WELCOME

ROLE OF A NURSE IN
COVID-19 PANDEMIC
 BACKGROUND

 The role of nurse changes as the health care is needed in the hospitals,
society or community. Nurses are providing essential health care services
throughout the health care system. In response to COVID-19 pandemic, the
role of nurse changes to care or respond to the needs of the patients, their
families and their caregivers.
 BACKGROUND

 They also should take part in policies making, doing procedures and taking
care of necessary supply of the material and equipment in the hospitals. All
over the world nurses are demonstrating their kindness, care, courage, values
and professional responsibility as nursing personnel.
 BACKGROUND

 Prior to the COVID-19 pandemic in many institutions / organizations, there

was a focus on nurses, mental health, physical health and wellbeing such as
workload, anxiety, anger, irritability, burnout etc. They have to follow the
rules, regulations, ethics and standard of nursing.
 BACKGROUND

 However, while working in the isolation units or intensive care unit with
COVID-19 patients, the nurse has to decide how much quality care they can
provide to the patients while taking care of themselves.
 BACKGROUND

 Hospital authorities have the responsibility to provide optimal work

environments for all staff involved in the care of COVID-19 patients and
health care professionals must follow the protocols that protect their ethical
rights as a health care professional.
 BACKGROUND

 In a 2018 policy brief, the American Nurses Association, said “nurse leaders
are the key to preventing and containing widespread illnesses. They have the
skills and education to develop coordinated global networking and properly
identifying of infectious diseases”.
 BACKGROUND

 Nurses’ are playing very important roles, when dealing with the COVID-19
patients because they are the one who is performing the screenings,
implementing triage, proving care to the patients, communicating with the
caregivers, proving health education on prevention and protection from
coronavirus and handling the critical conditions.
 BACKGROUND

 In 2019 annual report, the WHO said the world is not adequately prepared for
a global health crisis. Since pandemic outbreaks are unpredictable, global
health agencies have to develop plans that will provide appropriate and
timely responses, the WHO said. Among those who must be involved in
planning are the nurses, the organization said. Indeed, nurses around the
world are filling roles to assist in the corona virus response.
ROLE OF NURSES IN THE SCREENING, TRIAGE, AND
STANDARD PRECAUTION

 Nurse should familiar with scientific updates of COVID-19 disease and use of
appropriate methods to assess, categorize the triage system, different test
and management of patients.
ROLE OF NURSES IN THE SCREENING, TRIAGE, AND
STANDARD PRECAUTION

 While screening the individual the nurses should take the following
information from the person’s risk for COVID-19:
 sign and symptoms of respiratory tract infections,
 travel history of the last few days and exposure to someone who has been
confirmed to have COVID-19.
 After screening process the nurses should take the decision the person should
be tested for COVID-19 or not
ROLE OF NURSES IN TAKING CARE OF PREGNANT
WOMEN

 The nurse should understand and trained to provide obstetric care and enough
competent to implementing in recommended infection control interventions.
 Pregnant women with known or suspected case of COVID-19 should inform to
the obstetric unit/department prior to arrival of the pregnant patients.
ROLE OF NURSES IN TAKING CARE OF PREGNANT WOMEN

 The necessary arrangements such as appropriate infection control preparations, identifying the
most appropriate room for labour and delivery, all necessary sterile equipment’s placed
properly and personal protective equipment’s are appropriately positioned, assign and inform all
healthcare personnel who will be involved in the patient’s care before the patient’s arrival.
ROLE OF NURSES IN TAKING CARE OF PREGNANT WOMEN

 Encourage the pregnant women that they should be attending the routine
antenatal, postnatal and abortion care whenever necessary. If there are any
complications, additional care should be provided to the pregnant women.
MODELS OF ANC DURING
COVID-19 PANDEMIC


 HOME VISITING

Specific Considerations
 Plan home visits based on risk management for woman and personnel involved
 If COVID-19 risk identified during or after home visiting, advise patient
regarding the use of PPE and other procedures (self-quarantine) to minimize
the risk of transmission
 HOME VISITING

Specific Considerations
 Prior to entering the woman’s home, assess the clinical status and social
circumstances for both woman and any support persons at home
 Use standard home visiting risk assessment tools
 If risk of transmission or safety concerns identified, postpone the home visit
 Maintain physical (social) distancing (1.5 meter from the woman) during the
visit where possible
 HOME VISITING

