, many people know what it means have someone you care for hospitalized, it’s a bad experience and it can be worse if we hadn’t the chance to visit him or her. That’s what happened during the pandemic: in the first months of lockdown all visits were prohibited so people didn’t have the chance to be near their loved ones during a bad situation, or see them in life for the last time. In the case of a paediatric hospital, parents had to wait to see their new-born or child, they didn’t know anything about their  child’s situation after entering the hospital, and obviously the nurse had a critical role here.

Before Covid it was normal for a nurse to that a relationship with parents or relatives to help keep them calm, but with the new Covid protocol, this relationship changed as Valerio Confalone explained,

the relationship with patients and their family changes: before we worked more in contact with the patients’ relatives, now we can’t show them a smile or stay in contact for many time with the families, preventing us from caring for them as we want. We lost a lot of relations even though we did our best. This changed our work very deeply and now needs time to restore”,

and the relationship decrease didn’t help the nurse to explain to parents why they can’t let them see their child or do a little exception, also in a big hospital there are many cases every day, and this situation repeated every time, it’s hard to deal with worried parents for understandable reasons but they have done their best every time.

After the first two months the visits were reopened but with important limitations as only one parent was allowed inside for max 30 minutes, but also technology helped by doing video calls.

Luckily smaller hospitals such as the one where Charlie and Tiziana work, succeeded in maintaining the visit schedule during the lockdown, helping patients and relieving their  parents and relatives. Now things are better and sooner or later the visit schedule will return to normal.

In the end, also nurses faced other difficulties, such as the lack of equipment (masks first) and sanitizers when the lockdown started, but also their anxiety during the entire pandemic: to be infected and take the virus home was number one, so every time they see the possibility that someone has Covid symptoms the anxiety started, and also the new protocol didn’t permit them to take things lightly, as other steps were added to the previous procedures and it had to be strictly respected, but even while this set other pressures on nurses, even with their anxiety, even with so many new task and relationship changes, they always did with professionalism their work.

 

-Equipment and rules introduced during the pandemic

The pandemic brought many problems to hospitals as the medical staff had to adapt everything to deal with the new, deadly enemy. So many things changed also in the equipment camp, from what to use to how to use it.

Many new protocols followed one another as we raised our knowledge about Covid, as Alessandro Viducci says

“there is a protocol within the big protocol, there is a paragraph with how to dress and undress with this security systems, as I say they are gloves, masks, glasses and suits, and in case of proceedings on patients’ respiratory tract there were techniques and movements to keep in mind and attention as in intrabronchial and intratracheal inhalation, the aspiration tube was kept higher in the hand: this object was in contact with patient secretions, so it became a serious infectious agent, it was really contaminated, that’s the way.”

All this aggravated the nurse’s job to fight the virus spread.

The most common equipment introduced was the mask. There are three types of mask: the ffp1 or chirurgic mask, which prevented the person if infected to release the pathogen by  the mouth but don’t defend from others. After we have the ffp2, this mask has a filter to avoid fine particles from being breathed in, so defend you from inhaling the pathogen and others from yours. The last class are ffp3 which have the same features as the ffp2 but drastically decrease the possibility to get the infection by more sophisticated filters.

At the pandemic’s start the interviewees’ hospitals’ were ordered to always wear the ffp1 inside the hospital, so the mask from an equipment to wear in precise tasks became a routine for the nurses during all their long work shifts, without the chance to take them off even for a few seconds. After the most dramatic moment of the lockdown they had to wear the ffp2 inside the ffp1 to break down the possibilities to be infected. Also in some cases, around positive patients, they have to wear the ffp3, and so also such things as glasses, gloves and suits were introduced.

Also they have to frequently sanitize their hands, by using disinfectant for washing them.

The rise of masks and disinfectants used in the first moments of the pandemic were scarce, and caused a difficult situation for everyone in the hospital. Luckily with the rise in the production of masks and disinfectant, the problem was solved and now after the lockdown and with vaccine introduction the sanitary operators returned to using only the ffp1, a sign the things are getting better!

