Covid story 15

COVID-19 and Nursing Education – Reflections from a Dean and Faculty Member

Andréia Cascaes Cruz

PhD, RN, Professor at the Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil; First Secretary of the Brazilian Society of Pediatric Nurses, COINN Board Member

Myriam Aparecida Mandetta

PhD, RN, Professor at the Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil; President of the Brazilian Society of Pediatric Nurses

At the time of writing, over 1.3 million COVID-19 cases, with roughly 57 000 deaths, have been confirmed in Brazil, according to WHO data. Nonetheless, COVID-19 has not had a major impact on babies’ health in the country, as few neonates have been affected and nearly all those testing positive have recovered. Brazil comprises a huge territory, with stark differences in neonatal care. Meanwhile, the COVID-19 pandemic has adversely affected parents and whole families likewise. The birth of a new family member has now acquired an unprecedented feature: parents are now alone—a dramatically changed family event.

Having a child admitted to a NICU (Neonatal Intensive Care Unit) is hard on families, which in times of COVID-19 has been made more difficult to bear. Families are now affected by mandatory separation, not only between parents and baby, but also between the two parents. In some NICUs, either the mother or the father (but never both) are allowed to stay with the child. This visiting time, moreover, is limited to three hours a day in some NICUs.

Before the pandemic, parents were free to remain with their children for unlimited time in Brazilian NICUs, while siblings and grandparents were granted visits once or twice a week—a family inclusion arrangement only recently adopted in the country, reflecting strides made following Family-Centered Care (FCC) implementation. As FCC advocates in Brazil, there are now concerns at the prospect of losing this hard-won achievement that has benefited not only babies and families, but also healthcare professionals.

The effects of the pandemic on working nurses have been considerable, and burnout has been the main manifestation. Severe staffing shortages, extra shifts, and fear of contamination have compounded the workload of nurses in NICUs. Another element is moral distress. Many nurses suffer with baby–parent separation and the attitudes of some mothers—nurses have reported incidences of mothers hiding their COVID-19 symptoms, while others, despite evident symptoms, have refused to be tested for fear that a positive result will isolate them from their babies for at least 15 days. Nurses are feeling lost amid this “unknown landscape.”

The COVID-19 pandemic has forced families and nurses to face an as-yet unmapped challenge, and there is an urgent need to devise ways of mitigating their distress.