Care Of COVID-19 Patients Research Articles

A Mental Health Survey of Medical Professionals Working During the COVID-19 Pandemic at Shaukat Khanum Cancer Hospital, Lahore.

IntroductionThe last months of 2019 saw the emergence of a novel coronavirus, SARS-COV-2, capable of causing widespread disease in humans. The rapid spread of this new disease culminated in one of the biggest pandemics in known history. The far-reaching social, economical, and health effects of this pandemic are still unfolding on a global scale.Given the interconnectedness of social, environmental, and biological factors in manifesting psychiatric illnesses, it is fair to assume that the profound effects of this pandemic would likely increase the strain on mental healthcare systems. The objective of this study was to assess the mental health burden amongst healthcare workers at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC) at the start of the COVID-19 pandemic and to identify any differences in the mental health scores of anxiety, depression, and sleep disturbance for professionals directly involved in the care of COVID-19 patients as compared to those who were not.Material and methodsThis was an observational cross-sectional clinical study that used self-reported questionnaires after approval from the hospital's ethical board. The sample size was calculated based on a study published previously by Huang using a 23.04% incidence of anxiety in medical staff. Depression was quantified using the Patient Health Questionnaire-9 score (PHQ-9), anxiety by the Beck Anxiety Inventory, and sleep quality using the Pittsburgh Sleep Quality Index checklist (PSQI). A total of 221 healthcare workers who completed the questionnaires were included in the study and the results were analyzed using SPSS Statistics v. 23 (IBM Corp., Armonk, NY). Levene’s test was used to assess the equality of variances, and an independent sample t-test and chi-square test were applied for the comparison of means. A one-way ANOVA test was used to compare means across more than two groups.ResultsOf the 221 healthcare workers recruited in the study, 57% were males, and 43% were females. Among the sample, 43% of participants were doctors, 27.1% were nurses, and others were technicians and medical assistants.It was observed that 50% of males and 36% of female healthcare workers experienced moderate to severe depression at the onset of the pandemic. Furthermore, 35% of males and 25% of females suffered from moderate to severe anxiety, and more than 80% of our study population reported poor quality of sleep.ConclusionThe present study reported a high prevalence of anxiety levels, depressive symptoms, and poor sleep quality among the healthcare professionals working in SKMCH & RC Lahore during the COVID-19 pandemic irrespective of direct contact with COVID-19 patients in a healthcare setting.

Home care in COVID-19 patients with the home-quarantined condition: A study from Iran.

ObjectivesDuring the COVID-19 home-quarantines, home care services may act as an auxiliary component of health care system, which reduces the burden on the formal health care system. This study aimed to investigate the status of informal home care provided for home quarantined patients with COVID-19 in southwest Iran.MethodsThis descriptive study was conducted on 288 patients with COVID-19 in Ahvaz (southwest Iran). Inclusion criteria included a known case of COVID-19, willingness to participate in the study, recommendation of home quarantine from a health center, having a smartphone, and fluency in reading and writing in Persian, and the exclusion criterion was a history of COVID-19 longer than 3 months. The data collection method was structured interviews based on a questionnaire (face-to-face-telephone calls-video call). SPSS software was used for the analysis of data.Results45.5% of the participants in the study were women with a mean age of 37.82 (10.48%) and 55.5% were men with a mean age of 36.12 (11.93%). Findings showed that in most cases, the spouse (61.4) is responsible for the care of the patient, and in other cases, parents are responsible for this duty. 57.3% of the patients stated that they themselves had to leave home to provide for necessities of life, and 37.2% stated that they were in charge of cooking. 47.9% of the patients evaluated the quality of quality of care provided at home as good. Most of patients and caregivers referred to hospital for getting information (35.8% patients and 34% caregivers). Most of patients recovered from diseases (60.8%) and 39.2% were hospitalized. Although 43.9% of men and 33.6% of women were hospitalized and a there was a significant difference between men and women (P < 0.04).ConclusionDuring COVID-19 pandemic home care to reduce the burden on the health system are very important. We must also know that this type of care requires informed and planned support and sufficient community education. The health care system needs to put self-care and family care among its top priorities. The focus should be on educational and mental support of informal caregivers along with measures that protect their relatives from COVID-19.

