A look at how some of HMC’s nurse leaders are responding to the challenges faced in Qatar
Nursing is a profession that requires knowledge, skills, dedication, caring and empathy requires knowledge skill. We are all aware of the challenges health systems around the world, including Qatar, are experiencing due to the COVID-19 pandemic and throughout, nurses continue to deliver care, demonstrating their dedication, competence and professionalism every day. This is evidence-based care in challenging circumstances. They have done so with professionalism and highlight the degree to which they are integral to the success of Qatar’s healthcare delivery.
In the coming weeks we will highlight the work of some of the nurses leading our response to the pandemic and who will continue to be instrumental in shaping nursing for the future.
Ms. Parwaneh Elias Shibani
Assistant Executive Director of Nursing in Al Wakra Hospital & Mesaeed Hospital
Ms. Parwaneh Shibani joined Al Wakra Hospital in 2013, first as a Director of Nursing, rising to the position of Assistant Executive Director of Nursing. As the number of COVID-19 infections grew in Qatar, a strategic plan was formulated to provide more critical care capacity for the growing number of COVID-19 patients. The decision was taken to open the recently constructed hospital building in Mesaieed. South of Al Wakra city, it delivers care to patients with mild to severe Covid symptoms.
As one of the senior nurse leaders in Al Wakra, Parwaneh was asked to lead nursing services at in Mesaieed Hospital. She has been deployed there since 11 March 2020. However, whilst the building was constructed but it had not been commissioned to be an operational hospital thus a rapid response was required to prepare the facility.
While Parwaneh has many years of work experience, she said that nothing she has seen before could have prepared her for the sheer scale of the work that was needed before the hospital could receive patients. Commissioning a new hospital during an evolving crisis naturally encompasses a whole range of challenges, not least the limited time available and supporting with staff concerns over infection risks. Parwaneh and her team worked methodically to develop systems and processes necessary to open a fully functional hospital that is safe for patient care.
Parwaneh worked closely with medical colleagues as well as the engineering department and the ambulance service to ensure the timely setup of new systems and patient pathways, in accordance with HMC’s corporate clinical standards.
She developed the appropriate nursing workforce plans to support the scope of service intended for this facility and the peak of the pandemic, she led 405 nurses, including nurse educators, nursing house supervisors, Head Nurses, Charge nurses, and 333 staff nurses operating i12-hour shifts.
Parwaneh also established a healthy work environment. This including ensuring her staff had the right personal protective equipment (PPE) and appropriate orientation and infection control training to support their safety and that of the patients. She worked with staff to improve work practices, such as the implementation of "care bundling” to minimize the number of times nurses entered patients’ rooms. She also liaised with support services, such as procurement, catering, security and transport, to ensure that necessary equipment was ordered and that patients and staff were nourished and nurtured.
Parwaneh explained that by encouraging true collaboration and strong partnerships, they were able to develop creative solutions and build a highly effective team.
Parwaneh noted how this experience has demonstrated the value of small gestures of kindness and compassion and the impact this has on patients. She stated how proud she was of her team when many of them came together and voluntarily donated hygiene items to those patients who had few possessions with them. By engaging patients in their care during their treatment, they were able to make them feel more empowered and supported that she believes helped with their recovery journey.
Parwaneh recounted how a patient once told her how much they appreciate what she and her team have done, and how this made her feel immensely grateful that she was given this opportunity to help other human beings as well as serving her country.
Ms. Sawsan Seed
Acting Director of Nursing
Lebsayyer Field Hospital
Sawsan was identified as a nurse that could lead a team whilst being a high performing team player. She has the experience and knowledge needed to be involved in a start-up environment where each new development is a fresh challenge.
Sawsan initially joined the team at Mukhaines Camp, a large Red Cross-run residential compound. It was established as a quarantine facility to accommodate males, who were either “suspected” or “confirmed” as COVID-19 positive guests.
She led by example, demonstrating quickly to colleagues, who were fearful and apprehensive about dealing with Covid positive guests that if appropriate safety policies and procedures were followed, they were not at risk.
Sawsan was then selected for the role of Acting Director of Nursing and Midwifery to establish the Lebsayyer Field Hospital. It was set up as a step-down facility for male patients who had been discharged from COVID-19 Hospitals and as these patients were not fit to be discharged home immediately following treatment in hospital, they needed further rehabilitative care before becoming self-caring and self-reliant in the community.
