COVID HELP by Dr Kiran Dintyala

So let me check if everybody have muted themselves so that there is no just Benz. Yes, We are live, right?

Okay, that's great. So good evening everyone to those in India, and good morning to those people in America. As you all know, we have been doing these sessions every day for the past almost a month now to help people fight Covid. It is not simply about fighting. Covid is actually about fighting the misinformation that is in the society. And about COVID Because what's happening is a lot of people, because of the negative news cycle being constantly run in the news media, they're getting so fearful, stressful, worried. Apart from all of the stress caused by Covid. So how can we educate people with the right information? How can we keep their hopes up? How can we help them feel positive in the midst of pandemic? Yes, how to feel positive. I know it's not easy, but how can you do that? So that is what we have been trying to do the past few weeks in these live zoom sessions. And every day we have been talking about various topics about treatment, about mental health, about vaccination, steroids, and many other things. So today, I'm very much pleased to welcome my colleague, my friend and nursing program coordinator at Eisenhower Health, Ms. Doris Velasquez, who has been phenomenal, actually, because when I interacted with her last year, around this time, I think August, September, I think, yeah, almost a year ago, in the midst of a terrible wave of COVID when there were new residents, nurse residents, who just started their program, and then also new residents who just graduated and then pushed into this COVID wave in taking care of the patients. And even experienced nurses, experienced doctors, were having so much trouble. So Doris has witnessed all that and was working with them closely to help them do well, cope with the stress, protect themselves, protect the patients. So she has done a phenomenal job. And we would like to definitely glean from her experiences how she handled it. And what is the message for the nurses in India, Doris, with that, please, if you have anything that you want to comment on to start with, please go ahead.

Sure. Can you hear me?

Yes, I can hear you, Doris.

Great. It was definitely an experience, I can say, because no one would have predicted that specific thing in 2020. At that time, we had a cohort of 16, 16. And we were getting ready to onboard a new group. Those 16 came along when there was no Covid. It was quite a transition for them. And again, not only that, everybody in general, the entire medical staff was learning how to cope. We were learning as we Were going along in the progress of that. It was very difficult. Those 17 nurse residents got to see firsthand. I'm sorry. The 16 got to see firsthand of all that came into the making. As things were coming along. As things were. Things were constantly changing. CDC guidelines, the PPE factor, the treatments and everything else. As that progressed, they had to adapt to the changes. The initiation of COVID units was very difficult for many of them to handle. And we as educators provided as much support as we could. One on one support. One of the things that we did for. For this particular group that was pretty helpful was not only having that one on one support, that rounding that we do on them as educators to ensure that they're coming along okay is we also gave them the opportunity to reflect on their experience. So we do what's called the COVID 19 reflection of the nurse in the front lines. It's pretty much them being able to write freely, express themselves through words of how they feel, how the COVID is impacting them personally, professionally, what are the fears? What are the fears for their family, how they're coping with the changes that are happening in the environment in and outside of the hospital. That in a sense was a pretty good experience for them to help.

Tap.

What they were feeling internally and put it on paper. And so those stories we've collected and we've done that with every group that has come thereafter, it's been pretty helpful. We also talk about it openly during our seminars. Every month we meet and we can talk about what's happening. And even though there's been a lot of positive change over the last year, I think it's been very beneficial for them because they're coming into this Covid now. We had those 16 that started back in the fall of 2019. Then we had a group that we picked up in the summer of 2020. So that group came straight into everything that was happening. There were the fresh graduates. Then we picked up another group in the fall, right before the large Covid surge that we had in December and January. So it was very difficult times. Right now we have over 70 residents in the house. And it's very difficult, but it's one of the things that we do right from the get go to allow them to express themselves, not only providing that support when we meet face to face, but also giving them the opportunity to express their feelings through their writings. The reflection journaling has really helped as well.

When you mentioned about the reflection journal, Doris. I was speaking to Doris a couple of days ago, and when she mentioned about the reflection journal. I really love that idea because when you write things, whatever your feelings are, whatever you're going through, it helps you get out that emotion, isn't it, Doris?

I think it really does help. Yes, of course. It's just like writing a journal. Like a diary.

Like a diary. Right. So getting out that emotion. And also it helps you reflect what happened. Because in the process of writing, your brain just can't go wherever it wants. It has to focus. You know, when you're thinking about it, it goes to this and then goes to that, it goes that. So there is no proper unifying experience when you are just thinking. But actually when you write, you're forcing your brain to come to this moment of awareness and then concentrate and then reflect, oh, this is what happened. And then, oh, wait, because when you had to write, you had to think about it properly. You just can't scribble whatever you want. Right, right. That's a very good experience.

Yeah, it helps put things into perspective. I mean, because you can recount things, the experiences. Again, when all of this started back In March of 2020, we had those graduate nurses that were coming out, working on their own independently, after their preceptorship. So now they were thrown into the mix of things and. And it was very overwhelming. It really was. And everybody was learning, not only the new nurse. I mean, the experienced nurses as well, were coming along together and going through just a variety of emotions. And it was very difficult. And I think you had to lean on each other for support. And we, as educators, we round on the nurse residents to ensure that they're coming along okay. And Covid posed a lot of challenges. Again, as units were being converted over to full Covid units, the fear and anxiety was setting in everyone. So it was difficult times. And again, as things started to progress throughout the year and we gained additional residents, we learned with the first group, and we provided that additional support and reflective exercises to ensure that we kept on with what was positive. I think they really benefited from it. We were able to have open discussions on it in our seminars. And it just made for a much more conducive group to be able to share. And we were all in this together.