Case Study on Nurse Care for Covid-19 Patients with MDRO (Multiple Drug Resistent Organism) in Isolation Intensive Care Unit, Bali Mandara Hospital

Covid-19 pandemic has made major changes in human civilization. Nurse care becomes more complex for Covid-19 patients who also confirmed with MDRO. MDROs are bacteria resistant to three or more antimicrobials from different classes. This study aims is to know nurse care of patients with Covid-19 and MDRO.The design of this study is qualitative method (case study). The subjects were two patients with Covid-19 and MDRO in Isolation Intensive Care Unit. Data collection techniques were physical and supporting examination, medical record review. Data from the analysis were written descriptively. Priority nursing diagnoses was impaired gas exchange related to ventilation-perfusion imbalance characterized by dyspnea, decreased consciousness. The patient is attached to a VC SIMV mode ventilator. After being treated in Isolation intensive care unit for approximately 14 days, the patient was able to breathe spontaneously with an O2 nasal cannula. The conclusion is nurse care for COVID-19 patients with MDRO is carried out based on isolation precautions (droplet and contact transmission). Nurses are expected to provide professional nurse care to Covid-19 patients with MDRO so the quality of care remains up to standard even during pandemic.

The Challenges of Intensive Care Unit Nurses Caring for COVID-19 Patients in Indonesia: A Qualitative Study

Background: After one year of the pandemic, Indonesia experienced a crisis where the addition of COVID-19 cases increased significantly in several big cities; it made the healthcare system collapse, including the intensive care unit (ICU) service for COVID-19. ICU nurses, who are at the frontline of fighting against COVID-19 and defusing this crisis, are faced with various challenges in providing care for COVID-19 patients, and exploring such challenges are significant. Purpose: This study aimed to explore the challenges experienced by Indonesian nurses who work in the ICU caring for COVID-19 patients.Methods: A multi-centered-qualitative study with a descriptive phenomenological design was used. Twenty nurses working in the ICU of COVID-19 in eight COVID-19 referral hospitals in seven major cities in Indonesia were recruited using purposive sampling. Semi-structured individual video call interviews were conducted to collect the data from July-September 2021. Data were analyzed using Colaizzi’s (1978) method.Results: The nurses reported the challenges throughout caring for COVID-19 patients in ICU, which are described in four major themes: (a) working under pressure and moral distress, (b) choosing to do the best, (c) adaptation, learning, and research, and (e) survive physically and mentally healthy.Conclusion: This study describes the challenges experienced by nurses working in ICUs during the COVID-19 crisis, such as working under pressure, facing dilemmas caring for patients, and trying to survive working in inadequate professional conditions. An in-depth understanding of these challenges in the current pandemic can help managers in the hospital to provide psychological support, adequate training for ICU nurses, and high-quality protocols for upcoming emergency scenarios, as well as maximizing resource management (human and material).

Bismuth subsalicylate as potential treatment for Covid-19 pneumonia: A case series report

Various literature cited suggests that bismuth may have usefulness against Covid-19 both in vitro and in vivo. During the course of caring for Covid-19 patients we administered bismuth subsalicylate to those who displayed diarrhea and/or gastric complaints. Using relatively conservative criteria, upon retrospective review, we noted marked improvement in oxygen requirements in most of the cases. This improvement was observed even when prior therapy with standard anti-Covid drugs had failed. Our overall impression is that these positive results support a detailed evaluation of bismuth as an adjunct treatment for the treatment of Covid-19.

Use of Personal Protective Equipment Among Healthcare Workers During the First and the Second Wave of the COVID-19 Pandemic.

