Recommendations in covid-19 times: a view for home care

Abstract

Home care stands out from the technical-scientific knowledge learned during the training of nursing professionals, as entering someone's home and developing care actions requires much more than knowing and acting. Because care is carried out in at the patient and his family's environment, and the health professional is a mere guest(4). For those with mild illness, hospitalization may not be necessary or may not be possible due to the overcrowded health system, unless there is concern about the fast worsening of the condition. [...]if there are patients with mild illness, the care at home can be considered, as long as they can be followed-up and treated by family members and health professionals respectively. In any of these situations, patients with mild symptoms and without chronic conditions, such as: pulmonary or heart disease, kidney failure or immunocompromised conditions that subject the patient at increased risk of developing complications, can be treated at home. Recommendation for home nursing care in cases of COVID-19 In cases where care should be provided at home, if possible, the nurse should assess to check if the home environment is adequate for the continuity of care; the health professional should assess whether the patient and family can adhere to the recommended precautions as part of the isolation of home care (for example, hand hygiene, respiratory hygiene, cleanliness of the environment, movement limitations around or at home) and if safety issues can be addressed (for example, accidental ingestion and fire risks associated with the use of alcohol-based friction)5.

Headnote

ABSTRACT

Objective: To suggest recommendations for the practice of Home Nursing in the context of COVID-19. Method: Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. Results: Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. Final considerations: the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.

Descriptors: SARS Virus; Homebound Persons; Home Health Nursing; Home Care Services; Delivery of Health Care.

RESUMO

Objetivo: Propor recomendaçöes para a prática de enfermagem domiciliar no contexto da COVID-19. Método: Estudo reflexivo, produzido com base em leituras correlacionadas com a área temática, disponíveis em diretrizes atuais da Organizaçâo Pan-Americana da Saúde, Organizaçâo Mundial da Saúde e Ministério da Saúde. Resultados: Foram construidas recomendaçöes segundo evidencias científicas atuais para prevençâo de infecçöes, controle de epidemias e pandemias no contexto domiciliar brasileiro. Considera&ecedil;oes finais: As reflexöes realizadas contribuem para nortear açöes com vistas a uma melhor assistencia ao paciente, familiares cuidadores e comunidade na perspectiva de um cuidado domiciliar seguro em relaçâo â COVID-19; se caracterizam como uma discussáo inicial sobre o tema, estimulando que novos estudos sejam realizados com base na evoluçâo do cenário atual.

Descritores: Vírus da SARS; Pacientes Domiciliares; Enfermagem Domiciliar; Serviços de Assistencia Domiciliar; Assistencia â Saúde.

RESUMEN

Objetivo: Proponer recomendaciones para la práctica de enfermería domiciliaria en el contexto de la COVID-19. Método: Estudio reflexivo, producido a partir de lecturas relacionadas con el área temática, disponibles en directrices actuales de la Organización Panamericana de la Salud, Organización Mundial de la Salud y Ministerio de la Salud. Resultados: Han sido construidas recomendaciones a partir de evidencias científicas actuales para prevención de infecciones, control de epidemias y pandemias en el contexto domiciliario brasileño. Conclusiones: Las reflexiones realizadas contribuyen para orientar acciones con vistas a una mejor asistencia al paciente, familiares cuidadores y comunidad en la perspectiva de una atención domiciliaria segura en relación a la COVID-19; se caracterizan como una discusión inicial sobre el tema, estimulando que nuevos estudios sean realizados a partir de la evolución del escenario actual.

Descriptores: Virus del SARS; Pacientes Domiciliares; Enfermería Domiciliar; Servicios de Asistencia Domiciliaria; Asistencia a la Salud.

INTRODUCTION

At the end of December 2019, the first cases of the disease called COVID-19, caused by the SARS-CoV-2 virus, were recorded in Wuhan province, China(1), from that moment the numbers of infected people increased and spread to all continents, but only on March 11th, 2020, COVID-19 was defined by the World Health Organization (WHO) as a pandemic.