Common considerations
 Assessment for danger signs in pregnancy
 Antenatal education
 Psychosocial screening
 Routine ultrasound
 Vaccination
 Screening tests
 Supply of Iron; Folic Acid; Calcium; and other context-specific recommended
supplements
SELF-QUARANTINE/ISOLATION

Specific Considerations

 If face-to-face contact throughout self-isolation/quarantine is important, use

droplet, contact and standard precautions.
 Resume scheduled healthcare when self-quarantine/isolation complete
SELF-QUARANTINE/ISOLATION

Specific Considerations

 Provide data concerning infection prevention and management practices

which will stop prevent transmission of COVID-19
 Ventilate rooms by opening windows
 COMMUNITY CLINICS

Specific Considerations

 Consider appointment scheduling to avoid groups of patients waiting

 Advise women to arrive on time (not early) for appointment
 Advise to call ahead and present for care at hospital as advised by doctor or
midwife
 HYBRID MODEL

Specific Considerations

 Assess needs as well as history taking and explanation for physical

examination process on the day prior to visit by phone or video call (VC)
 For hospital visits, advise patients to wait outside the building until to be
called in (e.g. in personal car or safe social distance in grounds)
 HYBRID MODEL

 Specific Considerations

 Limit face to face visits to 15 minutes just for physical examination

 Do the follow-up after visit using phone or VC
 Schedule face-to-face visit for cares that needs physical association /care
(e.g. vaccination)
ANTENATAL CARE SCHEDULE DURING
COVID-19 BASED ON WHO
RECOMMENDATION
VISIT METHOD PRINCIPLES

12 weeks Face to Face  Comprehensive

history and plan for
care
 Blood Pressure
 Blood tests
 Ultrasonographic
Standard (USS) –
where available
 Initial risk
assessment
ANTENATAL CARE SCHEDULE DURING
COVID-19 BASED ON WHO RECOMMENDATION
VISIT METHOD PRINCIPLES
20 weeks Remote contact ongoing risk assessment

26 weeks Remote contact ongoing risk assessment

30 weeks Face-to-Face Blood Pressure

Blood tests
Abdominal Palpation
including Fetal Heart
Rate (FHR)
measurement
Ongoing risk assessment
Birth planning
ANTENATAL CARE SCHEDULE DURING
COVID-19 BASED ON WHO RECOMMENDATION
VISIT METHOD PRINCIPLES

38 weeks Remote contact Unless risk factors for

hypertension in
pregnancy or growth
restriction identified
previously

40 weeks Face-to-Face Blood Pressure

Blood tests
Abdominal Palpation
including fetal Heart
Rate (FHR)
measurement
Ongoing risk assessment
Birth planning
 CONCLUSION

 The long-term effects of maternal morbidity and mortality on families and

communities should not be underestimated. Currently, concentrating on
COVID-19 would possibly distract pregnant women from routine antenatal
care.
 Also, it is important that they take precautions to protect themselves against
COVID-19 and report symptoms of infection to healthcare workers.
 CONCLUSION

 Therefore, it is necessary to provide appropriate antenatal care models for

pregnant women depending on their circumstances and available facilities, in
order to prevent its complications in the current pandemic.
 In the current situation, home based care model can be considered when
pregnant women are stable enough to receive care and enough midwifes and
adequate health care are available.
 CONCLUSION

 Also, referral to community clinics should be limited to emergency cases with

significant risk factors.
 On the other hand, self-quarantine/isolation should not lead to missing of
prenatal care, especially in high risk pregnant women.
 CONCLUSION

 It is important for mothers to be informed enough about the warning signs to

go to the relevant centers when they feel threatened.
 Generally, it seems that the hybrid model can be an efficient and preferred
model to manage prenatal care in pregnant women.
Role of nurse in intranatal period
during covid-19 pandemic
Introduction