IntroductionTo treat and properly care for COVID-19 patients it is vital to have healthy healthcare workers to ensure the continued function of the healthcare system and to prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to patients, co-workers, and the community. Personal protective equipment (PPE) can prevent healthcare workers from being infected with and transmitting SARS-CoV-2. Experience and training are pivotal to ensure optimal protection. This study aims to examine the use and failure of PPE and compliance with PPE guidelines during the first and the second wave of the COVID-19 pandemic among Danish healthcare workers.MethodsHealthcare workers from the Central Denmark Region and the Capital Region of Denmark were invited to participate April–June 2020 during the first wave and November 2020–April 2021 during the second wave. Day-by-day, participants reported work procedures, use and failure of PPE, and compliance with PPE guidelines. Register-based information on sex, age, department, and profession was available for all participants.ResultsIn total, 21 684 and 10 097 healthcare workers participated during the first and the second wave, respectively. During the first wave, 1.7% used filtering face piece-2 or -3 (FFP2 or FFP3) respirators and 8.2% used face masks [fluid resistant (type IIR) masks, masks with visor (typically type IIR), and other unspecified face masks] during physical contact with patients. During the second wave, the corresponding figures increased to 17.8% and 80.7%. During respiratory procedures, the use of FFP2 or FFP3 respirators increased from 5.6 to 24.3%, and the use of face masks from 14.7 to 77.8%. The no PPE use decreased from 21.3% during the first wave to 0.4% in the second wave, during respiratory procedures. Total PPE failures decreased from 0.7 to 0.4% from the first to second wave. The proportion not complying with PPE guidelines declined from 3.6 to 2.2% during physical contact with patients and from 6.5 to 4.6% during respiratory procedures. PPE failure and non-compliance varied by age, sex and type of department. Frequent reasons for non-compliance were forgetfulness and lack of time, and during the first but not during the second wave, limited availability of PPE.ConclusionWe found a substantial increase in the use of PPE and a substantial decrease in PPE failures from the first to the second wave of COVID-19 in Denmark. However, there is still a need for continuous focus on compliance in use of PPE among healthcare workers.

Pengelolaan Limbah Medis Padat Bahan Berbahaya dan Beracun pada Rumah Sakit Rujukan Covid-19

Waste generated by hospital is categorized as waste containing hazardous materials (B3) which can pose a hazard to the environtment, public health and other living things if disposed of directly into environtment. The purpose of this study was to describe the management of B3 solid medical waste at the Regional General Hospital of West Sulawesi Province as the Covid-19 Patient Referral Hospital. This research is a descriptive study with an observational approach. This research was conducted at the Regional General Hospital of West Sulawesi Province which is the only Covid-19 referral hospital in Mamuju Regency. The sample of this research is the person in charge of medical waste, waste transport officers and third-party medical waste transporters as special Covid-19 patient care rooms. Data collection was carried out by direct observation in the Covid-19 patient care room. The results show that the management has been running in accordance with the SOPs issued by the Ministry of Environmental and the Director of Environmental Health including the waste sorting process is not carried out because all solid waste resulting from the activities of Covid-19 patients is classified as B3 waste. The process of transporting solid waste from the officer’s treatment room uses complete PPE. The waste treatment process is not carried out at the hospital but is handed over to a third party. The process of storing waste in a temporary storage place for B3 waste that has previously been packeged in a special container. The conclusion in this study is that the menagement of B3 solid medical waste at the West Sulawesi Provincial Hospital has been carried out in accordance with the guidlines for managing the waste of the Covid-19 referral hospital.&#x0D;

Assessment of Awareness and Preparedness About COVID-19 for Oncology Nurses in Saudi Arabia.

