PRESENTING BY

BHALLAM MOUNIKA
M.SC. NURSING
GRADUATE
COVID-19 pandemic has changed the image of our world
with its circular impact on health, living tradition,
economy, and politics. In particular, the tradition of the
health industry has changed dramatically because of the
unpredictable nature of the pandemic. Since the breakout
of COVID-19, health care providers have faced
multidimensional challenges in carrying out their
professional duties and responsibilities.
31st December 2019 was the day when the first
Coronavirus case was identified officially in China. We
have come a long way since then, with drastic
developments in the worldwide healthcare scenario. The
number of patients of COVID-19 and their contacts
undergoing quarantine is increasing by the day, and these
will continue to increase at a faster rate in the days to come.
In a developing nation such as India, with a population of
1.34 billion, the existing healthcare infrastructure and
delivery system have already been facing challenges of
accessibility and affordability. This COVID-19 pandemic
will further overwhelm the already overburdened
personnel working in the healthcare sector. The doctors,
nurses, paramedics, and other hospital staff are bearing the
onslaught of this infection directly.
 The world is facing unprecedented challenges in the
face of a global pandemic. Coronavirus disease 2019 (COVID-
19) has, to date, killed thousands worldwide. The data related
to numbers of tests administered, positive cases,
hospitalizations, and deaths, changes on an hourly basis.
Mounting concerns regarding the strain on health care systems
globally are already occurring and likely to get significantly
worse. This health crisis impacts not only frontline staff and
clinical leaders but all systems and communities.
 The importance of a strong public health infrastructure
and care delivery systems that promote population health
outcomes have long been known, the COVID-19 crisis has
added a sense of urgency to these needed reforms.

The current pandemic has immeasurably transformed

the profession -impacting the available workforce, highlighting
inequities in health outcomes, and opening new opportunities
in care delivery. As we work to heal and transform our
fractured health care delivery systems, nurses must be at the
helm.
 Professional identity is a critical issue
for nurses because of its close association with
issues such as nursing roles, responsibilities,
values, and ethical standards, which are unique
to the nursing profession. However, during the
COVID-19 pandemic, in addition to facing
regularly high levels of physical and emotional
stress, clinical nurses suffer regularly from
moral distress because of conflicts rooted in
complex ethical issues related to their
professional practice, high levels of acuity,
patient deaths, and long working hours.
 As we begin to move forward past the pandemic and
into its aftermath, the nursing profession must grapple with its
future, and understand how we as the nation’s most trusted
profession -now, more than ever -can be part of the solution
to the long existing societal health challenges highlighted by
the pandemic.

Nurses are the soldiers on the battlefield fighting the

enemy. And they are undoubtedly fighting with all their
strength. These healthcare personnel are under tremendous
physical and mental stress. Apart from their health, they are
concerned about transmitting the infection back to their
homes, to their families and friends.
 Nurses are well-suited to make population health
decisions, address social drivers, and provide leadership in
health crises such as COVID-19. Situated at the intersection
of medical and social expertise, nurses provide holistic,
patient-and community-centered services to promote
affordable, high-quality care. Nurses have been frontline in
caring for COVID-19 patients, as well as in prevention,
education, and other preventative health measures to slow
the spread of disease.
 As COVID-19 cases rise, our nation’s nursing unions
and public health nurses have been listening to colleagues
on the front lines of the pandemic, taking notes, fighting for
protection, and demanding change for the betterment of our
profession and the care of our patients.
1) A serious problem during this pandemic has been poor
planning, preparation, organization and leadership from some
governments and health systems, including the failure to
ensure adequate stockpiles of needed medical supplies,
including personal protective equipment for nurses and others.

2) Fear of the increased risk of infection to themselves and their

family because of their exposure to positive COVID-19
patients at work.

