"Patients in ICU are a stark reminder of the ferocity of Covid-19" - Naas nurse speaks about life on the frontline

Senan Hogan

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Senan Hogan

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editor@kildarepost.com

"Patients in ICU are a stark reminder of the ferocity of Covid-19" - Naas nurse speaks about life on the frontline

Theresa Dixon, assistant director of nursing in the Intensive Care Unit of Naas Hospital

A long-serving nurse at Naas General Hospital has given a vivid and inspirational account of her part in the daily battle against Covid-19 at Naas Hospital.

Kildare currently has the second highest infection rate after Dublin and there are several patients with the virus at Naas Hospital.

Theresa Dixon, assistant director of nursing in the intensive care unit, also issued a ‘plea’ to people to continue to comply with restrictions.

Here is Theresa's account of a day in her life: 


My name is Theresa Dixon.
I am a senior nurse at Naas General Hospital, having worked in the hospital for almost 37 years.
I have been employed as assistant director of nursing on night duty since October 2018, prior to which I was clinical nurse manager in intensive care for 16 years.
I have chosen to return to work in intensive care for the duration of the pandemic facilitated by the assistance of my colleagues in nursing administration.
I am proud to be able to utilise my knowledge and skills to assist my patients and my colleagues during these challenging times and I would not wish to be anywhere else right now.
My day begins at 6.30am preparing for an 11.5 hour shift in ICU.
Following breakfast, I set off with a bag packed to include a second set of nursing scrubs which I will change midway through my shift.
I have my temperature recorded on entry to the hospital, greeting my colleagues on the way while maintaining social distancing and enter the ICU to don the new ICU uniform of PPE suits, gowns, gloves, goggles and visors before the day shift starts at 7.45am.
This is a constant reminder of the reality of Covid-19 and a measure of how dangerous this virus can be.
Our hospital has prepared well for Covid-19 and to date we are grateful that we have access to proper PPE and robust PPE training.
As a manager in ICU, it is my responsibility to ensure that staff have adequate PPE and I do a daily stock check and advise our Covid-19 stores co-ordinator of requirements.
We are also extremely grateful to Heroes Aid, who through GoFundMe.com me donations, have augmented our supplies of vital PPE.
Staff patient allocation is prepared in advance with each patient requiring 1:1 nursing care.
All patients admitted to the ICU are critically ill.
The course of the illness is unpredictable and the patient’s condition can deteriorate rapidly.
As an ICU nurse, I carry out a full clinical assessment at the start of the shift noting the improvement or dis-improvement in the patients’ conditions and preparing a plan of care for the day.
The ICU nurse is present at the bedside for the duration of the shift, relieved only for meal/toilet breaks and is monitoring the patient minute-by-minute, hour-by-hour, delivering evidence-based life-saving interventions to their patient throughout the shift.
I assess the patient’s breathing making changes to the ventilator based on assessment and blood test results.
I also assess cardiac function based on continuous monitoring of blood pressure and ECG recording and medications are delivered accordingly.
Anaesthetic and medical rounds take place in the morning, following daily portable chest x-rays and interventions.
Attention to patient’s personal hygiene is an especially important part of our care, delivering oral and eye care and attention to pressure area care ensuring that the patient’s comfort needs are met.
As an ICU nurse, I work as part of a team of professionals including the doctors, physiotherapist, dietician, occupational therapist, pharmacist, pastoral care, health care assistants, household staff, attendants and secretarial staff.
Each professional plays a significant role in the patient's journey through ICU.
In line with international best practice, many of our patients are now nursed in a prone position (face downwards) in intensive care.
Each patient is turned prone at approximately 4pm and remains in this position for 16 hours.
The patient is then reversed into the supine position (on back) at around 8am.
This is a challenging and labour-intensive procedure and requires the presence of at least five people to turn the patient, who is on a ventilator.
At 10.30am, it is vitally important that the ICU nurse is facilitated to take a break from the bedside.
I relieve my ICU colleagues ensuring that adequate numbers of ICU trained nurses are present in the Unit at all times.