Background: As is widely known, preparing nurses to deal with patients infected with COVID-19 is crucial, and knowledge about COVID-19 is needed. However, few researchers have discussed concerns about the overall healthcare system’s preparedness for COVID-19 or oncology nurses’ awareness and preparedness (A&P) regarding the disease, especially in Saudi Arabia.Objective: Provide a broader understanding of oncology nurses’ A&P regarding the COVID-19 pandemic in Saudi Arabia.Methods: This was a cross-sectional descriptive study to assess the oncology nurses’ awareness and preparedness regarding the COVID-19 pandemic at King Khaled University Hospital in Riyadh (KKUH) and King Salman Armed Forces Hospital Tabuk (KSAFHT). The population of the study was oncology nurses who were working in day-case, clinic, and inpatient stations in these two hospitals, as well as oncology-certified nurses who were not working in oncology but volunteered to be part of the study. The calculated sample size was 146 nurses. These nurses were selected via convenience sampling. The data were collected with the help of a predesigned questionnaire that was used to assess Libyan hospitals’ preparation for the COVID-19 pandemic and the preparedness of healthcare workers survey. The Statistical Package for Social Sciences Software (SPSS) version 23.0 (SPSS Inc., Chicago, IL) was used to enter and analyze data.Results: According to the data collected from 146 oncology nurses, as per the study’s knowledge score criteria, 136 participants (93.15%) had a high level of awareness regarding COVID-19, and only 10 participants (6.85%) had a low level of awareness. The nurses’ level of awareness did not show significant association with the age (p = 0.394), gender (p = 0.582), experience (p = 0.566), or education (p = 0.062) of the study participants. Furthermore, the p-value showed no statistically significant difference among awareness scores in relation to the designation of nurses. On the other hand, 135 study participants (92.47%) had adequate preparedness and only 11 participants (7.53%) had inadequate preparedness. The level of preparedness was associated with the age, gender, experience, and educational status of study participants with the help of the chi-square test.Conclusion: The results of this study revealed that the nurses working in the oncology departments in two key Saudi hospitals have sufficient awareness and are prepared to deal with COVID-19 patients. Although nurses working in oncology departments are not primarily responsible for taking care of COVID-19 patients, they may still encounter COVID-19 patients, and they must take all possible protective measures to minimize the spread of COVID-19, as well as provide proper diagnosis and care for these patients.

Exploring the experiences of frontline nurses caring for COVID-19 patients.

AimThis study seeks to gain a comprehensive understanding of the experiences of frontline nurses who provided direct care for COVID‐19 patients.BackgroundDue to the COVID‐19 pandemic, the demands on healthcare systems have been higher than before. Although previous studies have explored the experiences of frontline nurses, these experiences could vary depending on each country's social, cultural, and historical contexts.IntroductionIn the midst of the global pandemic, sharing the experiences of COVID‐19 frontline nurses could have implications for both nursing and nursing policies that could be applied to future pandemics.MethodsThis descriptive qualitative study comprised 14 South Korean nurses with a minimum of one month of experience working within a COVID‐19 department. Individual interviews were conducted on a virtual platform, and a thematic analysis was employed. The consolidated criteria for reporting qualitative studies were used to ensure a detailed reporting of the study.ResultsFour themes and 12 subthemes were developed. The themes included: (1) feeling forced into a world of uncertainty; (2) providing unique care for COVID‐19 patients; (3) perceiving barriers to providing quality care; and (4) seeking meaning in caring for COVID‐19 patients.DiscussionNurses recognized their unique roles in caring for COVID‐19 patients and sought new meanings within their profession. However, the poor work environment exacerbated the physical and emotional burden among the nurses and compromised the provision of quality care.ConclusionThis study highlighted the nursing policy issues that need to be improved to ensure better quality care and a stronger healthcare system.Implications for nursing policyGovernmental action is essential to ensure that nurses can maintain the quality of care they have provided during COVID‐19 and any future pandemics.

Experiences of redeployed healthcare workers in the fight against COVID-19 in China: A qualitative study.