A labor and delivery nurse cares for women and

their infants before, during, and after birth. When
it comes to covid-19 the mother and baby both
are at risk, so the nurse has to provide
comprehensive and skillful care
A labor and delivery nurse will monitor mothers
and children, provide postpartum care, and
educate new mothers about the care of their
newborns.
 Educate the family members about the newborn
care
Labor and Delivery Nurse
Responsibilities:
 Teaching childbirth preparation .
 Providing emotional support to the mother as well to the family members
 Providing information, guidance, and hands-on clinical care about the covid-
19 and its outcomes to pregnant women.
 The nurse should be caring, compassionate, and
knowledgeable about covid-19 and all its aspects
of pregnancy, labor, and birth, as well as post-
pregnancy care, complications, and treatments.
 Monitor and time contractions during labor and
delivery for covid-19 positive mother
 Administerepidurals (pain management) and
other medications;
 Assist the doctor in inducing labor
 Monitor the vital signs of the mother and the
heart rate of the baby;
 Monitor for potentially dangerous complications of
medications commonly given during labor and
delivery;
 Communicate with the doctor to provide timely
and accurate information;
 Identify complications and notify the doctor;
 Prepare for cesarean (c-section) delivery,
including emergency c-sections.
 Monitoring fetal heartbeat and length and strength
of contractions during labor.
 Coachingwomen, assisting with any complications
and administering medications during birth.
 Performingtests on newborns after birth whether
the newborn is positive to covid-19 infection or not.
 Providingguidance to new mothers on all aspects of
recovery and infant care.
 When compared to the normal pregnant women
with the covid-19 positive pregnant mother there
is some stress and anxiety towards her condition
and fetal being
 Sothe mother have some panic attacks and
emotional disturbances in that case the nurse has
to provide assurance to the mother
 Immediately after delivery
 Educate
the mother about the preventive
measure like
 Wearing mask
 Washing hands with soap before touching the
baby
 Donot touch face, frequently like wise the nurse
has to educate the mother
 Educatethe mother about the disease condition
and mode of spread
 Ask the mother about her interest on breast
feeding
 Ifshe is interested in breast feeding educate the
mother about the precautions while breast
feeding.
 Emotional support is the vital thing in the
complete care
 Provide emotional support
 Have a kind nature towards the mother.
ROLE OF AN MIDWIFE
DURING COVID-19
PANDEMIC
 During the COVID-19 pandemic postnatal
midwifery-led care remains a key public
health intervention for women and their
families.

 In some of the most challenging areas for

health, delivering high-quality care for all
postnatal mothers should be the standard
—before, during and after COVID-19.
 Home or virtual visits by midwives should be provided to reduce the number
of times women and newborns need to leave their home.
 As the world struggles to adjust to life during a pandemic, maternal health
needs don’t go away—they grow. Now more than ever, the health needs of
postnatal mothers must be safeguarded.
 In order to comply with
 Social distancing requirements,
 Hand washing
 Covering nose and mouth while coughing and
sneezing
 Midwives could deliver home or virtual visits.
 Maintain one meter distance away from sick
people.
 Individualized postnatal care, according to the
needs of the mother and the newborn.
 Midwifery-led postnatal home visiting could raise consciousness in parents on
establishing
 breastfeeding
 family planning
 contraception after birth
 preparation of milk formula
 smoke-free environments at home
 home hygiene
 care of the neonatal – especially after NICU discharge.
 Therefore the safest place for a women to deliver is at a functional health
facility with skilled birth attendant even during covid pandemic.
 Midwifery-led virtual visits via videoconferencing decrease the number of
visits to health facilities and enable mothers to be consulted immediately
and from their own home.
 Virtual visits have been demonstrated to be as safe as in-person visits.
 Therefore, as early as possible, midwives (especially those serving rural and
remote areas) should receive all the relevant technology equipment and
training regarding remote consultation.
 The World Health Organization (WHO) recommends at least four postnatal
visits for all mothers and newborns,
 on day 1 (first 24 hours),
 on day 3 (48–72 hours),
 between days 7–14 and
 six weeks after birth.
 However, a face-to-face consultation is required for physical examination
and/or screening of mother and the newborn.
 Home visiting should be prioritized
for women with
 Psychosocial vulnerabilities,
 Operative birth,
 Premature or low birthweight baby
 Other medical or neonatal
complications.
 Awareness should be raised about exposure to COVID-19 during a home visit,
where midwives should abide by strict infection control equipment and
procedures when entering and leaving homes.
 Midwifery-led services are vital during the postpartum period for women
suspected or confirmed with COVID-19. Parenting and breastfeeding support
can be offered through face-to-face or virtual visits.
 Μothers with COVID-19 should be advised to
establish breastfeeding or to express
breastmilk, applying appropriate infection
prevention and control measures.
 All breastfeeding women should be shown
how to hand-express their breast milk and
be advised on how to correctly store and
freeze it.
 Breastfeeding counseling,
 Neonatal care,
 Family planning counseling,
 Psychosocial parent support,
 Practical feeding support and
 Home hygiene should be provided to all mothers and their families, whether
they or their children have suspected or confirmed COVID-19.
 They need adequate support to provide quality,
 Holistic
 Women-centered postnatal care to mothers and newborns 
 In these exceptionally complex circumstances in order to promote safe
and respectful family-centered care, during periods of crisis including the
current COVID-19 pandemic.
ROLE OF NURSE IN
COVID-19 BREAST
FEEDING
 INTRODUCTION:-
Breastfeeding protects newborns from getting sick
and also helps protect them throughout their infancy
and childhood. Breastfeeding is particularly effective
against infectious diseases because it strengthens
the immune system by directly transferring
antibodies from the mother. As with all confirmed or
suspected COVID-19 cases, mothers with any
symptoms who are breastfeeding or practicing skin-
to-skin contact should take precautions.
 WHO recommends that mothers with suspected or confirmed
COVID-19 should be encouraged to initiate or continue to
breastfeed. Mothers should be counselled that the benefits of
breastfeeding substantially outweigh the potential risks for
transmission.
 Many women if they are suspected with covid infection or have
been detected with covid infection, they are reluctant to
breastfeed the baby. This will not be done.
 Breast milk does not contain covid virus. They do not deprive the
new born from breast milk. Even if the mother is diagnosed with
covid positive infection, the mother can breast feed her baby.
NURSES ROLE
 Healthcare professionals have a
key role to play in supporting
mothers throughout the critical
hours and days after birth,
enabling them to develop an
adequate milk supply and
preventing a long-term impact of
COVID-19 on breastfeeding.
Ways in which healthcare professionals can support
mothers to protect and promote breastfeeding during
the pandemic include:
---During COVID-19, many new mothers were sent home from the hospital within
hours of giving birth, without the necessary community and midwifery support to
initiate breastfeeding.
-Difficulties in obtaining support can cause great stress for new mothers, and can
result in many weaning rapidly.
– keeping mother and baby together, in accordance with current
guidelines
– ensuring maximum support during the critical period after birth
– identifying and monitoring women with risk factors for an