Doris, when you have so many people, patients getting infected and they are in fear, the family members severe anxiety. And of course, the nurses themselves are anxious and worried about what is going to happen to them as well as to the patients. How did you guys handle it? What's your advice? If, let's say in India right now, there is a Big wave of COVID people are dying everywhere. And then those who are brought to the hospital, they're trying to do their best. What would be your advice on how to handle this fear and anxiety?

I think what we need to do is really think about why we came into the profession to begin with. Nursing is a unique profession. We come into it because we want to care for others. It's within us. And although it's posed some challenges, Covid has poses challenges with the potential of infection, bundling care, limiting the time that we spend with patients. I always say to the nurse resident, and I myself worked on the floor during the COVID surge and is trying to do everything in your power to make a connection with the patient, despite the gear, despite the Shield, despite the N95 mask or any specific, you know, gear that you have, you know, on you. I think it's important to. When you step into that room, to work with that patient is to see the whole patient, the individual, and make a connection, make that specific. Whatever it is, whether you're administering a drug or doing a treatment, changing and dressing, whatever the situation is, making that connection meaningful, connecting with that patient, despite what is happening, because it is important. These patients are isolated, they're fearful, they have anxiety, and we, of course, do not want to contract it. But we need to look beyond that and do everything in our power to look at that patient and connect at that moment and make that exchange meaningful. Because we teach that regardless, regardless if there's no Covid, if there was no Covid whatsoever, you always want to try to make every patient interaction meaningful because they're people.

Absolutely. I mean, that is a very powerful point. Everyone listening to this one, make a note of that, making that connection. And it is so hard to make that connection in the midst of this COVID pandemic, because normally you would go, you don't have a mask. They can see your face. You can see their face, and then they can understand you clearly when you're not wearing the mask. A lot of time, I myself, when I went into patient's room and I was wearing the mask and gowned up, they can't hear me properly, you know, and we need to speak out loud. And then sometimes we have these machines in the room that suck out the air, you know, in the. What is it? Negative pressure rooms. So ICUs. And you can't hear what they're saying, and they can't hear what you're saying. It's very difficult. And then you can't even touch them when you can. But you know, we don't really touch patients the way that we used to touch is a very powerful form of reassurance. You're just putting your hand on their shoulder, on their hand, and just that. And then couple of kind words makes a huge difference to make that connection, even in the midst of COVID Yes, it is difficult, but just a couple of kind words and if you are wearing everything, just a tap on their shoulder, just hold them for a second and say, we are here for you. I know it is difficult.

I'm so sorry. I'd like to say that again. Having done it myself, is just being able to look beyond the situation. And you're stepping into that room to take a blood sugar or administer a medication, look in the room, see what you identify that the patient has, make that connection. Even you have your gloved hands, you can still make a touch towards the patient. That's one of the hardest things that the nurses have expressed to me about not being able to touch the patient and provide the care that we're used to, the care that we learn in nursing school, to be able to connect with the whole patient. The power of touch is so important. But again, we can still do it. We just have gloved hands.

Exactly. I mean, that is very powerful what you said, Doris, again, because Covid doesn't really spread so much by just touching people, especially if you're wearing the gloves. In my experience, seeing hundreds of patients, I can tell you this much. It predominantly spreads when someone has a respiratory disease with COVID and they're coughing, and then you are not wearing the mask, you're not taking any precaution, and it's just not one time cough, but you are with them constantly without ppe. So what I noticed is mostly in families in friends groups where they were not taking precaution. Okay. And then one got it, and then everyone else gets it. That is what I noticed predominantly. My mother had it, now I have it. My husband had. I got it. So family members, you know, I have a close friend and we have been hanging out together. I got it. These are the stories I constantly heard. Now, there are so many doctors and nurses involved in this entire COVID pandemic. Yes, some of them are infected. I'm not saying no one got infected, but Most of them, 95, even 99% of us who are wearing the masks, taking precautions, we did not get infected, you know, I think so. Yes, it is important to wear the ppe. Yes, it is important to be very cautious because. But just because of that, do not Abandon your patient completely. What you need to do is do your best with the gear that you have, whatever you could to make connection. And it's just not about touching. Maybe you saw something in the room, like Doris said, that, oh, I could talk about this for a second. Something personal, you know, or there's some family member called, and then you have taken the phone call from a family member. You can relate to them in a very nice way. So. Yes, Doris, go ahead.

No, I apologize, Dr. Dantalia. I was going to say that also, I'd say, you know, being able to, you know, look at them. Give them the opportunity. Give them the opportunity to say how they feel. Let them express themselves to you. Yeah, I know that they recommend the limits limit the time you spend with the patient. But again, those few moments can be made meaningful by providing that opportunity for them to speak. Because sometimes, well, usually with isolated patients, they can't have any visitors. And so you're the only contact that they have. So at that moment, when you step in the room to try to connect with the individual and have them converse, they want to be heard, they want to be treated as individuals, and it's so important to make the time to do that. Then, of course, when you are done with your activity, you have to leave the room and exit. But it's just a matter of making every effort possible to connect with that individual. Because you don't know when we'll be the next time that you come back in. Right. Or at this point now with COVID patients, we don't allow any visitors still for those COVID patients, But again, it may be a while before they get a call from their family. So it is important for us. We're the only people that they're allowed to see to make every effort to connect, whether it be eye to eye, giving them the opportunity to speak to you, giving them an opportunity. Opportunity to sit up, do an activity, or however it is important. I remember going into many rooms and being able to see any photos or items that they had around their room and start talking about that. And again, they noticed. And of course, we started a little conversation. That's important because, again, they feel isolated, they feel alone. So we have to do what we can to make them feel good about themselves and that they're human beings, that we're there to support them and care for them to the best of our ability.