3) Emotional stress resulting from being labelled as ‘dirty’ or

‘clean’ and then split into the ‘confirmed’ and ‘suspected’
COVID-19 teams, respectively.
4) Ostracisation from the public displayed through incidents
involving, but not limited to, the discrimination of nurses in
their uniforms on public transport and private hire drivers
refusing to ferry nurses to the hospital. Foreign health-care
staff were asked by their landlords to terminate their lease
prematurely.

5) Deployed non-intensive care unit (ICU) staff’s fear of

being inadequate in providing a higher level of care for ICU
patients after going through an intensive care preparedness
training course.
The coronavirus disease 2019 (COVID-19) pandemic has
resulted in significant challenges for nurses, both
professionally and personally. frontline health professionals
are challenged by a lack of pandemic preparedness, scarcity of
clinical supplies, and implementation of social distancing.
✿ Personal protective Equipment (PPE) & supplies

✿ Ethical Dilemmas

✿ Long-Term Care

✿ Mental Health

✿ Opioid crisis and COVID-19

✿ Health Human Resources Challenges

✿ Emergency licensure/registration

✿ Twitter nursing engagement activity

✿ Addressing Inequities

✿ Expanded Nursing Workforce Roles

✿ Primary Care and Telehealth

✿ Untapped Capacity
During the first wave, accounts of shortages and anticipated
shortages of supplies, including surgical and N95 masks.
✓ In response to the urgent shortages and ethical challenges
arising around PPE, by developing Key Messages on PPE to
support and advocate for nurses to considerations on ethical
dilemmas for nurses when appropriate PPE is unavailable, and
information related to available guidance from national and
international groups related to strategies to optimize the use of
masks
✓ Continuing to advocate for rapid deployment of protective
equipment to ensure nurses have access to the supplies and
equipment needed to provide safe quality and ethical care for
their patients.

✓ Given evidence related to transmission from persons who are

asymptomatic, or pre-symptomatic, PHAC has also noted that
for the public, when physical distancing may be difficult to
maintain, members of the public can consider wearing a non-
medical mask or face-covering.
✓ Adequate medical equipment and supplies are an essential part
of ensuring quality and safe care for patients.

✓ Testing kits for COVID-19 are critical to the early identification

and isolation of cases to limit spread within the community.

✓ Shortages of testing kits has been reported, contributing to more

targeted testing of patients in province.
✓ For nurses working at the point of care, lack of appropriate
supplies can create moral distress due to level of care they are
able to provide as well as concern for their safety and that of
their family. Nurses recognize their duty to provide safe,
competent, compassionate and ethical care. However, it is the
employer’s duty “to protect and support them as well as to
provide necessary and sufficient protective equipment and
supplies that will “maximally minimize risk” to nurses and other
health-care providers.”
“In a global public health emergency, we may find ourselves
questioning whether our existing ideas about what is good,
right, and just continue to hold true, or whether we need to
adjust our ethical beliefs because of the extreme situation we
find ourselves in.

Nurses carefully consider their professional role, their duty to

provide care and other competing obligations to their own
health, to family and to friends. In doing so, they understand the
steps they might take both in advance of and during an
emergency or pandemic situation so that they are prepared for
making ethical decisions. Value and responsibility statements in
the Code support nurses’ reflection and actions.
✓ Refer the regulations and guidelines provided by government,
regulatory bodies, employers and professional associations;
✓ Help to make the fairest decisions possible about the
allocation of resources.
✓ Help set priorities in as transparent a manner as possible.
✓ Provide safe, compassionate, competent and ethical care (in
disasters, as much as circumstances permit).
✓ Help determine if, when and how nurses may have to decline
or withdraw from care.
✓ Advocate for the least restrictive measures possible when a
person’s individual rights must be restricted.
 The vulnerability of the long-term care (LTC) sector has
been increasing for decades. LTC is comprised of an aging
population, requiring more complex care, but simultaneously a
critical shortage of care providers. In addition, as the complexity
of care has increased over recent decades, staff mix has shifted. At
a time when more nursing care is required, the bulk of the care
giving falls on unregulated care providers.