Working alongside colleagues in the Ambulance Service, Human Resources and many other support services, Sawsan worked tirelessly to get the facility ready to be operational and accept its first patients. Together with Dr. Abdulla Rashid Al Naimi, the hospital’s Clinical Lead, Sawsan led the team through the journey from commissioning and opening of the facility, to the current state of operational effectiveness.
Patients there were often fearful for their own health but also worried about their jobs, their family and their friends as most are far from their homes when they become ill. Sawsan identified the need for mental health support for patients at an early stage and engaged the help of colleagues in Mental Health Services to support them in the hospital and where necessary, after discharge.
Providing leadership and motivation to 170 nurses, working 12-hour shift patterns is challenging in any hospital but in a field hospital, where the environment is tense and the nature of illness uncertain, it is further complicated. With 500 patients to care for at the height of the pandemic, identifying the need for emotional and spiritual care is as important as physical care.
Sawsan notes that having a good relationship with her colleagues has helped her to deal with any impact on her personally. She has identified the need for good communication, talking to patients and colleagues to alleviate stress and identify their worries at an early stage.
She speaks very proudly of this being her opportunity to support her country during this crisis and to giving her utmost in terms of the knowledge and expertise to Qatar in its time of need. She also speaks of her personal development and growth of her leadership skills and management capabilities during this time. Sawsan feels equipped and prepared to lead again if the need arises and to provide the direction and strength needed to combat a second wave if she is required to do so.
Ms. Enaam Alnaemi
Assistant Executive Director of Nursing in Emergency Department
Ms. Enaam Alnaemi had worked for the past 18 years in the Emergency Department in Hamad General Hospital, where she was the lead emergency nurse for the past eight years. When the coronavirus gained momentum in Qatar, she joined Dr Khalid Abdulnoor Saifeldeen, who was appointed the medical lead for the Field Hospital Old Industrial Area (FHOIA)
When a lockdown was initiated for the industrial area at the height of the pandemic as one of the government initiatives to curb the spread of the virus, the decision was made to establish a local hospital facility called Field Hospital Old Industrial Area (FHOIA). Enaam was appointed by Dr Khalid to help with the commissioning of this facility, as her extensive experience and skills of being a nurse leader in the emergency were immensely valuable in this role.
Enaam and her colleagues worked tirelessly as a team to build a new operational facility in less than four weeks from concept idea and design to being functional – an amazing achievement.
Enaam was involved in a wide range of operational planning efforts, including identifying and arranging equipment and nursing related requirements; since workforce planning, scope of practice and pathways development were essential. She liaised with the medical team, ambulance service staff, and contractors whilst leading over 120 nurses. This was more complex because of the urgency and the lockdown situation limiting movement of people and goods.
FHOIA's scope of service is to provide care for predominantly craft and manual workers who live in the industrial area. Providing a wide range of healthcare services, the hospital also managed 150 outpatient visits on a daily basis.
During the busiest period, they had approximately 800 patients every day coming to the emergency department. Patients had to be triaged, stabilized and then transferred to another facility based on their clinical need, and this had to be done rapidly and efficiently to cope with the large volume of patients.
About 200 of these patients were either suspected of, or COVID-19 positive patients. If patients were suspected to have COVID-19 s or were asymptomatic, we were treated and transferred to one of the isolations and recovery sites. If their condition required hospitalization, they were taken to the Mesaieed Hospital to continue their treatment there.
FHOIA is a very busy facility with a significant patient turnover that requires a very strong, dynamic and experienced team to cope with the volume of patients seen daily. Amidst these challenges, Enaam helped to establish patient pathways and help the doctors and nurses establish good practice in an unfamiliar location. With senior colleagues, she set up an effective infrastructure and communications channels and work with new teams.
Enaam recalls that while it was hard work to begin with, she felt truly grateful to have been able to use her many years of emergency nursing experience to contribute to the delivery of urgently needed care to patients. She has seen first-hand that with commitment, vision and effort, everything is possible, and this gives her confidence that Qatar can efficiently and effectively manage a pandemic.
Ms. Nadya Al-Anzi
Executive Director of Nursing for Private Nursing Services,
Home Healthcare Services and Community Medical Equipment Services
Ms. Nadya Al-Anzi has gained extensive professional experience in healthcare over 22 years, starting as a case manager responsible for in-patient and community services in 1997. Responding to the need for more structured community-based healthcare in Qatar, Nadya has spent the last 13 years working to develop HMC’s community healthcare services.
She explained that before the full extent of the COVID-19 outbreak was realized in Qatar, the home healthcare nurses would play a key role in delivering the health agenda.