Yes, Doris. And you know, yes, that is all true. But how can nurses do that when they themselves are in so much fear, anxiety, worry? How do we handle that, like, how can nurses take care of themselves in the midst of this craziness that they are seeing every day? And it's so difficult, so many patients, and the normal nursing workflow itself is difficult. And now all of a sudden you need to wear all this gear and then go in and come out. That makes it much more difficult, time consuming. And so how do the nurses take care of themselves and get their fears under control, how to calm themselves?

We've done a lot of activities for the nurse residents to really search within to find ways to manage their stress levels and come prepared to work, obviously. And it is difficult because, again, the fear and anxiety. Just yesterday we had our brand new group of nurses. They started three weeks ago, and one of them had their very first COVID patient. And again, first thing out of her mouth was, I was scared, I was fearful. I never worked with a COVID patient before. And again, it's just a matter of I would say that if you're donning your PPE gear correctly, you're doing everything that you need to do. You go in with a positive mindset that you're there to care for the patient. So it's really trying to look into your inner soul and just taking a deep breath before you step into that room and say, I'm here to provide the care for the patient. Because we have to do it, whatever it takes to find our peace, whether it be what gives us strength, you know, we have to have some type of faith. We have to have faith that we're going to go in the room, care for this patient, provide the best care that we can, and come out of it okay. You know, so whatever it is, whether it be, you know, the faith that we have, whether it be our family, our focus, it's almost to the point of just being able to center yourself before you go in, center yourself before you go in, taking that deep breath, a deep moment to say, this is my responsibility. I'm caring for this patient. I'm going to go in, provide the best care, make it a positive experience, and I'm going to come out. We do talk to the nurses about being able to center themselves. It doesn't have to be with COVID Sometimes it could be their first code blue, sometimes it could be their first deteriorating patient experience. It's a matter of being able to take control of the situation and somehow depress the fear and anxiety. Because again, we have to focus on what we're tasked with, and that is caring for the patient. That's our responsibility.

Yeah. The point Here is really everyone to understand. If you are not able to calm down yourself, then you won't be able to help the patient be calm. If you're not able to focus on the task at hand because you're so anxious, worried, fearful, then you won't be able to really help others as much as you really want to. Okay? So the presence of mind means yes, all this is happening, but in this moment, this is the only thing that is there. And I'm going to focus on this one. Bringing yourself away from all the negative thoughts and coming to the present moment, whatever that is happening right now, that is the key. It is not an easy task in the midst of this chaos, but it can be done. Okay? Nursing self care is very, very important. Not just during COVID even after Covid, okay, all the time. Because our jobs are very stressful, very stressful. Their expectations, doctors saying something, patient saying something. You're dealing with the pharmacy people you need to admits, the medication and then someone else calls you. There are constant distractions. You need to learn how to multitask. You need to learn how to focus exactly what exactly you are doing without getting distracted, no matter what is happening. And then you need to take care of your health. All these things have to be done. And for that, what I suggest is take 10 minutes, probably in the morning and 10 minutes in the evening for yourself to just relax. To just relax. 10 minutes. I'm asking, I'm not asking for half an hour. Even if you take 10 minutes to relax, that will help a lot. When you know there are some breathing exercises, there are some relaxation exercises that you could practice, make it a habit to do every single day. And when you do that, what happens is all the negative thoughts around you, actually they are not around you. All the negative thoughts in your mind about the situations around you, all that slows down, all that dies down. Your mind is essentially your thoughts. Whatever you are thinking, that becomes your reality, that becomes your mind. It's like simply watching tv. If you're watching a horror film on tv, then you're going to feel horrible. If you're going to. If you watch a feel good movie, a happy movie, automatically you feel happy. It's pretty simple. Okay? Now you see, whatever you focus upon, that becomes your reality, that becomes your mind itself. So the thoughts that you're pouring in, thoughts you are entertaining in your mind, that becomes your reality. You need to know this. Instead of focusing on all the negative things that are happening around you, you say, wait, I am going to change the TV channel. Like that. I'm not going to anymore watch this horror film. No matter the TV is telling me that no matter the things happening around me, I'm going to change the channel to something I like. And you bring back your focus, think something positive, say to yourself, that's fine, I can do this. I am confident. So you need to do some of this self talk also. Alright? And when you do the relaxation exercise, all the negativity slowly subsides. The relaxation is nothing but having your body mind let go of all the negativity, let go of all the thoughts, and you come to a state of peace and joy. I feel good. You do this for 10 minutes each day in the morning and 10 minutes at night. And if you don't see a positive change, a transformation in you in a month, you come and ask me, okay? I bet you're going to see a positive change. Try it for yourself. Okay? I will share the relaxation exercise with you in the end. But the point is the nursing self care is important, especially the mental health aspect right now.

It's absolutely important.

And eat well.

No?

Eat well, right, Doris? They need to take care of. Eat well.

Yes. Eating well, getting enough rest and sleep is very important. Finding a form of exercise or activity outside. I run almost every single day and that is my energy. It just gives me everything that I need to start my day. So running is important. Outside, outdoor activity. Some people use music, some people use meditation, some people pray. Everybody has a different form of finding a means of balance in their lives.

Yeah, finding the balance. Now, Doris, another thing is, how did you handle when your own staff got infected?

Well, it was very difficult throughout 2020 because again, we were learning everything about the virus, the treatment, nursing care, infection prevention measures, etc. Along the way, quite a few of our staff members and personal friends of mine got infected and hospitalized and it was very, very difficult. Some were in the intensive care, we had some on our medical surgical Covid units. And I took care of a very good friend of mine as well. And that was very difficult. I did everything in my power, you know, to do everything I could for her. You know, again, having that many patients in that ward at that time was very difficult. But one of the things that I did for my friend was I brought her, you know, special magazines that she liked to read and it really made her day. She could not have any visitors. You know, it's just you do the special little things that you can for each patient. You know, again, for the other patients, it's sitting them up, you know, Helping them open up, you know, things on their tray. The trays would be brought to the patients. And of course, you know, limited time was spent in the room. And it was very helpful just to take a little extra step to help each patient get situated with their meal. The one thing I can honestly say is presence. When you're in a patient room, be present. That is so important because patients recognize that. And I tell the nurse residents, it's so important that when you spend that time with that patient, the connection is made possible through presence. I think it's important for them to know that you're there, that your mind is not elsewhere, that you're there focusing on them at that moment.