Since then, health institutions around the world and nursing services have been under continuous pressure against a potentially fatal respiratory disease, but it is still uncertain, as so far there is no specific vaccine or treatment against the virus, so quarantine and social isolation have been the measure taken by several countries in an attempt to reduce transmission.

The role of nurses and other professionals goes beyond hospital environments, many of them work in the homes of patients, and in this health scenario, home patients are usually those with acute, chronic, unstable, in palliative care, with respiratory syndromes, neurological, hypertensive, diabetic disorders, and are also susceptible to the SARS-CoV-2 virus(3).

Home care stands out from the technical-scientific knowledge learned during the training of nursing professionals, as entering someone's home and developing care actions requires much more than knowing and acting. Because care is carried out in at the patient and his family's environment, and the health professional is a mere guest(4).

The home is the place of care, it is in this environment that relationships are built and strengthened, beliefs, values, habits and traditions are considered and discussed in the planning of actions, as the home scenario influences and affects the recovery and health of the patient(4).

The care provided by nurses at home, even if considered relevant, is still incipient given the specificity of the current scenario. It is considered that studies addressing the theme of COVID-19 at home can be identified5. However, currently, there are no specific norms, policies, or scientific consensus on the description and recommendation of nursing care at home for COVID-19, thus showing a knowledge gap.

In this perspective, this theoretical-reflective essay was developed from readings associated with the theme, having as the main sources materials produced by the World Health Organization, Pan American Health Organization, and Ministry of Health. These documents were developed from previous and current guidelines with the best scientific evidence for preventing infections, controlling epidemics and pandemics.

OBJECTIVE

To suggest recommendations for the practice of Home Nursing in the context of COVID-19.

Home nursing practice and COVID-19

The WHO recommends that all people suspected of having COVID-19 with severe acute respiratory infection be screened at the first contact with the health system and that emergency treatment be started based on the severity of the disease. It also recommended that all cases confirmed in the laboratory be isolated and treated in a health facility5.

The WHO, later, updated the treatment guidelines for patients with Acute Respiratory Infection associated with the SARS-CoV-2 virus including guidelines for vulnerable populations (for example, the elderly, pregnant women and children). In occasions where isolation in a health facility from all cases is not possible, WHO emphasizes prioritizing those most likely to have poor results: patients with severe and critical illnesses and those with mild illness and risk of poor outcome (age > 60 years, cases with comorbidities, for example, chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer)6).

If all mild cases cannot be isolated in health institutions, those with mild illness and without risk factors may be isolated in nontraditional units, such as reused hotels, stadiums or gyms, where they can remain until symptoms disappear and laboratory tests for the COVID-19 virus are negative. Alternatively, patients with mild illness and without risk factors can be managed at home5-6).

For those with mild illness, hospitalization may not be necessary or may not be possible due to the overcrowded health system, unless there is concern about the fast worsening of the condition. Thus, if there are patients with mild illness, the care at home can be considered, as long as they can be followed-up and treated by family members and health professionals respectively.

Home care can also be considered when hospital care is not available or is unsafe (for example, size is limited and resources are unable to meet the demand for health services). In any of these situations, patients with mild symptoms and without chronic conditions, such as: pulmonary or heart disease, kidney failure or immunocompromised conditions that subject the patient at increased risk of developing complications, can be treated at home. This decision requires careful clinical judgment by the multi-professional team and must involve an assessment of the safety of the patient's home environment for continuity of care(5).

Recommendation for home nursing care in cases of COVID-19

In cases where care should be provided at home, if possible, the nurse should assess to check if the home environment is adequate for the continuity of care; the health professional should assess whether the patient and family can adhere to the recommended precautions as part of the isolation of home care (for example, hand hygiene, respiratory hygiene, cleanliness of the environment, movement limitations around or at home) and if safety issues can be addressed (for example, accidental ingestion and fire risks associated with the use of alcohol-based friction)5.

