A matter of “go, decide, and do it” – infection control nurses

Today is International Nurses Day. Four infection prevention and control nurses recount their experience of COVID-19 in Malta so far.

Photo was taken in 2018, in pre-COVID-19 times

Tista' taqra bil- Malti.

As people are getting used to putting their lives on a lower gear, work inside Mater Dei Hospital is as busy as ever and medical front-liners show an impressive determination to stay the course. 

Infection control nurses Noel Abela, Rebecca Cachia Fearne, Claire Farrugia and Deborah Xuereb are just four of the hundreds of Mater Dei staff members and University of Malta Alumni who are supporting Malta’s response to COVID-19.  

Disinfect hands, don the gown, put on the mask, then the visor,  and carefully put on the gloves – the routine which has by now become second nature to all pandemic front-liners at Mater Dei, was largely set in motion by this team of nurses, and their colleagues, based on the recommendations of the global health authorities.  

They explain how they have helped determine which protective gear was to be worn by staff, how to doff and dispose of it safely, and how to make correct use of it via professional training sessions. 

“We always have to be one step ahead

“As the Infection Prevention and Control Unit, we always have to be one step ahead, so we saw the increasing workload way before hospital started receiving COVID-19 positive patients. But this gave us time to prepare ourselves well”, said Claire, who also noted that the team, led by Prof. Michael Borg, collaborated with other departments to develop pathways through which COVID-19 positive patients would be transported to minimise contact with other patients.  

And as infection prevention and control nurses, COVID-19 was not the first extraordinary circumstance they had to deal with at work. “Although the risk of transmission is higher than other viruses, the ways of prevention, such as keeping a distance, washing hands very often and wearing gloves, are practices we’ve been advocating for since day one”, Deborah said.  

Whenever Prof. Gauci mentions new cases amongst health care workers or patients housed within Mater Dei during her daily update, Infection Prevention and Control nurses assist with the carrying out of contact tracing, and ensuing assessment of whether there was any substantial exposure to the confirmed case/s.  

They use evidence-based set criteria that evaluate whether a person, be it a member of staff or a patient, has had significant contact meriting further action. 

Noel, Rebecca, Claire and Deborah also played a major role in the upskilling of medical staff via training sessions on the use of personal protective equipment, which in turn served to help better tackle the surge in cases, This training, which was an integral part of the hospital’s risk management strategy, will still be valuable even after the pandemic is over.

“Things between us are going smoother than ever”

Claire explained that what they do on a daily basis is essentially risk management, but with a stronger human element. “We assess the risk, develop a way to mitigate and deal with what comes after … and we listen to other staff members’ needs and concerns”.  

Agreeing wholeheartedly with their colleague, the others admitted that, despite being specialised nurses, they have had to wear many other hats over the last few months. They have dealt with suppliers, management, engineers, and so on – but this flow of work, although voluminous, has not disrupted their team dynamics at all, if anything it strengthened it.  

“Things between us are going smoother than ever. I think it’s because like everyone else on the frontline, we were faced with a situation of go, decide and do it”, said Deborah.   

The most challenging hat they’ve worn so far, however, was that of being good listeners to health care professionals, some of whom were growing anxious as many changes unfolded at their place of work in such a short amount of time.  

Thankfully, the University of Malta community pitched in to keep health workers safe, and even designed customised 3D-printed masks to help these frontliners.

Rebecca thinks that the mental health toll on some medical frontliners has largely been due to the media’s negative portrayal of the COVID-19 situation on a global level. Since the World Health Organisation announced a mystery pneumonia in December of 2019, the media has been following every step of the journey with incessant headlines and continuous updates.  

“Some of our colleagues told us they had to stop following the footage on TV and get away from their social media accounts for a while, as this was becoming mentally damaging to them”, she said. Add the long days of work, the lack of time with close relatives, and for some, the choice to live away from their loved ones, and the pressure mounted. “We are all in the same boat – at the beginning, this was an unknown for all of us, so that made us anxious to a certain extent. Now that we’re learning more, we are more informed and are more eager and prepared to fight the battle.” 

One tool which has majorly contributed to the enrichment of their career, as well as the building of their tough shell, is their university education, something which they’ve experienced both sides of, as a student and as a teacher. Ms Farrugia, Ms Cachia Fearne, Ms Xuereb and Mr Abela are Senior Visiting Lecturers within the Nursing Department within the Faculty of Health Sciences.

“Malta is doing well….but success can be dangerous”

One of the first lessons taught to all University of Malta nursing students in their clinical practice, Rebecca said, is the concept of patient-centred care. This gave them the ability to put the patient at the centre of each of the decisions they make, no matter how big or small.  

Another trait they obtained throughout their education is the need to always question everything, and never take things at face value. This allowed them to not just base their decisions on what they know, but on what would work best in that particular circumstance.

Before COVID-19 actually started dominating every aspect of our lives, 2020 was designated by the World Health Organisation as International Year of the Nurse and Midwife. Deborah said that in a way, this brought out the role of nurses in ensuring a higher level of care, and the need of achieving more autonomy for the profession. 

Malta is doing well….but success can be dangerous, Noel exclaimed. “Just because no or only a few new cases are confirmed on one particular day, some think it’s okay to just grab their car keys and drive off to the beach. It’s incredibly unfair on those who are more vulnerable”, he says, without even mentioning how unfair it also is on them.   

This is not the time to sit back and relax. Social distancing should definitely stay, the nurses concluded, “and we promise to keep up our commitment towards patient and staff safety”.   

Applications for programmes in nurse education at the UM are now open online

The Department of Nursing offers a full-time and a part-time degree in nursing. A new programme, the Preparatory Course for the Bachelor of Science (Honours) in Nursing will also open in October 2020.  Nurse education programmes for nurses from overseas are also offered through the Foundation Programme in Nursing and the Certificate for Graduates of Non-EU nurses. 

Queries regarding the programme may be posted via email: nursing.healthsci@um.edu.mt.

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