Absolutely. And, you know, knowing a little bit about COVID treatment, of course, you all know, being nurses, how to treat Covid and what needs to be done. But solidifying that knowledge very clearly, you know, I think is going to help a lot in alleviating the fear. For example, what everyone must know about COVID is compared to, for example, last year, where we had no clue what we were doing. Like, the first day when I saw the COVID patient, like, oh, my God, okay, so I need to go inside the patient room. So I went to the patient room, talked to him, came out quickly. I took much lesser time than what I usually spend at bedside, and then I said, I don't know what to do. Pray to God. That's it. That was my first experience more than a year ago. Now it's much different. We know so much more about COVID and the treatment. And if you know these points right, it is going to make your life much more difficult. The fear is going to come down. For example, I'll very quickly summarize important points about COVID how to manage it, so hopefully that will help you. One is, number one, Covid is not equivalent to death, even though we are seeing a lot of death. Okay, 80 to 85% of people who got coronavirus, they just have mild symptoms or no symptoms at all. They just have maybe little fever, loss of smell, and they just get better. They just get better even without us doing anything. 80 to 85% people. All right, now there is another 10% of people who get moderate disease where they have more cough, more fevers, a little bit of difficulty breathing, oxygen saturations less than 95%, but more than 90. Okay. They're somewhere between 91 and 95, their oxygen levels. So they have moderate disease. And even these people improve with simple treatment with steroids. Okay, I'm talking about low Dose steroid, not high dose steroid, low dose steroid like dexamethasone, 6 milligrams every day for 10 days, they get better. So you see now 95% of people only have mild to moderate disease and they just get better, better. Okay? Now there is another 5% of people who progress to severe illness, okay? Severe illness where they're really short of breath, their oxygen levels are less than 90%, and they're really struggling. And for these people, of course, they need to be hospitalized and they need to be taken care of. But even in them, most of them recover with simple treatment with steroids, because steroids are anti inflammatory. Okay? And we start steroids not in the first week typically, but actually in the second week because that is when inflammation sets in in your lungs. So just knowing these things will reduce the amount of anxiety and fear. Because let's say you got Covid and you're thinking, I'm done, I'm dead. That gives a different signal to your body. Then, oh, wait, actually, doctor said that 95% of people improve anyway. All right? And even that 5% though, progress to, you know, severe disease and get hospitalized. Even most of them improve. There is only 1%, maybe two at max, who get critically ill like they are on a ventilator, struggling. And even among them, the mortality, the number of the percentage of death is less than one person. Far less than one person. When you know that, oh, 99% people, they just get better even though they go through some struggle. If you remember it this way, that is how you can remain positive in the midst of this pandemic. Right? So I will actually, you know, share. I have written a short book called Seven Keys to Surviving Covid. Okay. Especially for people in India. I will share that with you all today, all the nursing team members here, so that it's for free, okay? So that you could read a little bit every day so that you can familiarize with the entire spectrum of COVID And I think that is going to help you. So this is the book seven Keys to Surviving Covid in India, A Complete guide to fight the pandemic. All right? I'll provide you the link where you can download it at the end of this session. All right? But educating yourself constantly about COVID treatments. And now there is new treatment that is available, like the antibody cocktail that we are talking about, when to use it. Everything is in there. Okay, now coming back to Doris. Doris, how. How do you. How. What do you recommend? When there is a death, there is a death of the patient. And we tried everything that we could. So how do you handle those emotions? What do you suggest?

It's very difficult. I worked alongside of a staff nurse who had a COVID 19 code blue. And our hospital had certain measures established with this. Any COVID 19 patient who coded. There were certain steps and procedures. Very limited number of people allowed in the room. And we had a physician, a respiratory therapist and a nurse that would be in the room. Again, it was very, very difficult because nurses, we want to go in. We want to go in and start compressions and ventilations and everything. But there were certain steps that came down. When we came with a COVID 19 patient, we had to follow those steps and our CO team would respond very quickly and go right into action again. The whole purpose was to decrease the possibility of contamination, contraction of the COVID 19. That's one of the reasons there were very limited number of people allowed in there. I recorded for this Code Blue, the patient did expire. The patient expired. It was very difficult for the primary nurse because she had been working with the patient earlier in the day. Very painful for this nurse. She broke down in tears, had a lot of emotions. I was able to help record for this Code Blue. So I was watching everything that happened. When any patient expires, it's just very detrimental to the nurse. Sometimes nurses have feelings of guilt. Guilt. What could I have done differently? Was it something that I did? You know, again, sometimes it's beyond our control when these things happen, you know, and the nurse, you have to find a place where you can decompress, be able to, you know, debrief on the situation and allow that time for emotions and, you know, just being able to have that time for yourself. This particular nurse that day had a very difficult time with it. She would not leave the floor. She wanted to continue her charting. There's a lot that we have to do as nurses to charge immediately when a patient expires. There's also additional work that we have to do with our documentation as well. Basically, it's allowing the individual time to. To debrief on their own, decompress. And so we took her aside and worked with her to allow her to express her emotions, to clear her mindset, because it's very difficult. And we had a lot of other nurse residents that experienced deaths was very, very difficult for them. It's finding the time to be able to have a moment for yourself and to allow yourself, you know, that opportunity to cry, express that emotion, let it out, taking that time for yourself. But again, you have to Come back. You have to come back to proceed with the rest of your shift. And that's very difficult. My background is ER nursing. So again, before I went into education, I worked in the ER for eight years. And we saw many deaths of many different age groups. Children, young adults, elderly, you know, and it's never any. It's never a good thing. It's. There's always, you know, nobody likes a death. But again, you know, it's learning how to cope with it, how to be able to work through finding that time to debrief and, you know, decompress somehow and to collect ourselves, to be able to come back and continue working. And it's not always easy, but we have to find that moment, set a time for ourselves to be able to do that and come back. Come back and focus on what we need to continue doing.