Public health responses were triggered while COVID-19 was spreading. China redeployed healthcare workers to serve the most vulnerable populations and communities in the initial epicentre-Wuhan. However, it is not known how redeployment processes impacted on healthcare workers in a pandemic crisis. To explore the experiences and needs of frontline healthcare workers who were redeployed to care for COVID-19 patients in Wuhan, China, and understand the long-term impacts of the redeployment experience on their work and life. A qualitative study was conducted with redeployed healthcare workers using semi-structured interviews and thematic analysis. This study is reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) guidelines. A total of 20 redeployed healthcare workers (13 nurses and seven physicians) participated, and four themes were generated: (1) Initial feelings and emotions of redeployment-Participants experienced worries and concerns, a sense of isolation and loneliness on their arrival to the epicentre. (2) 'It is like a war zone'-Healthcare workers faced a range of risks and challenges of caring for COVID-19 patients in Wuhan in the context of resource strain. (3) Uncertainty and coping strategies in patient care-Despite the hardships experienced, participants continued to deliver high-quality patient care including psychological care and palliative care, good communication and building mutual trusting relationships. (4) Reflection and far-reaching impacts of caring for COVID-19 patients-Participants felt motivated and encouraged as efforts were recognised by the government and wider society. Redeployed healthcare workers shared their unique needs and experiences of coping with redeployment and challenges they faced in the context of resource strain, which has significant implications for policy and future practice. The reality of a pandemic may reduce healthcare workers' willingness to work due to various reasons including inadequate preparedness of facilities and workplace safety. It is important to support frontline healthcare workers in order to maintain an adequate healthcare workforce in pandemic crises. Continuously evolving pandemic circumstances and uncertainty highlight the importance of an organized national pandemic response plan for subsequent waves of COVID-19 and future pandemics.

Protective measures against COVID-19 for nurses and midwives in Bangladesh

COVID-19 is a devastating disease with worldwide effects. To control and prevent COVID-19 and save lives, preventive and protective measures have been encouraged globally. Nurses and midwives have been among the most vulnerable groups to COVID-19 infection because their jobs involve heightened exposure to COVID-19-infected patients. This survey study aimed to investigate protective measures against COVID-19 for nurses and midwives. This was a descriptive quantitative survey study. The sample was 1706 nurses and midwives. A self-reported survey questionnaire was used to collect the data on protective measures against COVID-19 for nurses and midwives. Data were analysed through descriptive statistics. The study found that the majority of nurses and midwives did not receive COVID-19 training. Despite this, they were willing to care for COVID-19 patients and aware of methods for preventing COVID-19 infection. In addition, most participants had taken COVID-19 preventive precautions. Almost two-thirds of participants were vaccinated against COVID-19, and a vast majority had used appropriate PPE as a protective device against it.

Implementation of a Virtual Huddle to Support Patient Care During the COVID-19 Pandemic.

During a surge of COVID-19 cases, the volume of acute care patients with hypoxemic respiratory failure placed a high burden of responsibility on internal medicine, pulmonary and critical care medicine, and clinical pharmacy services. We describe the COVID-19 Tele-Huddle Program, a novel approach to communication between key stakeholders in COVID-19 patient care through a daily video conferencing huddle. The program was implemented during a 4-week surge in COVID-19 cases at a large, academic medical center in Houston, Texas. Data collected during the COVID-19 Tele-Huddle Program included the type and number of interventions implemented, number of patients discussed, and COVID-19 therapies provided. In addition, hospital medicine team members completed a user-experience survey. A multidisciplinary consultation service using video conferencing can support the care of patients with high disease severity without overwhelming existing inpatient medical, intensive care, and pharmacy services.

Improvement of the psychosocial support for frontline nurses in public hospitals during COVID-19 pandemic.