It is extremely difficult to work while wearing the suits/ gowns now required as part of our uniform.
The current warm weather has exacerbated the situation and staff can become hot and dehydrated.
Removing the PPE on exiting the patient zone is carried out with extreme care to minimise the potential for contamination.
We apply cream to our nose and face areas which become very sore from wearing the face masks.
Chats with colleagues in the coffee shop or corridors is a thing of the past as we practice social distancing and minimise the time spent in conversation.
After a quick break I don the PPE and return to the patient’s bedside.
The daily life of the ICU nurse has significantly altered in response to Covid-19.
Each day, as nurses in Naas General Hospital, we are both personally and professionally affected by the challenges presented by Covid-19. The biggest challenge is to ensure that patients and staff are safe.
The intensive care unit, like all ICU units in the country, has increased capacity in preparation for the admission of critically ill patients affected by
Covid-19.
We have ICU patients being nursed off-site in the recovery area of theatre adjacent to the ICU Unit.
In response to the extra demands and challenges as a result of Covid-19, staff from all disciplines in the hospital have proactively and collectively stepped up to the challenges.
Many nurses have redeployed from their current roles and have trained to support the ICU nurses and for this we are forever grateful.
Equally, Allied Health Professionals have contributed to reducing the workload of the ICU nursing staff.
It is humbling but not surprising to witness the collective response from all our colleagues, without whom we would be lost.
Our meal breaks are the only breaks we get during our long 11.5 hour shifts.
My colleagues and I are extremely grateful to the public for the display of support for the frontline staff during this pandemic.
The constant and welcome supply of food, gifts and messages of support and thanks will be forever embedded in my memory.
During my break I take the opportunity to change my scrubs and to link in with my daughter who lives in Malaysia and to check up on my mother who is in her 98th year and living at home.
Between 2pm and 8.15pm the long shift comprises of intensive assessment planning and evaluation of the patients' status.
As an ICU manager, along with my colleagues, I deal with internal transfers of the patient to CT and external transfers to other hospitals.
Our patients cannot see our faces and verbal communication, encouragement and positive re-enforcement are hugely important.
One of the biggest challenges for our patients and staff is having no family members present.
There is an eerie silence in the corridors of the hospital with no evidence of visitors.
We are constantly reminded of the daily national death count.
Behind each number is a grieving family.
Prior to Covid-19, ICU nurses would constantly communicate face to face with family members and end-of-life care with family involvement was a hugely important component of care.
We now interact with family members over the phone and are acutely aware of the grief and torment suffered by family members, separated from their loved ones during illness and death.
This is not normal practice and we do our best to allay the fears and anxieties of our patients and their loved ones during this awful time.
At the end of our 11.5 hour shift I remove my PPE, otherwise called ‘doffing’, and shower before I leave ICU to return home.
My ICU scrubs are placed in a bag to be washed at a minimum temperature of 60C.
The steering wheel and door handles of the car are cleaned when I reach home.
On arrival home I immediately shower again before I meet with family members.
I am hugely concerned about passing on the virus to family members, ‘bringing the virus home.’
Hand sanitising gels are visible throughout the house and compliance with social distancing rules are maintained as appropriate.
It is difficult to switch off even on my day off as I feel compelled to listen to the news for updates on new cases and daily death rate figures.
The only solace is a walk with my dog in the countryside within my 2 km radius.
There I take time to appreciate the calm of nature, listening to bird song and watching the little lambs playing and squirrels scurrying up the trees.
The patients occupying the beds in our ICU are a stark reminder of the ferocity of Covid-19. I am grateful and proud of our government and the Department of Health for their management to date of Covid-19. I am also proud of the citizens of this state who have complied with the restrictions and helped to flatten the curve. My plea is that we must continue to comply with frequent hand washing, the rules of respiratory coughing and sneezing etiquette and maintenance of social distancing and together we will beat this.
Thank you so much.