Nadya worked with her senior team to initiate strict infection control protocols for all her nurses going into the field. This required that all nurses had the appropriate safety equipment and followed procedures.
As part of the initial national infection control measures, the government opened quarantine sites to accommodate patients who needed to be cared for outside their home environment. Nadya had responsibility for 48 hotels and guesthouses commissioned by the government as quarantine sites; this included oversight of appropriately trained nursing staff and effective systems for them to operate in.
Nadya and her team had to manage any other co-morbidities that quarantined guests may have had, such as diabetes or high blood pressure, providing the appropriate medication and dietary requirements.
Many of the quarantined guests were frightened, lonely and upset whilst being confined for 14 days away from their home. Nadya came to the realization that it was as important for them to receive psychosocial support, as it was to receive medical care or food. The free Mental Health helpline was very beneficial as it provided a comforting avenue for people to reach out to a professional and get support when they needed it. People manage stressful situations differently and having access to psychological support is very important in such challenging times.
Nadya also oversaw the ongoing screening services at Hamad International Airport, which was an important initiative from the outset of the pandemic, identifying people with signs of coronavirus infection. As the airport will see many more passengers travelling due to the easing of restrictions, the local screening service will continue to perform an import safety function.
As a Qatari woman and a healthcare professional, Nadya said it is a personal goal to conduct herself professionally as a nurse and contribute to the care of people in need. She was therefore honored to have been asked to join the team leading HMC’s various COVID-19 responses and thereby support Qatar's national efforts. She is grateful to her family who have been very supportive, after their initial reservations about her visits to the quarantine sites but they acknowledged her fervent desire to do what she believed was right.
Message from the Chief Nursing Officer
The work of all nurses, throughout this challenging time, is evidence of the strength and value of the profession. The role of nurses in ensuring high quality healthcare is always essential and more so at times of crisis. Leaders are only as good as the teams who support them, and their achievement are a reflection of the work done by everyone. More nurse leaders and their responses to COVID-19 will be highlighted in the coming weeks.
Mesaieed Hospital Nurses Getting Creative to Boost Staff Morale
An account from Khulud Maghreby, Nurse Educator and Planner
In the face of the increased anxiety throughout the COVID-19 pandemic, the frontline nurses at Mesaieed Hospital adopted several strategies to boost their positivity and help them look after their patients.
Fortunately, strong leadership support helped ensure a positive work environment that contributed to staff satisfaction and better patient care. The situation was aided by strategies such as ensuring that nurses had a carefully calculated patient-nurse ratios and patient care assignments included the ‘buddy system’ where experienced nurses supported their less or inexperienced counterparts. Moreover, our nurses were rotating between lower and higher census units.
Staff transportation and single accommodation were arranged to provide added support for those living far away. In recognition that physical health is closely linked to mental health, nurses were provided with meals, encouraged to eat well and stay hydrated.
When professional help was necessary, the nurses did not hesitate to have access to national mental health support helpline for professional advice on managing stress and tips to boost wellbeing.
All the support that we received from the leadership and corporate teams was helpful. Regular, open and transparent communication messages from the SWICC kept us updated about national COVID-19 numbers. The SWICC messages and gratitude to key individuals and teams were heartwarming as it indicated that senior corporate leaders genuinely appreciated the work that frontline staff were doing.
This empowered the staff on the frontlines and daily to do also act. Professional unity across multi-disciplinary teams was a welcome development. Staff leaned on one another for strength and created bonds with peers. For example, whenever, a sad incident occurred, they took time out to share and talk about their experience and remind each other that they are doing a good job.
The team was extremely happy about positive outcomes of patients and we celebrated every recovered patient, which boosted our morale and that of patients receiving ongoing treatment.
The staff decided to create a motivational video highlighting the importance of compliance with infection preventive measures. The video, which was shared internally within the team, incorporated a positive angle, highlighting how they are making a difference.
Little gestures can make a significant difference to staff wellbeing; like asking simple questions like, “how are you?” and “how is your family?”. Drawing smiling lips on the facemasks or sending each other encouraging messages via social media also contributed hugely to relieving stress during difficult times.
There is something cathartic about doing a good deed and helping those in need and there were numerous instances where nurses went beyond their call of duty to help the patients admitted to Mesaieed Hospital. Showing empathy through providing support and encouragement to the patients, such as enabling them to communicate with their families and friends and thereby alleviating some of their concerns. At times, nurses donated personal hygiene items and phone chargers to those patients who had little themselves.