AimThe aim of this study was to explore and describe the psychosocial support for frontline nurses during the COVID‐19 pandemic in the Tshwane district, Gauteng Province, South Africa.BackgroundThe COVID‐19 pandemic has brought a lot of psychosocial distress for frontline nurses taking care of COVID‐19 patients. The frontline nurses were scared of being infected with COVID‐19, or exposing their families and loved ones to the risk of infection. A high number of nurses were infected with COVID‐19, and some died due to the virus.EvaluationThis study followed a qualitative, explorative, and descriptive research design. Data were collected using semi‐structured interviews and individual interviews were conducted. Seventeen participants, who consisted of all categories of nurses taking care of COVID‐19 patients, were interviewed until data saturation was reached. Non‐probability sampling method was used as a technique to select the participants. Data were analysed using Tesch's method of open coding.Key issuesThe following five themes are identified: (1) acknowledgement, appreciation, and recognition of frontline nurses, (2) conducive managerial practices, (3) debriefing and training of frontline nurses, (4) human resources support, and (5) psychological and social support for frontline nurses and their families.ConclusionThe implementation of the psychosocial support for frontline nurses taking care of COVID‐19 patients is critical in improving patient care.Implications for nursing managementThe findings of this study should alert nurse managers to plan the best way to support frontline nurses caring for COVID‐19 patients.

Nursing care and the psychology effects on post-care nurses serving COVID-19 patients in Vera Cruz isolation room, Dili, Timor-Leste

Introduction: Coronavirus 2 (SARS-CoV-2) is a syndrome of acute respiration that is serious like corona acid ribonucleic detected, made separation and identification in pneumonia sick patients in Wuhan, China in December 2019 (WHO, 2020). Timor-Leste on May 1, 2020, 24 cumulative cases was confirmed, 16 cases recovered, 12 cases are still being treated, and 12 patients experienced psychological pressure from patients and health professional. This study aimed to determine the knowledge of nurses; nursing service and the psychological influence of nurses after providing care for Covid-19 patients. Method: Qualitative research with a phenomenological approach has been used in this study, ten nurses who have worked serving Covid-19 patients participated in this study, and data was collected using interview guidelines, voice recorder, deep-interview, data analysis techniques by organizing data, grouping, categorical data, topic and answer formulation, data assessment and writing the results. Result: The majority of nurses understand and apply Covid-19 prevention, but some are confused the cause. Have not carried out nursing care according to the standards of the International Counsel of Nursing (ICN) and the Timor-Leste Nursing Association, as (assessment, diagnosis, intervention, implementation, and nursing evaluation), reasoned: new job, no format, less manpower, no orientation from senior, emergency time. The majority experienced psychological effects after providing care to the Covid-19 patient. Conclusion: This study concluded that nurses understand Covid-19, the nursing care implementation is not yet based on ICN and ETNA standards and after returning home the nurses experienced psychological effects.

Joining Forces: The Addition of a Palliative Care Practitioner to a Resident Teaching Service During COVID-19 Pandemic as a Tool to Improve Patient Care and Provider Communication.

The COVID-19 pandemic has presented an array of novel issues for hospitals and their staff, 1 of the most noted being increased patient isolation due to visitation restrictions. This has created new challenges for health care systems and their workers. To leverage the expertise of Palliative Care Practitioners (PCP) as described here to improve patient/provider communication, patient experience, and quality of care during the COVID-19 pandemic. To address these new obstacles to patient care presented by the pandemic, a PCP was incorporated into the physician team caring for COVID-19 patients at the time of admission. Members of the care team were surveyed and interviewed regarding their experiences with this added support. During a period of peak hospital strain from COVID-19, team members consistently reported that daily PCP involvement led to improvement in communication with patients and families, greater provider awareness of psychosocial stressors, and decreased physician burnout. Integration of a PCP into a clinical care team during the COVID-19 pandemic was perceived as a valuable asset to patients, families, and clinicians.

