As ICU beds filled with COVID-19 patients last spring, hospitals learned that very sick patients were able to breathe better when they were flipped onto their stomachs. This positioning, called proning, has been used for decades to improve clinical outcomes for those suffering from acute respiratory distress syndrome (ARDS), the lung condition that patients with severe COVID-19 cases develop.
Proning for ARDS was first described in 1976 in an article published in the journal
Critical Care Medicine by ICU nurse Margaret Piehl and physician Robert Brown. As a fellow nurse, it’s not surprising to me to learn that a nurse helped pioneer and gain acceptance for this lifesaving procedure.
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The COVID pandemic has made it abundantly clear how important nurses are to our healthcare system. They have heroically cared for patients and have rapidly integrated new knowledge on the disease into the care they provide. Some nurses are also generating new knowledge through research—whether they run clinical trials as clinical research nurses, or lead their own research programs studying topics from metabolic disease to dementia to symptom science.
But the truth is that all nurses are scientists.
To become a nurse, you don’t just learn human anatomy. The required prerequisites for nursing education are science courses, from high school to nursing school, where future nurses learn chemistry, microbiology, physics, genetics, pharmacology and pathophysiology. This foundation of science enables them to apply their knowledge to the complexities of caring for people.
Take ICU nurses, who have been on the front lines caring for critically ill COVID-19 patients. They have gotten where they are not only for their care and compassion, but for their science training and acumen in managing the complexity of a patient's illness.
Besides holding a patient’s hand, communicating with patients and families, bathing and comforting, ICU nurses are assessing and adjusting intravenous fluids, medications and oxygen levels that inform how to keep the patient in pH balance, oxygenated correctly and at the appropriate cognitive level for their recovery. They do this with knowledge and skills in assessing and monitoring electrocardiograms, arterial blood gases (oxygen, carbon dioxide and pH), managing ventilator settings and observing body responses that include fluid retention, skin color, vital signs, lung and heart sounds and brain cognition.
Adam Hadas, a critical care nurse in New York City, integrates science into his nursing practice every day. During the height of the COVID-19 pandemic in New York, he was redeployed to work in various hospital units, including a COVID-19 ICU. Along with the rest of the scientific, medical and nursing communities, he engaged in rapid information sharing to hone his response to this awful disease, poring through journal articles and resources from organizations like the American Association of Critical Care Nurses and the Society of Critical Care Medicine. New knowledge about how COVID-19 affects the lungs had a direct impact on how ventilators were used in care. Hadas also regularly turns to resuscitation science in his emergency response work; through rigorous study, scientists have developed algorithms to achieve the highest survival rates for people experiencing cardiac arrest. Nurses’ understanding and deploying resuscitation science saves lives.
Nurses do this all simultaneously with appreciating and acting on what we in nursing call “the human response to illness” and helping patients recover. They do this with strong collaboration skills and with a team of providers, yet nurses are often the implementers of team decisions, given their presence at the bedside 24 hours a day. Nurses communicate across the 24-hour cycle with one another using a systematic and organizational plan so that no gaps in care occur and that a trajectory of recovery or humane end-of-life experience takes place.
It is difficult to fathom how all of this happens in the ICU or in a community setting, but it does—and this is what the mechanics of nursing look like, how it works and how we prepare those who endeavor to become nurses. Their foundation of scientific knowledge enables them to provide the care that so many of us applauded every evening last spring. Perhaps this is why nurses have once again been ranked the most trusted profession.
This is an opinion and analysis article.
