Pat Stricker, RN, MEd
Former SVP, Clinical Services
TCS Healthcare Technologies
The March 2020 CMSA newsletter article “Coronavirus-2019 (COVID-19): Information and Resources” focused on the unbelievable novel coronavirus that was sweeping the globe. As of March 17, it was in 159 countries worldwide, had caused 184,976 reported cases and 7,529 deaths. At that time, the U.S. had reported 3,536 cases with 58 deaths.
Now on July 14, 2020, only 4 months later, COVID-19 is in 213 countries, and the number of confirmed cases has risen to 12,929,306 with 569,738 deaths. The U.S. statistics have also jumped dramatically to 3,286,063 confirmed case and 134,704 deaths. These numbers are just astonishing, and we are still in the middle of a huge resurgence here in the U.S.
Our healthcare workers have been performing above and beyond all expectations, and they have been doing it for the past 4 months. They are to be commended! But this type of constant, difficult physical work, long hours, stress of caring for super critical patients and number of unstoppable deaths have taken a toll on some of the healthcare staff physically and mentally. They need a break. In many instances, clinicians have volunteered to go to other areas of the country to help bolster staffing levels in totally overwhelmed areas like New York and New Jersey. Nurses have been re-assigned from other areas of the healthcare system or they have volunteered to work in COVID-19 related units to help decrease the staffing shortage. This is always difficult because, while these nurses want to help, they often feel like they are not totally familiar with the ED, ICU, COVID-19 procedures. And given the urgency, how do you find the time to educate them to the nuances of these types of units and to this new disease?
One way is to have the nurses self-educate by using videos, recorded webinars, and COVID-19 simulations. Nurses know the additional types of information and skills they need to manage these patients. These may include technical skills, such as how to use a ventilator, or clinical skills, such as in knowing how to manage the respiratory aspects of a COVID-19 patient. Of course, self-educating will not take the place of more formalized on-site training, but it can be done before the new assignment starts in order to give the nurses a head start in gaining specific knowledge to help them feel more confident in working in ICU or with COVID-19 patients.
Because the critical care areas are overwhelmed with seriously ill COVID-19 patients in some areas of the country, the Society of Critical Care Clinicians has developed a free training program, Critical Care for the Non-ICU Nurse, which offers videos, webcasts, audio slide presentations, and other tools to help nurses become more comfortable with critical care nursing. They even have a 20 question self-assessment tool to help the nurse determine what her educational needs are. Click here to take the assessment.
Simulations
The COVID-19 Rx: Treatment Simulations is a great, free self-training program developed in May 2020 by the NEJM Group, a division of the Massachusetts Medical Society, for physicians in training to use to quickly and efficiently prepare for their clinical rotations. It consists of interactive learning simulations to teach clinicians the basic concepts of managing floor patients who are suspected or confirmed of having COVID-19. These are not intended for the care of critical care patients in ICU, but they provide excellent information about the care of respiratory patients. The goal of these simulations is to provide real-life situations requiring users to follow a process, develop a plan, and make clinical decisions to safely manage the patient’s condition.
The NEJM Group developed 2 types of simulations:
If you are thinking of volunteering, think you may be re-assigned, or just want to know more about the clinical aspects of COVID-19, you really should try these simulations. The software works on your laptop (not your phone) and there is nothing that you need to download. They are detailed, easy to use, and a fun way to learn! And they are free to use for your own purposes or to add to your training programs. I admit I favor this type of training, after having developed similar training simulations about 7 years ago, but the software at that time was very basic. It only allowed users to make decisions by choosing from a list of suggestions provided in the scenario, similar to the Interactive Primer simulation. It did not allow the users to actually make their own plan and decisions, like the Treatment Simulations do. These are a great improvement. Try them. I’m sure you’ll find them fun and informative.
It is best to start with the Interactive Primer to get used to the process. The simulation includes the following topics: oxygen devices, ventilation, hypoxemia management, COVID-19 therapeutics and complications, and injuries to heart, kidney, and liver. The simulation starts with an overview summary of the above topics and then shows a “beeper” notifying you of a patient that is being admitted to the internal medicine floor from the ED. You are given his ED assessment and notes and asked to think about what your admission orders may be. You put on your PPE before going in to assess the patient.
The simulation shows the patient in his hospital bed and his monitor shows his pulse, heart rate and rhythm and oxygen saturation. It then asks you which type of O2 device you want to use. Once you make a choice, the program tells you if the choice is correct or not and provides information about each of the four device choices. If you answered incorrectly, you can choose again. The goal is to understand what the correct option is, not to punish you for getting it wrong. You can repeat a section or the entire simulation as often as you wish. The goal is to make sure you understand how to treat this type of patient.
The program then stops and allows you to review what you have done and why the choices were correct or incorrect. It then wants you to make a diagnosis. It provides information on the history of this illness, physical exam in the ED and on admission, vitals for the past 3 hours, EKG from 2 hours ago, labs within the past 2 hours compared to a baseline from 3 months ago, current microbiology results, a chest X-ray for you to review, and the medical record showing past medical history, medications and other notes. You now need to choose the “most likely” diagnosis from the 8 diagnoses given. It then tells you again whether your answer was correct or not and provides you the reason why it was correct, along with information about why the other diagnoses were not correct.