If and whenever possible, a communication link with the nurse or the health team, or both, must be established during the period of home care, that is, until the patient's symptoms have completely disappeared. But comprehensive information about COVID-19 and its transmission is needed to define the length of isolation precautions at home. Patients and family members should be informed about personal hygiene, basic prevention and infection control measures so that they can care as safely as possible for the person suspected of having COVID-19 to prevent the infection from spreading to family contacts5. The patient and family members should receive ongoing support and education, and monitoring should continue during home care. Nurses should guide patients and family members to follow the recommendations explained in Charts 1 and 2 respectively.

The nurse, when preparing for home care, must select the necessary materials, must carry out a risk assessment to choose the appropriate personal protective equipment, and in this case follow the recommendations for contact precautions and droplets, and others as explained in Chart 3.

FINAL CONSIDERATIONS

This reflection aimed to suggest recommendations based on recent evidence to guide nurses work in home care with prevention and infection control in confirmed or suspected patients with COVID-19.

It is hoped that these guidelines will promote practical strategies for home nursing care with people and communities, aiming to expand the engagement and attitude in the search for better resolution of cases and situations of health risk in their real and potential scenarios.

It is believed that the recommendations now made can contribute to the expansion of discussions on home nursing care in the context of COVID-19, also, to guide actions to improve care about the safe care of the patient, family and territory.

Thus, this study is characterized as an initial step in the discussion of home care and COVID-19, it may offer subsidies for new reflections that promote and better elucidate the contributions of nursing from the advance in the world and Brazilian scenario, contributing to teaching and research.

As a limitation, these guidelines involve the need to adapt the political, social and professional structures, so that the professional can exercise, incorporate and implement such practices.

Sidebar

How to cite this article:

Tonin L, Lacerda MR, Caceres NTG, Hermann AP. Recommendations in covid-19 times: a view for home care. Rev Bras Enferm. 2020;73(Suppl 2):e20200310. doi: http://dx.doi.org/10.1590/0034-7167-2020-0310

Corresponding author:

Luana Tonin

E-mail: [email protected]

EDITOR IN CHIEF: Dulce Aparecida Barbosa

ASSOCIATE EDITOR: Antonio José de Almeida Filho

Submission: 04-18-2020 Approval: 04-21-2020

References

REFERENCES

1. Ministério da Saúde (BR). O que é coronavírus? [Internet]. Brasília (DF): Ministério da Saúde; 2020 [cited 2020 Apr 05]. Available from: https:// www.saude.gov.br/o-ministro/746-saude-de-a-a-z/46490-novo-coronavirus-o-que-e-causas-sintomas-tratamento-e-prevencao-3

2. Organizaçâo Pan-Americana da Saúde (BR). Folha informativa - COVID-19 (doença causada pelo novo coronavírus) [Internet]. Brasilia (DF): OPAS; 2020 [cited 2020 Apr 05]. Available from: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6101:covid19&Itemid=875

3. World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: Interim guidance, 17 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/publicationsdetail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

4. Lacerda MR. Brevidades sobre o cuidado domiciliar. Rev Enferm UFSM [Internet]. 2015 [cited 2020 Apr 15];5(2):1-2. Available from: https:// periodicos.ufsm.br/reufsm/article/view/18657/pdf

5. World Health Organization. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance [Internet]. Geneva: World Health Organization; 2018 [cited 2020 Jan 26]. Available from: https://apps.who.int/iris/handle/10665/272948

6. World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care [Internet]. Geneva: World Health Organization; 2014 [cited 2020 Jan 26]. Available from: https://www.who.int/csr/bioriskreduction/ infection_control/publication/en/

7. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance, 13 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 17]. Available from: https://www.who.int/ publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected

8. World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge [Internet]. Geneva: World Health Organization; 2009[cited 2020 Jan 20]. Available from: https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_ summary.pdf

9. World Health Organization. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance, 31 January 2020 [Internet]. Geneva: World Health Organization; 2020[cited 2020 Mar 17]. Available from: https://apps.who.int/iris/handle/10665/330857