The mask and sanitized hands became the routine with the new protocols that also brought new steps in procedures, as the Alessandro case for respiratory tract operation, who were studied and memorized without taking anything for granted, this became the routine, a very tiring routine as we can read in Charlie Beetman’s words:

For the equipment is true suffering because before entering you have many devices: gloves, overshoes, suit and others that you have to wear, we have 12 hour shifts, more if the patient is under critical status so you know when you enter but not when you can exit: we have to arrange the patient, he must be stable so many things to do, so this equipment, I talk for myself but I think my colleagues would agree, you make a lot of effort, we exit soaked, we do a 12 hour shift, we change clothes every time before entering, and it isn’t something easy to do but there are many rules to follow: wear a thing before another, disinfect,… because you can take the virus with you, so pay attention and obviously we always wear the mask, in some rooms you can’t stay more than a certain amount of time, even the time to eat something was reduced, we have to take turns to eat, unfortunately peaceful moments came less.

Even if all the new protocols and equipment became routine, there were also critical cases outside the new normal, when the virus was in front of you and all you had learned must be done without errors: the positive patients.

The interviewees’ departments weren’t Covid healing zones, so most of the procedures and protocols served to avoid spreading cases when one didn’t know to be infected, from the staff, patients or visitors, so we have tests and all the rules we have seen. Working directly with Covid patients was rare because the hospitals test even critical patients and if one is positive, they are sent to Spallanzani hospital (the hospital for infectious disease in Rome) or Polidoro Pole. If the interviewees had to work on Covid patients, it was to heal other problems outside Covid. So a critical operation where sanitary operators, nurses first, had to deal and stay in contact with an highly infective pathogen, as Valerio Confalone said:

when the test is positive, it changes everything: isolation, suits for self-protection, glass visors, masks, doubles gloves: a more defensive approach than simple patients. Another important change in our job was the rules to decrease the time near the patients, because an important rule with very infectious illness is to decrease time near the patients, so enter in the room, do all the work and immediately exit…..To exit from a Covid room there are an infinity of rules we had to keep in mind and we spent a lot of time remembering them. Undressing is a very dangerous phase and it provides a series of steps to be strictly followed to prevent contagiousness and also help the presence of an observing external person or a mirror to view if you are doing the undressing right”.

Working with Covid patients means wearing heavy equipment for hours and without even a minimal error, otherwise it can infect you, your colleagues, and your loved ones, even in the undressing, one of the most critical procedures.

So the pandemic changed the equipment, they became “heavier”, the procedures were raised with new protocols and an error meant helping the virus spread: a stressful situation where the nurse and the other sanitary operators showed nerves of steel!

 

-Covid’s monster, the isolation:

Agustina Cañamero, 81 anni, and Pascual Pérez, 84,married for 59 years.

This pandemics has many symptoms that don’t end with the bodily illness, even as the damage from Covid can be very heavy and permanent as  the “long covid case” or cause death, it also has important social implications, and one topic was under our eyes for all the time without being adequately mentioned: the isolation topic.

To fight the pandemic, social distance became a common rule in every country, society and realities: everywhere we have to stay at some distance from the nearby person, and stay home with only our family, far from friends and loved ones, some people are even alone without anybody. This monstrous reality became our routine, but it can be worse when our loved ones get sick, especially in the case of very bad things.

Many people experience the isolation effect: one of my interviewees, Valerio Ferroni, who was injured and hospitalized for a time, didn’t see close relatives and friends, even I was unable to see the last moments of my grandfather, caught by a tumour in full lockdown and died with only my grandma near. Even worse, this became routine in the hospital: everyday someone died without any loved ones near.

The perfect image from this nightmare are the words from Tiziana Satta:

The most traumatic thing was at psychological level: the suffering and isolation of children, it never occurred in the 28 years of work to see a child die without the closeness of their mother, this was the worst thing: I keep saying Covid hurt so much, but at a psychological level it destroy many people because it’s impossible leave a loved one to die alone, so we change our assistance with families because ours is one of few intensive care units that admits parents, even with Covid patients: one of our last patients, sadly died, we dressed dad and mom to let them stay with their child”.

These words are a lapidary, and also change how the nurse can provide care for people: stay and talk with loved ones or friends help our therapy, being happy helps our body to fight or recover from an illness, and in cutting these links, was as cut to our humanity. So the nurses’ work became more difficult followed by the feeling of sadness for their patients above all if they are children as the nurse Iacopo Di Vetta said:

It affected even the care, we work with children and for them not to see their parents for a long time affects our care a lot….for patients care was complex, especially for those who awaken searching for mommy and daddy, in my opinion that was an heavy burden, it changed our work, we have to stay more with children in an affection sphere even with the limits to replace a parent”.