STUDI LITERATUR: PENGARUH SPIRITUAL CARE PADA PASIEN COVID-19 DI RUMAH SAKIT

Spiritual care for Covid-19 patients involves the dynamic dimension of human life related to the way they are connected in the moment, with God, themselves, others and nature. Spiritual care has an important role in minimizing the psychological impact experienced by Covid-19 patients. Objective: to determine the effect of providing spiritual care interventions by nurses in the nursing care process when patients undergo hospitalization. Methods: database searches include Google Scholar, Science Direct, and Elsevier with keywords spiritual approach, CoronaVirus Disease patient, spiritual care, Covid-19 Patient. The inclusion criteria used by the author is to limit articles or journals published in the last five years starting from 2017 to 2021. Results: Analysis of 15 articles found that CoronaVirus Disease (Covid-19) patients undergoing hospitalization experienced improved mental health and receive support through a spiritual approach (Spiritual care). Conclusion: Spiritual care can effectively stimulate the coping of Covid-19 patients who are being treated in hospitals in improving their mental health, this has a positive impact on increasing the body's immunity of Covid-19 patients and changes in healthy behavior as an indicator of adaptive coping mechanisms.

Experience of Frontline Nurse Working in Hospital-Based Settings During the COVID-19 Pandemic

This study aims to describe the experiences of frontline nurses in dealing with COVID-19 patients during the pandemic. This research method uses a scoping review method with a search method on four journal databases consisting of Sage, PubMed, Science Direct, and Proquest. The results obtained were 424 articles were found in the journal database but only 9 articles met the criteria and were included in this study. Qualitative research data show that nurses experience psychological, social, and emotional stress. However, nurses can prepare coping strategies using self-care, distraction, and peer and family support. In conclusion, nurses in charge of caring for COVID-19 patients have serious challenges in maintaining individual coping with negative psychological and social responses. Therefore, it is important to strengthen government support and policies to improve nurses' welfare.&#x0D; &#x0D; Keywords: COVID-19, Qualitative, Experience, Frontline Nurse

Visualizing Stress and Coping Measures of Sari Nurses in Ozamiz City During Covid-19 Pandemic

The COVID-19 pandemic crisis resulted in abrupt changes in SARI (Severe Acute Respiratory Infections) nurses' life in healthcare systems, leading to stressful and overwhelming challenges in their daily battle against the virus. SARI Nurses are constantly faced with stressful situations that cause emotional exhaustion while managing complex care and treatment processes for multiple COVID-19 patients in a given time frame. Given the knowledge gap between the nurses' coping measures on job stress during the pandemic, it is relevant to understand the stress and coping measures of the SARI ward nurses in depth. This study was underpinned by the Roy Adaptation Model (RAM) to see the person as a bio-psychosocial being that interacts with the changing environment. Furthermore, this study utilized the qualitative narrative approach to explore the SARI nurses' stress and coping measures. The participants were selected through purposive sampling for the interview, and the gathered data were analyzed using narrative, thematic analysis by Michelle Butina. The themes generated reveal that the SARI nurses experienced situational uncertainties and struggles fitting in. However, along the course of their work, they were able to support each other by sharing concerns that made them adapt to the changing environment. As a result, the SARI nurses achieved continuity in carrying out their job effectively. Learning from their adaptive coping mechanism may help the health providers' community face fewer difficulties in another similar situation. Keywords : bio-psychosocial, challenges, healthcare systems, Roy Adaptation Model, Severe Acute Respiratory Infections

A Care Step Pathway for the Diagnosis and Treatment of COVID-19-Associated Invasive Fungal Infections in the Intensive Care Unit.