Yeah. Death is one of the most terrible things that we face as healthcare professionals, because no matter what you do, a time will come in your practice that you will have to witness death directly. And the more people that you are treating, the more the likelihood that you are going to face death of one of the patients. And in the midst of this COVID pandemic, this is just happening regularly. Even when this happens once in a while, it's hard for doctors and nurses to deal with it, you know, to cope with it. But when it is happening every day, your burden is increased a thousand fold. So what I recommend is you always need to ask yourself, did I do everything that I can in my capacity? Okay? And that's the reason I say that in no matter what our profession is, it is so important that we give the hundred percent that we can. Okay? When you do that and when you ask this question to yourself, honestly, you can say, yes, I have done everything that I could. All right? Now that will reduce the guilt. That will reduce the guilt. Okay? Now still there may be a lot of negative emotion inside. Like Doris said, we need to decompress it. We just need to let it go. Take time, talk to your colleagues. Don't keep it to yourself. Talk to your colleagues. Talk to any other person that you think that could help you let it out. A lot of times we think that it's my fault everyone is thinking badly about me. No, that rarely, rarely, rarely happens. I have found every single time, our colleagues, our co workers, those are our best support system in the midst of this craziness, okay? So rely on them, get together, talk to each other, support each other. And even more importantly, you need to learn how to not internalize the negative emotion. It's happening. Yes, I'm compassionate. I feel for their pain. I feel bad about the situation. But once you come out of that conversation, once you come out of that room, compose yourself, then move on to the next one because you have an expatient to take care of.

That's correct. That's correct. Sorry. Dr. Dantalia. One of the things the hospital has done over time is we've developed a peer assistance program. So there is a group of people that have been trained to help nursing staff so we can call them at any given time and they'll deploy someone.

There is a lot of noise. I don't know who it is. Thank you.

There is a. So if a death occurs and the nurse is having a difficult time, they can call this particular number and the person will be released to meet with a staff member so they can have a one on one personal session. So that is something that our hospital does as well. That's been in place before COVID And so we've utilized those particular people as well to help us. If it's like I said, peer to peer debrief is wonderful. But sometimes because we have so much going on, right. You know, they may need extra assistance, we can arrange for that peer assistance group to initiate that meeting between the nurse and the trained individual. That's a helpful thing. The other things that the hospital has done is provide a special therapist to meet with staff. When they've gotten to a certain stress level. They can make an appointment with this mental health specialist that will meet one on one for 30 minutes. That's another benefit that our hospital has recently started. When we had the COVID surge, the stress levels were really, really high. So they initiated this additional service for nursing staff. The hospital tries to keep it together. Again, you have peer support, but if extra measures are needed, we have our mental health specialist now available to us.

That's good. That's good. I think that is a very good point. Having a professional help you is always different. They not only just support you, but also they can give you tools, they can give you resources that maybe your peer doesn't know. And as a mental health specialist, that they know and they can guide you. So you know, we have Almost.

Close.

To 100 participants join. Is actually 85 participants join us today. And it seems they have some questions, Doris. So we'll take a few questions from them. And I want to share with you something before that. All you nurses, look at this here you are the angels in healthcare. You are so important. You are the Superheroes. You are the superheroes. Okay? So I want you to remember that every day you may feel like what you are doing is not significant. You get caught up in the stuff that is happening every day and forget how important, how great things that you are doing in the midst of this pandemic. Keep reminding yourself, keep reminding your colleagues too that you are the superheroes. You are the angels who are helping the patients. Okay, now let me start with this question from Karuna Shree, who is the nursing leader at Ayush Hospitals in a town called in a city, is a big city in, called Vijayawada in India. So I know a lot of new names for Doris here. But Karuna Shree, do you want to speak up? Karunasree, do you want to speak up? If so, you could unmute yourself and ask the question. So while we wait for her, the question is, how can we.

Yeah, hi, this is Karanshi here.

Yes madam, please go ahead.

Yeah, yeah. It's a nice, wonderful session for all of us this time. What in this challenging times, actually what is my query is like how we can balance ourselves, especially in these challenging times. We are doing a lot of multiple tasks, right? But we are draining like anything whole day from a day and night, okay, Handling of the patients, patient attendance like related to the care while they're delivering by the nurses. So how we can balance ourselves, like, because for the next day we feel like tired, there is no energy or anything is there to go ahead for the next work. So how we can avoid draining of our energy.