People living in LTC are particularly vulnerable and more

likely to experience severe disease or death from COVID-19 due
to age, frailty, comorbidities, immune system weakness and the
lack of prevention (vaccine) and treatment.
✓ Once COVID-19 is detected in staff or residents, self-isolation
of contacts means staffing shortages are exacerbated. This
increases patient ratios as patient illness and acuity also
increase. In many facilities, there is reserve of care staff, and
contingency if a significant proportion of staff are not working
due to illness, isolation or other factors.

✓ Family pressures and threats of eviction from landlords add

significant pressure on care aides to continue working. Also
notable is that not all unregulated care providers have sick
benefits, as many employers opt for part-time and casual staff
to reduce benefit costs.
Nurses are facing unprecedented challenges and can experience
significant work-related stress due to increased workload, lack of
resources and personal protective equipment (PPE), concern for
personal and family safety, moral distress, and exposure to
significant human suffering.
✓ First, rest assured you are not alone.
✓ Set time aside to breathe.
✓ Know it is OK to ask for help.
✓ Focus on the good and provide acts of kindness.
✓ Find a mantra.
✓ Know timing is everything.
✓ Stay informed by using reliable sources.
✓ Focus on what you can do and accept the things you can’t
control.
✓ Find ways to stay socially connected and engaged.
✓ Set daily routines that include being creative.
✓ Explore apps that benefit mental health.
✓ Write it out.
➢ pandemic and subsequent public health restrictions have
created unintended consequences for people who use
substances by creating significant challenges to accessing and
delivering harm reduction services.

➢ Specifically, the opioid crisis has led to the declaration of a

public health emergency, due to significant increase in deaths
from drug toxicity.

➢ The main challenges include decreased access to harm

reduction services due to pandemic restrictions; the
implementation of social/physical distancing; and limited drug
supply, which is leading to increased toxicity of available
product, due to border closings.
✓ Nurses play a key role in advocating and administering harm
reduction services such as naloxone kits and maintaining
supervised consumption sites and public health education.
✓ They need to be supported in continuing these critical
interventions to prevent further morbidity and mortality.
Reports of unplanned closures of nursing units and emergency
departments across the country, in part due to unsafe staffing
levels, garnered public attention. COVID-19 is expected to
significantly burden our health-care system, with estimates that
30-70% of the population could become infected.
Maintaining the nursing workforce, the largest health-care
profession is critical to a robust pandemic response. With this goal
in mind, the following represent challenges that is stressing the
shortages thus far.
✓ Increasing population health needs
✓ Risk of exposure and illness acquired in practice
✓ Work restrictions related to travel
✓ Work restrictions related to travel
In response to the increasing demands caused by the global
pandemic of COVID-19, some provincial/territorial nursing
regulatory bodies have initiated an expedited registration
process for recently retired nurses or nurses practising in other
jurisdictions. Currently, nurses are in the middle of the battle
against COVID-19. The pandemic situation has put these
professionals against various ethical challenges.
✓ In response to the increasing demands caused by the global
pandemic of COVID-19, some provincial/territorial nursing
regulatory bodies have initiated an expedited registration process
for recently retired nurses or nurses practising in other
jurisdictions.

✓ In consultation with respective jurisdictional governments, a

temporary reinstatement or temporary emergency licensure
allows retired nurses and nurses from other jurisdictions,
respectively, to rapidly obtain a license to practice in the event of
an emergency.