In March 2020, the World Health Organization declared COVID-19, caused by the SARS-CoV-2 virus, a pandemic. Patients with severe cases resulting in hospitalization and mechanical ventilation are at risk for COVID-19-associated pulmonary aspergillosis, an invasive fungal infection, and should be screened for aspergillosis if they have persistent hemodynamic instability and fever. Early detection and treatment of this fungal infection can significantly reduce morbidity and mortality in this population. To develop an evidence-based care step pathway tool to help intensive care unit clinicians assess, diagnose, and treat COVID-19-associated pulmonary aspergillosis. A panel of 18 infectious disease experts, advanced practice registered nurses, pharmacists, and clinical researchers convened in a series of meetings to develop the Care Step Pathway tool, which was modeled on a tool developed by advanced practice nurses to evaluate and manage side effects of therapies for melanoma. The Care Step Pathway tool addresses various aspects of disease management, including assessment, screening, diagnosis, antifungal treatment, pharmacological considerations, and exclusion of other invasive fungal coinfections. The Care Step Pathway tool was applied in the care of a patient with COVID-19-associated aspergillosis. The patient was successfully treated. The Care Step Pathway is an effective educational tool to help intensive care unit clinicians consider fungal infection when caring for COVID-19 patients receiving mechanical ventilation in the intensive care unit, especially when the clinical course is deteriorating and antibiotics are ineffective.

PRACTICE OF SELF-MEDICATION AND QUALITY OF LIFE ASSESSMENT AMONG HEALTHCARE WORKERS OF A TERTIARY HOSPITAL IN ASSAM DURING COVID-19 PANDEMIC

Objectives: The aims of this study were to collect sociodemographic, clinical data regarding practice of self-medication and to assess quality of life in healthcare workers involved taking care of COVID-19 patients. Methods: The study population consisted of 104 healthcare workers from Gauhati Medical College and Hospital directly involved in management and control of COVID-19 Pandemic. It was a cross-sectional observational study using non-probability sampling. Data were collected in a questionnaire developed by the investigators which included age, sex, and occupation, COVID-19 such as symptoms, medicines used, contraction and confirmation of COVID-19 positive, and self-medication when COVID positive, symptomatic relief, and adverse effects and usefulness of self-medication. The data for mental health were obtained in a questionnaire based on the Professional Quality of Life Scale (Compassion Satisfaction and Compassion Fatigue Version 5) with responses rated on a five-point Likert scale. Results: The study consisted of 104 participants. Males were n=42 (40%) and females were n=62 (60%). Doctors n=20 (19%), Laboratory Technicians n=22 (21%), Nurses n=44 (42%), Pharmacists n=13 (13%), Ward boys n=3 (3%), and Ward girls n=2 (2%) took part. Eighty-four (97.7%) respondents took paracetamol, 39 (45.3%) took cough syrup, 30 (34.9%) used nasal decongestants, 25 (29.1%) utilized throat gargle, 24 (27.9%) used azithromycin, 22 (25.6%) used cefixime, 13 (15.1%) took amoxyclav, 27 (31.4%) took ORS, 3 (3.5%) took Doxycycline, 4 (4.8%) used Ivermectin, 1 (1.2%) took Dexamethasone, and 1 (1.2%) used Multivitamin. About 68% (n=51) of COVID Positive respondents self-medicated with Azithromycin, 24% (n=18) with Ivermectin, 41.3% (n=31) with Doxycycline, 20% (n=15) with Dexamethasone, and 4% (n=3) with Levocetrizine and Paracetamol. The Mental Health Assessment Scores were obtained as the sum total of scores of answers to the 30 questions provided per respondent. About 7% (n=7) respondents with total score between 60 and 69, 12% (n=13) from 70 to 79, 29% (n=30) from 80 to 89, 22% (n=23) from 90 to 99, 16% (n=17) from 100 to 109, 13% (n=13) from 110 to 119, and 1% (n=1) between 120 and 129. This indicates that some participants had mild burnout, most had moderate burnout, and a few had severe burnout. Conclusion: Self-medication practices common among healthcare workers, increased during the COVID-19 Pandemic which must be appropriately managed to stay away from the ill effects. Providing adequate mental health resources and education to the affected health workers will motivate them increasing their productivity during the pandemic.