Yeah, I really think that we need to find every way possible to balance ourselves, family, work, in our own personal situations. We have to learn how to balance that somehow to be able to come back refreshed for the next day. Because there are challenging days and more challenging days up ahead. So I think that we also have to know our limits. So if there's times when we can only do so much in one given day and then we have to turn around and come back and do it all over again. So I think when it comes time to work your day through is to ensure that we are rested, hydrated, well nourished. In order for us to keep ourselves going, we need to have that balance. And again, as we commence our tasks throughout the day, again we have to know our limits of what we're capable of accomplishing in one day and what might need to be reserved for the next day. As far as patient care tasks are concerned, there's things that we cannot forego. Obviously there are responsibilities that we have regarding patient care. But if you're working in a different aspect of nursing, it's just being able to balance yourself somehow at the work setting. Again, I work in a leadership role as an educator, and again, I make a list of things that I need to accomplish on a daily basis. And I try to prioritize to the best of my ability. If I was working bedside, of course I'd be prioritizing tasks for my patients. We can't do it without having that sense of being ready to assume our role, being, again, well rested, balanced, fed, hydrated and ready to go. We have to take care of ourselves first before we can take care of others. That is most important. If we haven't had enough sleep, it's going to be hard for us to focus if we're hungry or haven't had something to drink. It can be difficult for us to manage our day. So we have to find a way to be able to be prepared physically, emotionally, and mentally as well. Leaving behind any uncertainties, any doubts, or anything else, and being able to focus on the task at hand, to be able to give our patients or our nursing staff the, you know, attention that they need.

Thanks, Doris. Yes, and that is a very important problem that you posed. Karanishrigar. So. How do we handle this? You're constantly on the run, right? You're running around all day. Everyone is asking you to do things. Patients are asking so many questions or, you know, you need to attend to their needs. Doctors are coming and giving you order, do this, do that, and then you don't sometimes even have time to take a break for two minutes to eat lunch.

Yeah, that's right.

So difficult. So I can totally understand what you are saying. Okay, now, there are a couple of things that I suggest along with what Doris said, making up in your mind every day in the morning, the that every day I save so many lives, I need to save my own life. You need to think about it that way. You nurses and doctors, too. Every day we save so many lives, we need to take care of our own selves. Self care is largely ignored in our professions. This mental attitude, this perspective will help a lot. So my formula for tackling this multitasking and not to be drained is number one, when you wake up in the morning, all right, make sure you have good breakfast. That is very important. That is going to give you the energy. And also I strongly recommend the relaxation exercise, which I will share with you. 5 to 10 minutes. 5 to 10 minutes. Just make it a practice because nourishing your Body is one thing that helps you, but cleaning up your mind, maintaining your mind, nourishing your mind is another thing. Just imagine, you know, to take care of our bodies, right? We eat, we take a shower, we take a bath, we brush our teeth. And we do that every day, right? We spend almost an hour, morning and evening to just take care of our body, but we never take care of our minds. Imagine what happens if you don't brush your teeth for a month, right? You're going to be. Your mouth is going to get rotten. So now we don't take care of our minds. We never clear our minds of the negative thoughts that are accumulated. We never clear our minds of all the nonsense that sits there because we are constantly absorbing negative information from outside. Because this world is predominantly negative, isn't it?

Yes. Yes.

So you need to empty your mind every day. You need to add that to your routine. 10 minutes in the morning, 10 minutes in the evening. That's it. All right? And when you do that, when your mind is clear, when your mind is calm, you'll be able to multitask better. If your mind is distracted and restless, you can't even focus on one thing at a time. You're prone to make mistakes. But when your mind is calm, you're like you're doing this total focus. And if someone comes and distracts you, like, all right, wait for a second, let me finish this. Or actually you answer their question and then meanwhile the phone rings. You take the phone call. Meanwhile the patient attender or someone else, they call you and you deal with that and then you come back to the task. Whatever you that you focus on, on without losing the train of thought, that is what is true multitasking is. And you cannot do true multitasking unless your mind is calm. A lot of people try to do multitasking and they feel drained because they're running around anxious. This, this, this, this, this, this. And the minds are restless. And also when you are restless and a stressed state of mind, when you're trying to do all these things each day, you are very inefficient. You just can't finish the work what you are supposed to, or even if you finish it, it is at the expense of your own self means you, instead of taking a half an hour lunch break, you simply eat a snack for five minutes and then move on. And then you don't have enough energy or you are staying until late to do your charting or whatever that is needed. And so you're not sleeping on time. It is all coming Back to one thing, that is keeping a calm mind. That is what is needed really. If you're calm, you'll multitask well, you'll perform well. You'll be able to take care of yourself well. You will clear your mind of the negative information. If you're calm, you will be present in this moment. You'll be able to take care of your patients. So that is my strong recommendation, apart from nourishment, how to keep your mind calm.

I'm sorry.

Yeah, go ahead.

I wanted to add that along with what Dr. Dentalia just mentioned is one of the things that I do before I go to work. I have a 30 minute commute to my hospital and it's at that time, my 30 minute commute, where I can get myself in that state of mind to prepare. It's kind of like my own personal meditation before I start my day. It's just like Dr. Dantalia mentioned, taking those moments to be able to find peace, you know, be able to collect yourself. That 30 minute drive for me is what makes me. It helps me prepare for the day. It's my way of just leaving all the negativity behind, going to work with a positive attitude to do the best job that I can throughout the day.

Yeah, Yeah. I have one more query, ma'. Am. How do you have handled the nursing attrition during these times? Do you have attrition, nursing attrition or any nurses? They are not obeyed to do Covid duty is what you have, how you have handled them.

As far as nurses not wanting to work with COVID patients.

Yeah.

Well, I can tell you that, you know, it is at our hospital, it is a requirement of the role. You know, if you're assigned a COVID patient, you have to take care of that COVID patient. At the beginning of this COVID pandemic, nurses were of a certain age were allowed to consider a medical leave if they could not. And we had some nurses that actually took medical leave, they took leave. They could not. It was a special personal leave that they allowed these folks to take if they could not work with the patient. Because again, at our hospital, it's just you never know what assignment you're going to have. And again, it's just important to stress that we're here to provide care for the patient regardless of the diagnosis. We have the personal protective gear available to keep everybody safe. Now we have our vaccinations. So the vaccinations are required for our staff. But I mean, they're not take it back. They're not required. A person can still decline the vaccination. But we've given every staff member the opportunity to be, to prepare themselves and, you know, be safe. So you have personal protective gear and then you have the choice of the vaccination. So again, a good majority of our patients got. I'm sorry, a good majority of our staff were vaccinated and it's to the best benefit for protection. So our hospital has given every ample opportunity for people to be safe. And so again, if the nurses choose not to work, they will not remain employed. They have no choice but to follow through and care for these patients.

