DAEGU, South Korea – Monday, at 506 West Ward in Kyungpook National University Hospital in Daegu, where gravely ill patients infected with the new coronavirus received treatment on 16 beds, monitors at the nursing station showed busy nurses with Level-D protective gear.

The ward was in a virtual crisis. Shortly after the hospital moved three patients to another institution after they got better, another patient's condition worsened drastically. The patient, who was admitted to the hospital on Feb. 29, had suffered from esophageal cancer. After contracting COVID-19, the patient suffered from worsening breathing problems from Sunday and died at around 3:54 p.m. on Monday. It was the 36th death caused by the deadly virus in Korea.

Bae Eun-hee, the head nurse of the 506 West Ward, said the hospital had to see many death cases because there were many severe patients with underlying diseases. Except for two or three patients who can sit by themselves among 12, the rest are in a critical condition, she said.

“If their status gets better, they are moved to other hospitals that treat patients with mild symptoms, just like the other three today. Then, we get new serious patients,” Bae explained. The four empty beds after three transfers and one death were filled with other severe patients in the evening on Monday.

The nursing station of the 506 West Ward of the Kyungpook National University Hospital in Daegu gets the written message from the nurses at the negative-pressure room.

Moving body to morgue, cleaning up patient’s stool

When a COVID-19 patient dies, it is a nurse’s job to move the body to the morgue because morgue staffs cannot touch the body due to the risk of the virus infection. After completing disinfection procedures to avoid viral exposure, nurses move the body to the morgue. The task needs five or six nurses.

After nurses put the body in the morgue, they had to clean up the stool of patients and change diapers. On regular days, a caregiver or a nurse alone could do such work. In the negative-pressure room, however, the work requires three nurses because protective clothing makes the work slow. Taking care of severe patients is much more demanding than tending to general patients.

Nurses at the negative-pressure room check patients’ status and notify the nursing station. There are double windows between the nursing station and the negative-pressure room, which makes it impossible to have a normal conversation. Medical workers usually use radios, communicate by handwriting, or use gestures for simple messages. They deliver urgently needed items through a small “pass box” next to the window. The pass box connects the two spaces to minimize the entry of the negative-pressure room. The two doors from the pass box do not open at the same time.

Struggling to persuade COVID-19 patients to move to multi-bedroom

The nursing station is a bridge that links the ward, the situation room, patients, guardians, and doctors. The station has 12 nurses, including two exclusively for dialysis. Bae, the head nurse, and Jang Eun-ryeong, the head nurse from the neighboring ward, are stationed there.

The nursing station not only checks patients’ status through monitors and orders proper treatment but supports the nurses in the negative-pressure room. The nurses at the nursing station also meet the needs of patients and guardians or persuade them for specific issues. On Monday, the two nurses had a hard time convincing COVID-19 patients to move to another multi-bed patient room.

“Sir, the negative-pressure is also available in the multi-room and other patients in the multi-room are in the same status. So, there is no difference in the environment between the single-room and multi-room. A more serious patient, who needs dialysis in a single room, is coming now but we’re short of patient rooms,” one nurse was talking on the phone.

The nurses had to finish moving patients before receiving a new severe patient but had trouble getting the patient consent.

Two head nurses sort out medical supplies so that nurses can easily use them.

Shortage of workforce, medical supplies more worrisome than heavy workload

After the storm, the two head nurses could not catch a breath but rushed to work again. Forty hoods, which they had asked for support, arrived. When medical supplies arrive, new work begins. They have to unbox them so that nurses who enter the negative-pressure room can wear them comfortably. The two nurses have to unpack the two items in one box and put 10 of them in another box.

The nurses said they were more concerned about the lack of workforce and medical supplies than demanding work. As they are fighting COVId-19, the ward needs more staff and medical items. The city’s support of medical supplies does not increase in proportion to the severity of COVID-19 patients’ symptoms. Therefore, the 506 West Ward is almost always in shortage of medical supplies.

“We need more hoods. The powered air-purifying respirator (PARP) is lacking,” Bae said. “We cannot help but use a lot of items to take care of severe patients. But when we hear people say we use too many items, our strength is gone.”

While the nurses were sorting out items, the bereaved family of the dead patient arrived. They explained the situation to the family and guided the funeral process. Patients who die from COVID-19 cannot have the usual funeral, and the nurses must explain this and ask for consent.

Bae said she had never rested a day since Lunar New Year's Day. On Monday, she came to work in the early morning to work for 12 hours.

“As the head nurse, I have to provide supplies for our nurses and make decisions,” Bae said, responding to a remark that she seemed to need some rest. "Even if I go home, I don’t feel I’m having a break because I’m worried about patients. I feel easier here than at home.”

However, her voice quivered slightly when she said, “I’m a little tired today.”

same@docdocdoc.co.kr

<© Korea Biomedical Review, All rights reserved.>