inadequate milk supply, and initiating milk supply with pumps where
necessary

– emphasizing, prior to discharge, the importance of regular and

frequent breastfeeding at home during the first two weeks after

delivery

– continuing support, for example through virtual support and

education, during the transition from hospital to home-based care

– guidance on how to obtain a hospital-grade pump, if required.

 WHO recommends that mothers with
suspected or confirmed COVID-19 should
be encouraged to initiate or continue to
breastfeed. Mothers should be counselled
that the benefits of breastfeeding
substantially outweigh the potential risks
for transmission.
 EDUCATE THE MOTHER ABOUT BENEFITS OF
BREAST FEEDING TO THE MOTHER AND INFANT.
 some recommended
Educate the mothers about
precautions during covid-19 breast feeding
 Practice hand hygiene.
 Wash your hands properly with
soap and water for at least 20
seconds before touching the baby
or extracting breast milk (manual
extraction or by pump).
 If soap and water is not
available, use hand sanitizer
that contains at least 60%
alcohol
 Avoid touching your face, eyes,
nose, or mouth with unwashed
hands.
 Wear a medical mask while
feeding.
 Sneeze or cough into a tissue, immediately dispose of it
and use alcohol-based hand rub or wash hands again with
soap and clean water
 Immediately changing masks in case of coughing or
sneezing, or at every feeding.
 Then wash your hands again and change the fresh mask.
 Replace masks as soon as they become damp
Precautions of Covid-19 positive mother during breast feeding
 The mother should be in negative pressure room in order to
prevent spread of infection.
 Wear a face shield before feeding the baby.
 Wear a medical mask while feeding the baby.
 Wash hands with soap and water or 60% alcohol based hand rub
before feeding
 Clean and disinfect surfaces around the living area.
 Maintain distance at least 2 meters from the baby and others.
 Precautions of caring for the covid-19 positive new borns
 Isolate the newborn with suspected or confirmed covid positive
from other children.
 If the baby in NICU(Neonatal Intensive Care Unit) expressed
breast milk to be given to the new born.
 Wear a face mask
 Maintain hand hygiene as routine
 Clean and disinfect surfaces
 EDUCATE THE MOTHER ABOUT