To complete the isolation picture, to continue our path about isolation I would put here the experience of Valerio Confalone, a nurse who joined the Red Cross to help people where the Covid hit more,

I spent a month in Liguria where I live, it was a hard experience within the pandemic and the lockdown as the deserted streets and after my work shifted to the nursing homes for the elderly I remember the strong image of these elderly, who before the pandemic were much more lively with an active social life.  Some were infected by the virus but in many cases were asymptomatic but due to the rules they have to stay in isolation in their rooms and I remember these elderly went out and died when bedridden. This is what most hit me because unfortunately it is ordinary in a hospital for infected people to die or go home, we saw it many times, even for other diseases however these elderly at the end of life, alone, bedridden and without the chance to see their sons and us as medical staff help them see their loved ones online at least one time at day, or the last because we don’t know if they will survive, this is the image I will bring with me for the rest of my life because it marked me a lot, that’s all”.

Through the nurse’s eyes we can a little understand what Covid really means for our society: the tragedy of losing a beloved person, even your own child, added to the nightmare experience to can’t stay near or see it, that’s the monster Covid created, a monster who reaches our heart, leaving scars that will remain forever.

 

-Lessons so far:

Pandemics are monsters that terrorise, kill and separate people. Monsters humanity has always fought, and now with Covid it is our turn. The last pandemic was the Spanish

AIDS activist group ACT UP organized numerous protests on Wall Street in the 1980s. HIV is only one of the many pandemics humanity has suffered through history.

Flu, a century ago: in this 100 years, our knowledge and science has defended us from the invisible killers, such as bacteria and viruses, letting us forget what a plague was.

But they didn’t disappear, the invisible killers are evolving even now, ready, in any moment, to spread new illnesses and hurt our society. Covid shows us that the danger is always behind the corner and in the future certainly another pandemic will spread, and every time only our knowledge and work can save us: learn what plagues do, activate countermeasures, develop a vaccine, and the work of the people in the frontline: nurses, medics, technicians, and our following the anti-Covid rules can block the pandemic’s way to our beloved.

On the other hand, pandemics show us also people’s ignorance, the will to not follow rules and those who don’t believe in the science community or follow conspiracy ideas or think the science community or rules are wrong or not proven ideas, undermining the work of so many people.

This work aims to understand the work and consequences of the pandemic, this time through nurses’ eyes, to learn from the present to be ready for the future. So I hope to have given you a little about the nurse’s reality with the pandemic, and what the nurses have done and so it will remain with you for a long time because we owe them so much and it’s important to know it. I leave you with these words from Valerio Confalone:

I hope all of this will remain impressed on you: dressing, undressing, difficulty breathing, the sensation of suffocation under the suits I will remember this, and in the future even with a smile, but this last part was an odyssey that I will remember with distress: we have seen a situation with many deaths and few tools to fight it”.

 

 

 

 

Credits
-I thanks all the interviewees who join this project: the nurses Alessandro Vittucci, Iacopo Di Vetta, Valerio Confalone, Tiziana Satta, Charlie Joseph Charles Beetman, Valerio Ferroni and Alessandro Dessena; also I thanks my mother Rita Carbonari, for helping me find the interviewees. -The you tube video that explain the correct procedure to dressins was taken by Azienda Zero official channel, the Regional Health Service of the Veneto Region. -Photos credits: Covid 3 Hospital of Casal Palocco Rome, Italy intensive care: https://www.ilmessaggero.it/fotogallery/roma/terapia_intensiva_covid_hospital_casal_palocco_ospedale-5176718.html Nurse in their equipment: https://www.latimes.com/world-nation/story/2020-04-17/nurses-are-the-coronavirus-heroes A visit under covid time: https://milano.corriere.it/notizie/cronaca/21_settembre_12/lombardia-pazienti-ricoverati-ospedale-via-libera-visite-parenti-dotati-green-pass-3a0d623e-13c1-11ec-87fd-e9be657da2ad.shtml Agustina Cañamero, 81 anni, and Pascual Pérez, 84,married for 59 years: https://www.corriere.it/esteri/20_giugno_22/coronavirus-commoventi-foto-residenza-anziani-spagna-di-nuovo-insieme-102-giorni-8b371876-b49f-11ea-b466-221e2b27ce86.shtml AIDS activist group ACT UP organized numerous protests on Wall Street in the 1980s. HIV is only one of the many pandemics humanity has suffered through history: https://www.npr.org/sections/health-shots/2019/02/09/689924838/how-to-demand-a-medical-breakthrough-lessons-from-the-aids-fight?t=1633010925308
Andrea Pellone
Andrea is a student at La Sapienza University in Rome Italy, still in the triennal degree with the will to learn new things.

Leave a Reply

Your email address will not be published.