For the Mesaieed Hospital nursing team, like for so many other nurses at the frontline of the COVID-19 battle, we made a conscious effort to remain positive for ourselves, our families and patients. This enable the team to give their best even during the toughest of times. This experience has underscored for all of us time and time again that there is no better calling than the nursing profession.
Impact and Role of Healthcare Providers During COVID-19 Pandemic
A review of the Team-Based Model of Care (TBC) Approach at Lebsayyer Field Hospital
What is Lebsayyer Field Hospital?Lebsayyer Field Hospital (LFH) is one of seven purpose-built COVID-19 treatment facilities in Qatar, authorized by the Ministry of Interior and Ministry of Public Health and managed by Hamad Medical Corporation (HMC). It was established in April 2020 as the first ‘step-down’ facility to support the existing COVID-19 hospitals and cater for mild symptomatic ambulatory recovering patients before discharging them home. The hospital is situated near Al-Shahaniya on the Dukhan Road; it is a 504-bed capacity healthcare facility divided into two units, each having 252 beds. It is staffed by more than 100 healthcare professionals that include doctors, nurses, nursing aides, technicians, and support staff.
The strategic location was chosen in order to use existing structures from the military camp that it sits on, but also because the location was situated away from the nearby residential areas for safety and not to disrupt their day-to-day activities. It is also close to one of the tertiary hospitals in the area, which is ideal in case of further tests and urgent treatment are needed for any patient.
Defining Team-based Model of Care (TBC)National Academy of Medicine (NAM) stated that the basic idea of a team-based model of care is a group of individuals who coordinate their actions for a common purpose, mainly for the prevention or treatment of disease and health promotion. It strives to meet patient needs and preferences by actively engaging as full partners in their care while promoting all health care professionals to function to the maximum extent of their education, certification, and experience. S. Heath (2019)
Application of TBC in our Facility
Lebsayyer Field Hospital
(LFH)
Al-Shahaniya-Dukhan Road
Team Composition:The LFH medical team comprised of Medical Doctors (Residents and on-call Attending Physician), Charge nurses, Team leader nurses, Staff nurses, Swab Nurse, Nursing Aide (NA), Patient-Care Assistants (PCA), Pharmacist, and Admission Officers (AO).
Clinical Care:With collaboration of each health care team member, LFH is committed on improving health outcomes, optimize health services and strengthen healthcare system to the fullest extent.
Team Process:Each expertise has its defining characteristics, whereas doctors are the overall in-charge for interventions and supportive treatment. Attendance of consultant doctor at all times to be the primary decision maker particularly when critical situations arise, along with the physicians from various specializations could effectively work together to manage patients. On the other hand, nursing directors and supervisors are the ones involve in the operations to properly delegate the roles and responsibilities. By selecting a charge nurse and a team leader in each unit, team members will systematically identify what is their exact role. Educators are initiators of action plans in doing competency trainings to staff nurses from various departments (operating theatre, pediatric, oncologic, psychiatric, long term, outpatient clinic) to have an immense role in establishing rapport and teamwork in dealing with direct patient care for COVID-19 patients in a new facility. Each specific role and skill has a different perspective, but through proactive participation and application of dependent, independent, and collaborative interventions, healthcare professionals will be more efficient and innovative to give a much-needed boost in the delivery of exceptional care to patients.
The table shows how TCB model is applied in LFH divided into three for better illustration.Principles of Team-Based Health CareShared GoalsThe healthcare providers work hand in hand to create shared goals that will benefit the patients' recovery in a systematic and ideal manner. In LFH, our primary goal is to take care of patients who are discharged from one of the HMC COVID-19 facilities. The criteria for admission to the field hospital are ambulatory adult patients, without any comorbidities or complications. Essential care is continued by appropriate health education along with proper isolation before the patient is sent home that will prepare them to be more aware and adhere the precautionary measures to avoid further spread and resurgence of the virus.
The LFH clinical leadership, with endorsement from the corporately based System Wide Incident Command Center (SWICC), formulated a process to implement this principle and achieve the goal. Upon admission of COVID-19 ambulatory patients, a comprehensive assessment and plan of care are performed in a quick, systematic manner. Electronic Medical Record or EMR and telecommunication are utilized for communicating and assessing patients' needs to continue to conserve the use of Personal Protective Equipment (PPE) while minimizing the exposure of health care professionals (HCP) to ambulatory COVID-19 patients. Whenever a patient needs further assessment, full PPE is worn by a healthcare provider.