✓ Each regulator may have different eligibility requirements and

processes that may change as the situation unfolds.
Participated in various methods of engagement and outreach with
nurses to identify emerging issues related to COVID-19. One
such method was regular social media polling, whereby CNA had
been conducting weekly polls on twitter to get a pulse on nurses’
perceptions of, and responses to, the COVID-19 pandemic.
✓ The intent of this engagement activity was to hear from nurses
about trends, issues, and what they identified as being
important to them regarding the COVID-19 outbreak. This
activity supplemented surveys, key informant discussions,
weekly webinar discussions and other activities.
Racial and ethnic inequities in access to high quality health care
services existed before the pandemic and have carried over into
disparities in access to COVID-19 testing and treatment.
✓ Nurses must recognize and help address the ways in which
societal inequities perpetuate disparate health outcomes.
✓ While nursing education focuses predominantly on providing
acute care in hospital settings, COVID-19 has shown the
importance of educating current and future nurses to address
health outcomes at a population level.
Currently, most workforce discussions have been centered
around hospital-based care, yet little attention has been paid to
the public health nursing workforce. This is desperately needed
to mitigate the current pandemic, address the societal health
consequences that have resulted, and manage future acute and
chronic population health crises.
✓ COVID-19 may be the impetus to revive funding for a
strong public health workforce. The pandemic has
highlighted the need to address health needs at a population
level, make timely, evidence-based decisions, and provide a
unified voice in educating the public roles that public health
nurses have long been experts in.