 If the mother and baby is temporarily

separated, the mother is encouraged to express
her breast milk, and someone else, such a
nurse, will feed the child.
 \Although the baby would not breastfeed at
the breast, mothers must still wash their hands
before and after pumping.
 Role of a nurse in
management of new born
with covid positive mother
 Measures to control
infection

strict infection prevention procedures were used

during the deliveries
strict isolation and infection control measures
continued beyond the deliveries

Delivery providers and nurses wear full PPE (“full

PPE” = isolation gown, N95 respirator or powered,
air purifying respirator, face shield or goggles, and
gloves) during the entire labor and delivery process
of mothers with confirmed or suspected COVID-19,
and mothers wear surgical masks.
Newborns ≥ 35 weeks’ gestation

Newborns ≥ 35 weeks’ gestation

For newborns not predicted to need extensive resuscitation, a neonatal
delivery nurse (fully donned) enters the room immediately after delivery
and evaluates gestational age, tone, color, and respiratory effort. If there
is good tone with spontaneous breathing, the nurse wraps the newborn
with warm blankets and places her/him into a prewarmed transport
isolette.
Hospital staff caring for these newborns don a gown, surgical mask, face
shield, and gloves. In order to minimize PPE use and potential
exposures, routine newborn tests such as screening for congenital heart
disease, obtaining the newborn screen, and hearing testing are performed
together
Newborns < 35 weeks’ gestation

Newborns < 35 weeks’ gestation

For resuscitation of premature, high-risk, and newborns with
anomalies born to mothers with confirmed or suspected
COVID-19, a fully donned neonatal resuscitation team enters
the room upon delivery.
The newborn is quickly assessed, and if spontaneously
breathing, is placed into the transport incubator.
If resuscitation is required, necessary respiratory support is
provided, and the newborn is transported to the neonatal
intensive care unit (NICU) and admitted into a negative-
pressure room with an antechamber.
Care is provided by a neonatal nurse trained in donning and
doffing PPE.
A second nurse monitors donning and doffing to ensure that
contamination of the primary nurse or medical provider does
not occur.
FEEDING OF NEWBORN
Careful collection techniques should be
used for pumped breast milk, including
providing mothers with a dedicated
breast pump.
Mothers should wash their hands before
and after pumping, and the breast pump
should be properly disinfected.
If possible, expressed breast milk should
be fed to newborns by a healthy caregiver
Storage of milk
SARS-CoV-2 has been detected on
plastic for up to 72 h, staff receiving
bottles of expressed milk from
mothers with COVID-19 should wear
gloves. After securing the cap, bottles
should be wiped with viricidal wipes
or diluted bleach solutions and placed
on a clean surface to air dry. After
drying, bottles may be placed in
hospital refrigerators in individual
patient bins
Parental education
Parental education
Advice regarding home isolation
precautions, Neonates are ideally
discharged into the care of an unaffected
caregiver. COVID-19 positive family
members are instructed to limit exposure
to the newborn, generally maintaining a
2 m (~6 ft) distance. If the mother is
breastfeeding or provides newborn care,
she is instructed on hand hygiene and use
of a mask until afebrile for 72 h without
the use of antipyretics, and >7 days have
passed since symptoms began.
 Follow-up

Infants are followed up 1–2 days

after discharge via telehealth.
The focus of the video visit is to
evaluate for developing signs of
infection, review home isolation
precautions, and discuss routine
concerns such as feeding, hydration,
and jaundice.
Neonates are weighed on the home
scale during the encounter, visualize
the neonate’s tone, colour,
demeanour, and respiratory status.
DONNING AND DOFFING

Donning PPE (Putting on)

1.Perform hand hygiene 1. Remove shoe cover

2.Put on shoe covers (if 2. Remove gown and gloves
applicable) 3. Perform hand hygiene
3.Put on gown
4.Put on mask/respirator 4. Remove eye protection
(if applicable) 5. Remove mask/ respirator
5.Put on eye protection 6. Perform hand hygien
(if applicable)
6.Put on glovs
DISPOSAL OF PPE KITS

face masks, gloves and paper

tissues should be hygienically
disposed of in a closed bin.
PPE material is treated by
incineration
GOI guide lines to be followed
during storage and
transportation for disposal
THANKING YOU