Guided by the principles of the Center for Disease Control and Prevention, the Ministry of Public Health and HMC Corporate Infection Prevention and Control guidelines, the LFH team developed strategies to identify and extend PPE supplies. Before carrying out outpatient care activities, health care workers are trained on the proper donning and doffing techniques, PPE optimization strategies such as extended use of PPE, limiting patient and staff face to face encounters, clustering patient care and assigning zones for staff to wear full PPE and standard PPE. Health education is given during admission and before discharge on how to follow home quarantine.
Since the facility has a multinational staff, those with the same language preference of the patient is used for better and easier understanding. In terms of healthcare providers' improvement, a weekly meeting is regularly scheduled.
Clear Roles and Teamwork:
HCPs have different capabilities and expertise; by identifying and utilizing each team member’s recent experience and knowledge as well as their limitations, this helps in assigning their responsibilities more effectively. For instance, HMC surgical unit nursing staff is more experienced in doing Cerner Powerchart documentation. In contrast, HMC NCCR staff nurses are experts in intravenous insertion and blood extraction. Experienced staff will be the lead on the delegated task. Other staff, particularly inexperienced colleagues, will serve as their buddy/assistant until everyone is competent enough to do the job independently. By following this principle, errors and miscommunication will be reduced.
Mutual Trust:
When HCWs know the importance of integrity and collaboration, the working environment will benefit patients and staff alike. Sharing ideas to achieve the main objective is appreciated by everyone regardless of the position, race, or nationality of the individual healthcare provider.
Effective Communication:World Health Organization recognizes inter-professional collaboration in education and practice as an innovative strategy that will play an essential role in mitigating the global health crisis. Constant discussion and proper handover will improve staff ability to establish interpersonal connections and maintain transparency among all team members.
Moreover, improve effective communication is also one of the international patient safety goals of Joint Commission International, to promote the highest possible quality of care. In LFH, a routine huddle is implemented through in-person briefings and using telecommunication applications. A briefing before the shift and debriefing after is a routine in the facility. Usage of SBAR (Situation, Background, Assessment, Recommendation) communication is used when inputting patient data.
Measurable Process and Outcome:
Source: Data from the World Health Organization and the Ministry of Public Health Qatar.
Where are we know and what is it for the future
According to the World Health Organization (WHO) and the Ministry of Public Health (MOPH), as of June 16, 2020, the total number of current active cases in Qatar is 21,536. Moreover, the total number of recovered instances in one month from May 15 – June 15, 2020, is 54,515.
Clearly, education and experience of each professional from different specialties played a huge factor in contributing to the positive outcomes and success that happened in LFH over the past first few weeks. This is because of the combined knowledge of each team member, excellent teamwork and mutual trust. In addition, each team member is highly motivated and took this situation as a learning opportunity to acquire new knowledge and skills in treating an unfamiliar disease. Hence, the TBC approach is an ideal system to utilize in a pandemic setting in order to cope with the increasing number of cases and to meet the demands of this continuous medical challenge.
As of today, June 16, 2020 (LFH) has taken care of 919 COVID-19 patients and discharge 636 recovered patients to their home. It has achieved great success since its establishment and is still committed to the ongoing efforts in containing and treating people affected by the virus. In the future, the staff trained in LFH, and similar facilities in Qatar, will support better outcomes in managing emerging diseases and other possible outbreaks in the country.
References:
World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [ last accessed March 2020]
Ministry of Public Health. Coronavirus Disease, 2019 9COVID- 19). 2020.
https://covid19.moph.gov.qa/EN/Pages/Newsv1.aspx?newsid=52 [ last accessed June 2020]
Saleem F. Qatar opens a 504-bed field hospital to treat Covid-19 patients. The Peninsula, Qatar's Daily Newspaper. 2020.
https://www.thepeninsulaqatar.com/article/13/05/2020/Qatar-opens-504-bed-field-hospital-to-treat-Covid-19-patients [ last accessed June 2020]
S. Heath. How to Use Team-Based care to Improve the Patient Experience. Patient Satisfaction News. Patient Engagement Hit. xtelligent healthcare media. 2020.
https://patientengagementhit.com/news/how-to-use-team-based-care-to-improve-the-patient-experience
[last accessed June 2020]
Matthew D. M., and Eileen T. L. Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context. National Institute of Health Public Access. 2011.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998339/ [ last accessed June 2020]
Centers for Disease Control and Prevention. (2020, May 18).” Strategies to Optimize the Supply of PPE and Equipment”. CDC: Coronavirus Disease COVID-19.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy [last accessed June 2020]
Centers for Disease Control and Prevention. (2019 March 20) “1918 Pandemic (H1N1 virus)
https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html [last accessed June 2020]
