Saint Peter's COVID-19 Nursing Care Guidelines

Introduction

These guidelines provide comprehensive information for nursing staff at Saint Peter's Healthcare System regarding patient care during the COVID-19 pandemic. The recommendations are based on the latest evidence from health authorities including the WHO, CDC, and local health departments.

Overview

COVID-19, caused by the SARS-CoV-2 virus, is primarily transmitted through respiratory droplets and aerosols. As nursing professionals, we play a critical role in patient care, infection prevention, and education. These guidelines should be reviewed regularly as recommendations evolve with emerging evidence.

Infection Prevention Basics

Hand Hygiene

Hand hygiene remains our most important infection prevention strategy:

• Use alcohol-based hand rub (at least 60% alcohol) for routine decontamination
• Use soap and water when hands are visibly soiled or after caring for patients with diarrhea
• Perform hand hygiene before touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings

Respiratory Hygiene

Ensure patients and staff follow proper respiratory hygiene:

• Cover coughs and sneezes with tissues or elbow
• Wear surgical masks when within 6 feet of suspected or confirmed COVID-19 patients
• Ensure proper ventilation in patient care areas

Personal Protective Equipment (PPE)

Patient Assessment and Monitoring

Initial Assessment

Upon admission or identification of a suspected COVID-19 case:

• Complete a full assessment while maintaining appropriate distance and wearing PPE
• Document presenting symptoms, onset date, and severity
• Record vital signs including temperature, oxygen saturation, respiratory rate, and blood pressure
• Assess for risk factors for severe disease including age, comorbidities, and vaccination status

Ongoing Monitoring

Frequent monitoring is essential for early detection of deterioration:

• Vital signs at least every 4 hours or more frequently if clinically indicated
• Continuous pulse oximetry for patients with oxygen saturation <94%
• Daily assessment of respiratory effort, oxygen requirements, and signs of worsening disease
• Regular pain assessment using appropriate scales

Patient Care Protocols

Oxygen Therapy

Medication Administration

• Follow current treatment protocols as prescribed by the medical team
• Administer therapeutic anticoagulation as ordered (typically for hospitalized patients requiring supplemental oxygen)
• Administer corticosteroids such as dexamethasone as per protocol for patients requiring supplemental oxygen
• Ensure proper administration of antiviral medications when prescribed

Proning Protocol

Awake proning may improve oxygenation:

• Consider for patients with SpO2 <94% on supplemental oxygen
• Instruct patients to lie in prone position for periods of 1-2 hours, several times daily
• Document tolerance and oxygen saturation response

Patient Isolation Procedures

Environmental Cleaning and Disinfection

• Use EPA-approved disinfectants effective against SARS-CoV-2
• Frequently clean and disinfect high-touch surfaces including bed rails, bedside tables, call buttons, equipment, and door handles
• Special attention required for equipment that moves between patients (e.g., monitors, IV pumps)
• Follow terminal cleaning procedures after patient discharge or transfer
• Properly handle and process laundry according to infection control guidelines

Staff Wellness and Support

Staff Monitoring

• Self-screen for COVID-19 symptoms before each shift
• Report any symptoms or potential exposures immediately
• Follow institutional protocols for testing and clearance
• Adopt buddy systems for peer support and monitoring for fatigue

PPE Safety

• Ensure N95 respirator fit testing is current
• Take scheduled breaks to remove PPE, hydrate, and rest
• Report any PPE shortages or concerns immediately
• Practice proper doffing procedures in designated areas

Communication Guidelines

Patient Communication

• Provide clear information about COVID-19, treatment, and infection control measures
• Use available technology (phone calls, video conferencing) to facilitate communication while minimizing exposure
• Encourage and facilitate virtual visitation when allowed
• Address patient and family concerns honestly and compassionately
• Utilize interpreter services as needed for patients with limited English proficiency

Team Communication

• Participate in daily huddles and briefings to update on patient status and protocols
• Report changes in patient condition promptly
• Utilize standardized communication tools such as SBAR for efficient handoffs
• Document all care, observations, and communications accurately in the medical record

Special Considerations

End-of-Life Care

Compassionate end-of-life care is essential even during pandemic conditions:

• Balance infection control with provision of essential compassionate care
• Facilitate virtual family presence when physical presence is limited
• Ensure appropriate symptom management for comfort
• Honor spiritual and cultural practices to the extent possible

Vulnerable Populations

• Pay special attention to higher-risk patients including the elderly and those with comorbidities
• Consider additional monitoring for pregnant patients
• Address special needs of pediatric COVID-19 patients, including considerations for MIS-C

Conclusion

Nursing care during the COVID-19 pandemic requires adherence to strict infection control protocols, vigilant patient monitoring, and compassionate communication. These guidelines provide a framework for care at Saint Peter's, but clinical judgment must always be applied. Regular updates to these protocols reflect the evolving nature of the pandemic and emerging evidence. As frontline healthcare providers, nurses play a critical role in patient outcomes and the overall healthcare system response to COVID-19.

For questions or clarifications regarding these guidelines, please contact your unit manager, the infection control department, or the nursing leadership team. Remember that these guidelines complement, not replace, your clinical judgment and individualized patient assessment.