Nurses’ Preparedness in Management of Physiologically Unstable Patients With Severe Covid-19 Disease at the Accident and Emergency Department, Kenyatta National Hospital, Nairobi

Abstract

Background: COVID-19 pandemic has disrupted global systems through exponential infections, severe disease, deaths, and profound negative economic impact. The health systems have been affected to the point of being overrun and overwhelmed. Most countries, including those with advanced healthcare systems, have been shaken because of the enormous numbers of critically ill patients and inadequate resources. Nurses have been at the forefront in responding to the pandemic in numbers. Due to the enormous number of patients, mobilization from other departments has been carried with questions about preparedness. Nurses are the primary caregivers in the accident and emergency department for acutely ill patients with COVID-19 disease, while their preparedness has not been ascertained. Objective: The objective of this research was to assess nurses' preparedness in the management of physiologically unstable patients with severe COVID-19 disease at the Accident and Emergency department, Kenyatta National Hospital. Methodology: A cross-sectional descriptive study design was used, and respondents were selected by convenient sampling method from a population of nurses working at the KNH Accident and Emergency department. The study involved 62 respondents. Data was collected by the use of a questionnaire. The data was analysed using R version 4.0.2 and presented using descriptive statistics in tables, graphs, or pie charts. Inferential statistics were also applied. The fisher's exact test at a 95% confidence level was utilized to analyse the association between level of training, specialization, COVID-19 training, and level of experience with nurses´ preparedness at A & E, KNH to manage physiologically unstable patients. Ethical principles of information confidentiality, anonymity in data reporting, voluntary participation and appropriate ethical approvals were observed. Results: 77% of the respondents had managed physiologically unstable COVID-19 patients. 52% were somewhat prepared, and 47% were confidently prepared to manage these patients. The majority were knowledgeable on proper triage of patients: 92% knew comorbidities causing poor outcomes and 72.6% on emergency signs. 82.3% knew of the PPE required to protect themselves. More than half had received training on triage and isolation procedures of COVID-19 patients, but only 38.7% were trained to manage these patients. The main challenge reported was lack of adequate PPE, fear of contracting the virus and fatigue (90.3%). The level of education was found to be associated with COVID-19 management preparedness with a p-value of 0.019. In contrast, experience (p-value 0.154), specialization (p-value 0.764) and training on COVID-19 (p-value 0.509) were not associated with nurses’ preparedness to manage COVID-19 patients. Conclusion: This study established that most of the nurses in the A & E department at KNH were prepared to manage physiologically unstable COVID-19 patients. Some levels of education were found to be significant in preparing nurses to manage COVID-19 patients. Contrary to most beliefs, essential variables such as the level (years) of experience and specialization that had been thought to be influential in nurses' preparedness to manage COVID-19 patients were found not to be as significant as we thought.