Now, another thing that can be done in these situations is reassurance. Trying to find out exactly why is it, what are you thinking and talking to them, holding their hand and saying, hey, I want to understand what is it that is bothering you? Someone sitting down with them and making that connection and understanding them can go a long way in clearing their doubts in their mind and tell that we are all in this together. What happens if tomorrow, you know, one of your family members gets affected? You know, we are there for them. Right. So I think explaining them that we are all in this together and holding their hand, clearing their doubts, I think that is what is going to help a lot.

Yeah, that's right.

I apologize. I was just sharing some of the experiences at our hospital because we had people that just flat out refused to work with the patient population and they were given the opportunity to excuse themselves from work for a while. But again, now it is important. It's part of, even though you have the fear and anxieties just to really help people cope with what's happening. I mean, and I think for the most part, you know, it's, it's, especially now with the vaccinations, I think the nurses feel a little more comfort working alongside these patients.

Getting everyone vaccinated is the key. And if, you know, I'm sure the healthcare workers are vaccinated there, right? Karana Shree. So if that is the case, the chances for people who got the vaccine to get any severe disease is very, very less. The chances if someone got a vaccine and that reduce the risk of getting COVID infection by almost 90%. And even if they actually get infected with COVID they only get mild disease. The chances for them to get severe disease is far, far less. Can it happen? Yes, it can happen in some people, but that is rare.

Yeah, that's, that's true, that's true what you are saying.

Right. So I think giving them sometimes the nurses or Whoever it is refusing, they're not thinking through everything. They're just reacting to the situation, being fearful, anxious about it. So someone educating them and explaining them and holding their hand and supporting them, that is going to make a big difference. Okay. Now anything else you have on your mind?

Yeah, so far, whatever queries I have, I got a right answer. So I am happy with the response. What you have given to us.

Thank you. Thank you now.

Thank you.

I don't know how time is looking on your side, Doris. I think there are a couple more questions. Do you have time to take those questions? Okay. This is Ramadevi, pulmonology nurse at Ayush hospitals. How do you prevent aerosol exposure risk in COVID patient care areas? How long do those aerosols settle in that area, stay in that area? And how do you take care of the situation and what is the percentage, how risky it is.

In regards to the aerosol, how to.

Prevent aerosol exposure risk in COVID patient care areas?

I do know like I said with that is that of course we're using our personal protective gear to protect ourselves. And when the patient is inside their room obviously they're in isolation. So they're not allowed to come outside of their patient areas. They have to remain in their actual rooms. If they're taken to diagnostics or however they do put on their special mask, they have to put on their face mask before they can leave the room and they're taken to diagnostics and brought back. But again it's just ensuring that we always keep our doors closed in those isolation rooms areas and ensuring that we're using personal protective gear to avoid the contamination potential. And again that's what we do to help minimize the risk factor. It. Is everyone still there?

Absolute email.

I'm so sorry, I think we got cut out for a while. I'm so sorry.

Hello ma', am.

Good evening.

Another question from Mr. Krishna Is the PPE usage still remain same from level 1 setting to level 3?

I'm sorry ma', am, can you hear me? Yes, yes, I think we lost each other there for a second. Dr. Dantalia. I think I didn't hear anyone for a while and I don't know if I was able to address that other question regarding the aerosols.

Aerosols, Ramadevi, were you able to. Did your question get answered? Okay, we'll wait for that next. I think there is another question here is the PPE usage still remains the same from level one setting to level three. I don't know what is Level one and level three. Is there a specific. I don't know what exactly the number means, Doris, do you?

I'm not quite sure.

Level three. Maybe. There is a different kind of numbering in India in this specific hospital.

Well, we're still following through again with using the complete personal protective gear when we're working with COVID 19 patients. That hasn't changed. Again, we have those PAPR helmets that we utilize. We're spending a lot of time with the patient or in the critical care setting. Those are being utilized. But nothing has changed for us in the matter of, you know, the care of the patient. It's still the same.

It is still the same. What they're saying is the stock is Limited, the N95 mass and all that. So what my recommendation, Mr. Krishna Teja, I think is that don't take risk. Don't unnecessarily go into anyone's room without the proper PPE kit. Okay? Even just because you got vaccinated, it makes you 90% immune. It doesn't make you 100% immune. So you don't want to take the chance. You need to wear the N95s. You need to wear any of the PPE kit that is standardized in your hospital and go into the patient's room. I think that is going to be important. You don't want to put your life at risk. Okay? You're already putting your life at risk. But you need to mitigate that risk by wearing the ppe. That's the key. Okay? Now there is one more question which is Revathi is asking. She's the infection control nurse there. Due to high COVID patient volume and shortage of nursing team, it seems nurses had had to extend their working hours and the workload with the mask. Wearing the mask for more than 12 hours a day, most of the time and every day for days and months without getting a break. Can this affect our respiratory health or not? If so, what can we do? That's an interesting question.

Yes, that is.

Any comments on that, Doris?

Well, I can say that again. You know, I know that hospitals have replenished their gear and I know that we have the availability of masks. So if one mask is worn throughout the day, you know, we can definitely switch out if it becomes soiled wet, obviously. But I think, I mean, it can, you know, affect them. But we definitely want to make sure that people follow through and protect themselves at all costs. It's better to have a mask than no mask at all, obviously, but we should switch out the mask if it becomes soiled you know, wet. Are they having difficulty with the number of masks available to them?