You beeper lets you know he has tested positive for COVID-19 pneumonia. Now the simulation is asking you to order medications from a prepared list. Again the program explains why your answer was correct or not and gives you information about other items that might be ordered. The program again stops and reviews what you have done so far to allow you to assimilate what has occurred, and it provides a summary of COVID-19 complications and injuries due to cardiac, kidney and liver. Your patient’s respiratory problems have now improved and you need to think about whether he is a possible candidate for ICU or whether he is likely to be discharged. After reviewing the summaries of his condition, you determine he will be able to be discharged and the simulation is finished.
Start the Treatment Simulations using the mild case to get used to the new process and then work your way up to each progressive case. These simulations are similar to the Primer in terms of presenting the case scenario, but they look more modern and you no longer have a “beeper.” You also have a chance to feel like you have an “interactive dialogue” with your patient during history gathering because it allows you to select a question and then the patient answers you (answer is spelled out in the “bubble” over his head). It’s not exactly a dialogue, but there is some semblance of one. As in the Primer, you need to make a differential diagnosis, order additional diagnostic tests, and treat the patient. However, you need to think about and initiate these actions, not just choose a selection after it is presented to you. In addition, patient and disease factors, and the choice and timing of treatments can impact the outcome of the illness. The simulations also provide a social and family history, additional procedures and imaging options, IVs and other fluids, and consultation options. There is also a timer and a gauge that shows you the probability of a good outcome.
While the simulations cover the same topics as the Interactive Primer, they make you do more of the thinking and planning than the Primer, where a lot of the information was given to you. They also provide you with a case review and educational information, but it doesn’t seem like there is as much review as in the Primer. However, this is a more realistic simulation, forcing you to formulate a plan, decide what is needed, and then make your own decisions, rather than being presented with options and checking off a selection.
You are encouraged to replay cases, especially at the critical and expert levels, so you can experience the variety of COVID-19 presentations. When replayed, each case could have different diseases and outcomes.
There are other types of self-teaching programs available also, and many of the COVID-19 courses are being offered free right now. While there are a lot of Slide/Text courses, I find those that involve audio and/or video seem to keep my attention better when doing self-training. I’ve listed some of the ones I found for you below.
Training Videos
The Society of Critical Care Clinicians offer COVID-19 Videos and Audio Presentations for Non-ICU Nurses. They have created a critical care nursing program for non-ICU (critical care) nurses because there is such a need right now for critical care nurses. These are the programs available:
Free COVID-19 Ventilator Course: Mechanical Ventilation Explained Clearly by Dr. Roger Seheult
Back To Basics: Caring For The Critically Ill – a free 6-part video series on: Intubation, Ventilator Settings, Lung Protective Ventilation for ARDS, Measurement Parameters for ARDS, Prone Positioning & Rescue Strategies in ARDS, and Arterial Line Basics. There is also a video on “Proning for Severe ARDS for Non-intubated patients who are awake.” Other training modules are available for a cost, e.g., mechanical Ventilation, Cardiac Boot camp, etc.
Training Webinars
The Society of Critical Care Clinicians offers COVID-19 Webcasts for Non-ICU Nurses
Tools
Self-Assessment ICU Knowledge Check for Non-ICU Nurses is offered by the Society of Critical Care Clinicians. It is a 20-question tool to help nurses determine what their educational needs are.
Audio Slide Presentations with Written Course Content
On January 26, 2020, just four days before the novel coronavirus (COVID-19) was declared a pandemic, the World Health Organization released its first COVID-19 training course, “Emerging respiratory viruses, including nCoV: Methods for Detection, Prevention, Response and Control." In the first 10 days, more than 25,000 people worldwide accessed the course, and after that nearly 3,000 new users signed up each day. As of mid-July, almost 347,000 people have registered for the course. WHO also developed an introductory video about of the course that has been watched by over 5,443,000 people.
The WHO offers 13 Audio Slide Presentations on COVID-19 that provide information on: specific facts, detection, prevention, diagnosis, treatment, guidelines, treatment facility design, data collection, contact tracing, and safety precautions (personal protective equipment, hand hygiene, waste management, decontamination and sterilization, cleaning and disinfecting, and injection and needle stick injury management).
Another popular COVID-19 course is the “Clinical Care Severe Acute Respiratory Infection” 10-hour training that is intended for ICU clinicians managing severe acute respiratory infections (SARI) during outbreaks of seasonal influenza, avian influenza, MERS-CoV, and other respiratory viral epidemics like COVID-19. The course includes 14 modules that provide the necessary knowledge and tools that can be used to manage these conditions: prevention, triage and early identification, diagnosis and testing, monitoring, oxygen therapy, mechanical ventilation, sedation, antimicrobials, sepsis, best practices, quality of care and ethical considerations.
We, as nurses, always need to keep educating ourselves to keep current, but also stay one step ahead of the new ideas and innovations that occur in healthcare. And these last 4 months have provided a lot of new things for us to learn. We would not have been able to keep up to date on COVID-19 if we did not have the internet to share the newest findings and best practices to everyone in a very timely manner. Take advantage of these free offerings while they are available.