✓ Furthermore, the societal health impacts of COVID-19 will

persist long after the initial outbreak, particularly in areas of
health equity.
The importance of primary care and outpatient management (e.g.,
home health) and nurses’ role in care delivery and coordination
within these settings are well established. However, COVID-19
caused a collision with a surge of patients needing testing and
treatment for COVID-19 in addition to baseline care needs.
COVID-19 has taught us the need to keep people in the
community and save hospitalizations for only those who have the
most critical needs as hospitals become more dangerous for
patients and healthcare workers.
✓ Nurse and advanced practice registered nurse-provided
telehealth has the potential to greatly expand access and
quality of care.
✓ Telehealth is one way nurses can address critical unmet
health needs post COVID-19 from basic primary care
to virtual hospitals for more intense treatment.
✓ In order to realize this potential, innovation on the part of
nurses, public health departments, health systems, and
policymakers are needed. This will also require strategic
investment in nursing education to address the nursing
shortage that is present and intensifying.
✓ Other areas exist for expansion of the nursing workforce into
community-based settings. Caregivers may be more reluctant to
place their loved ones in a long-term care facility, as residents
are unable to leave or have visitors, and as COVID-19
outbreaks are staggeringly high.
✓ For elderly individuals who need care, the demand for home
health services could thus rise exponentially.
✓ The COVID-19 pandemic has also heightened the need to
transform perinatal health care with nurses at the forefront of
innovative strategies to improve care and outcomes.
➢ Furthermore, the COVID-19 pandemic has illuminated the
untapped capacity from all levels of nursing roles including
clinical practice, leadership, health policy, advocacy, and
research. Nurses have a unique perspective and capability to
translate and integrate evidence from these areas into practice.
➢ As the health professional shortage has been exacerbated by the
crisis, many states have permitted full practice authority for
advanced practice nurses and these new licensure laws may
lead to long-lasting change going forward. This long fought for
reform has the potential to expand access to high-quality,
affordable primary care, where the majority of NPS (nurse
practitioners) practice.
✓ Another opportunity for nursing growth in the aftermath of
COVID-19 is in hospital and health system leadership. Health
system decisions involving PPE shortages, staffing, and health
informatics require the input of frontline individuals who
understand deeply the impacts of those decisions. Nursing
representation on hospital and health system boards can provide
invaluable insight, particularly during disease outbreaks and
other population health crises.
❖Many students live in distant geographical areas
with limited or no access to Internet, inadequate
financial resources, do not own the required
textbooks, depended heavily on campus
libraries and do not own computers.
❖Another issue brought about by the switch to
online delivery and suspension of clinical
teaching is the extension in the length of the
programme. Initially, students had registered for
a four-year programme. In the current situation,
it is estimated that the programme will be
extended for at least an additional semester to
facilitate the much-needed clinical experience
and the clinical hours required by the governing
bodies.
 We will eventually get past COVID-19, in
huge part by the hard work of nurses and
other medical professionals. We have learned
so much during this global pandemic that we
can use it to help change the nursing
profession for the better.
1. There is public awareness regarding a lack of nurse safety.
2. Nurses are discovering ways to practice nursing away from the
bedside.
3. Alternatively, some nurses are reinvigorated to care at the
bedside.
4. COVID-19 has inspired some nurses to move into specialty roles
within their hospital.
5. Nurses have adapted well despite impossible circumstances
in some cases.
6. Nurses will have more opportunities in telehealth
positions.
7. Nurses are finally publicly getting the credit they have
deserved all along.
8. As we eagerly await drugs and vaccines to combat this
pandemic, the only option that we possess, is to take
precautions to stay away from the infection, as much as is
possible for us. That will be the only protective measure.
Ambika Thapa Pachya, Uttam Pachya, et al., (2020) written a review on
Challenges and opportunities for nurses during COVID-19 pandemic at
Patan Academy of Health Sciences, Lalitpur, Nepal. One of the
challenges that nurses face during COVID-19 is workforce shortage. With
increasing number of people infected with COVID-19, it outstretches the
existing nursing health workforce, and disproportionately in the low and
middle incomes countries. They are at risk of infection and have high job
demand. The incidents of suicide among nurses are representation of
physical distress and psychological trauma. Role of nurses in patients care
during COVID-19 can be under-rated and stigmatized. Internationally
trained nurses and minorities nurses are at increased risk of discrimination.
Despite these challenges, COVID19 puts forward opportunities for nurses
on implementing humanistic theory in practice, self-esteem and sharing of
real time stories, contingency management and creativity. It opens platform
for leading infection prevention measures and advocacy of profession.
Being the pertinent stakeholders in patient care, nurses’ faces different
challenges as well as some opportunities. COVID-19 has opened avenues
for advocacy of nursing profession to get acknowledged for their dedication,
perseverance, high morale and contribution during the pandemic
management
Dorien Ulenaers, Joep Grosemans, et al., (2021) Conducted study on
Clinical placement experience of nursing students during the COVID-19
pandemic among Nursing students from nine Belgian nursing schools. The
gaps that were identified by students focused on the need for more psychosocial
support, establishing (regular) contact with their clinical placement supervisor,
recognition of the difficult work situation, and the need for more space to
unwind. Nursing students expressed a strong need to be heard, prepared, and
supported. Most students felt supported by their nursing schools. Because of
COVID-19, the role of the preceptor became more important. However, due to
several reasons, the perceptor did not always meet the student’s expectations.
Preparing students for specific competencies is needed. In spite of the efforts of
nursing schools and clinical sites, students often got lost in the chaos of the
pandemic. This resulted in practical worries, fewer learning opportunities, and
even fundamental doubts about their choice to become a nurse. Finally, it crucial
that nursing schools and clinical sites communicate about matters such as the
responsibility for testing nursing students, the provisions of uniforms and
personal protective equipment, and structurally sharing guidelines with students
to provide safe patient care
 The people need to be aware of the mammoth efforts
taken by them. On 22nd March 2020, at 5 pm, all Indians
acknowledged and applauded the efforts of these healthcare
professionals by clapping, cheering, ringing bells, plates, etc. Let
this not be restricted to a single-day event, wherein we applaud
and then forget the efforts. All of us need to remember and
acknowledge their efforts at all times.

By taking care of ourselves first, we will take care of the

society at large. So, yes, let’s be a part of this fight against
COVID-19, by supporting our doctors, nurses, and all healthcare
personnel. Together, we can, and we will defeat COVID-19.
 In this topic we discussed Regarding
Introduction, Health care delivery system in covid -19,
Nurses in covid -19 pandemic , Factors affecting the nurses
during covid-19 , challenges and overcoming of a nurse
during covid -19, challenges and overcoming of a nursing
Students during covid -19, Few ways that covid-19 will
change the future of nursing for the better.