So one is sometimes a lack of availability of the mask, but the other times it is actually wearing the mask all the time. All waters a day, every day for months. So the question is whether it is going to harm them. So far I haven't seen any evidence that wearing the mask for all this time is going to harm us. Okay? So I recommend not to worry about it, number one. Number two, even though you're wearing mask all day at work, when you go home, you're not wearing the mask. So remember that. Right. And number three, we all have been wearing the mask until now for the past 12 months. I didn't see any bad effects either in me or my colleagues, my friends and other people. So nothing to worry about it. That is what I could say. Yes, it is uncomfortable. Do I like to wear the mask all the time? No, I now hate masks so much.

You know what's amazing, Dr. Dantalia, is during flu season here in the States, you're required to get vaccinated for flu. I mean, they offer the choice of flu vaccination, right? And some people forego for many reasons, maybe adverse effects or they just don't want the flu vaccine and they have to wear the mask. They have to wear the mask when they're working in the patient care setting. But now we're all wearing it regardless, so it's become part of the norm for us. But there haven't been any reports that we've heard here in the States either of any such risks or problems. People have gotten used to wearing them for extended periods of time. Yeah.

And actually, if I don't wear the mask, it feels very awkward for me. You're like, oh, I think something is wrong if I don't wear the mask.

Right. Something's missing because it's become part of your uniform, of your daily attire.

It has become a part of human body, I think the mask now.

I think so too.

Yeah, go ahead. Sorry.

No, I was going to say it's like something's missing.

Something is missing. Like, for example, my glasses, right. Sometimes when I wear contacts and then I still do this to my glass, I do this even though I get so used to wearing glasses. And the same thing with masks, too. So if I don't wear it, like when I go out and if I walked into a room, you know, like walked into a restaurant or wherever it is, if I don't wear the mask, I feel like, okay, wait. So I take it out of My pocket and wear it. So he got to. I need to now again, you know, go back to that. Because now in America, in most places, we are not anymore mandated to wear masks. Especially in public places, you have a choice and especially if you got vaccinated. So people are still, a lot of people are wearing masks despite that. So we are creatures of our habits, right?

Yes.

I think we had a great session and I think we'll close this out in the next five minutes or so and let's see if there are any final questions that people have.

Okay.

Someone is asking the question, what is your recommendation? How many days continuously should we put on. Put the duty on for a staff? How many days can. Continuously. The staff can work, essentially, that is what it is. The nurses like three days, four days, five days. Is there a limit.

Here in the States we have where three days is considered the norm for nursing staff. Three days. But although due to staffing needs or however, some nurses will schedule themselves four days in a row. You know, typically it's three days in a row, Dr. Dentalia, that most people do three days in a row. Week one, week two, another three days. But again, sometimes that can be, you know, variable depending on staffing needs. Right now at the hospital at this current time, you know, we're. We had a staffing crisis yesterday and yesterday was our seminar where we bring all the residents together. So we have a total. We were going to have a total of 50 present yesterday. And out of those 50, we have 17 that just started. So they're brand new, they're undergoing their training at this time. The other 33 had to report to the floor yesterday because of the staffing crisis where they could assist with med pass, lunch relief, et cetera. So that's how we assisted the hospital yesterday with providing those nurses out there on the floor to help meet the staffing needs. But getting back to the question, yes, typically nurses will work three days in a row. And I think that allows them the opportunity to have that downtime and come back refreshed for the next week. I'm not sure how, you know, the staffing needs are in India, as far as, you know, the multiple days of work or how it varies. But in the States, we typically will work three days in a row.

Yeah, yeah. A lot of times the staffing issue and what to do and all that. So. So. But it depends on the local situation how to handle that. And I'm sure you guys still have a lot more questions, but because of. It's almost more than hour now and Then we need to get going. So we will end this call in a minute. And before that, I want to really thank Doris for making herself available and share her experiences with all of us. And I also want to urge you, I just shared a link in the chat box. Okay. I told you that I'm going to share you the book, right? The Seven Keys to Surviving Covid. And I want you to download this book, read it. It's like, what are the most important things that everyone must know about COVID to protect themselves and their family and their friends. That is what this book about. It's pretty easy read. Okay. It's not too much. I purposefully kept it short so that it's easy to read and easy to digest also. All right.

I'm going to share, if you don't mind, some of the information, of course, with the nurse residents. I think they would. They would like to read that.

Oh, sure. The Seven Kids to Survive the COVID Yeah, absolutely. Doris, please, please share with them. That's totally fine. And any last words, Doris, from you?

No, other than I'm so happy to have had the experience to come out and connect with everybody out there. Such a pleasure, and I'm just very grateful and I feel honored to share with you.

Thank you, Doris. And you. All the nurses in this meeting today, remember that you are the angels in healthcare and you are the superheroes. You are the superheroes. There is no Spider Man. There is no Ironman. None of them are coming to help us. You are helping us. So you remember that, okay?

And.

You know, I know we want to do a relaxation exercise. I think probably we'll schedule that for another day where we could do it peacefully and not stressfully. Relaxation exercise. So we'll do it on another day when we have more time to focus on it. Okay. All right, folks, thank you. Thanks, Doris.

Thank you so much. Have a great day. Goodbye, everybody.

To all those people in India.

Good night.

Good night, sir. Thank you.

Thank you. Take care. Have a wonderful evening. Thank you so much. Doris, you. You are simply wonderful. Oh, thank you. It's a pleasure to be able to meet you and be able to share a little bit of our experience here in the U.S. thank you. Hi. I'm sure this must be useful to all the nurses in the call. We hope we can connect more such sessions with you as our speaker in further sessions. Please join us if anytime, if it is possible. Yes. Thank you so much. Thank you. It's been my pleasure.

Yeah.

Take care.

Bye.

Thank you so much. You.