In 2019, the World Health Organization Declared 2020 the “Year of the Nurse and Midwife”—a Prediction that Proved Prescient Amid the Pandemic
Janine Galeski has long helped families say goodbye to their loved ones. As a family nurse practitioner on a palliative care team in a Northeast Ohio hospital, Galeski (NUR ’12, ’14) works with patients and their families, trying to ease physical and emotional suffering at the end of life.
But the COVID-19 pandemic has changed patient care—adding stress, fear and taking away typical sources of comfort, such as a compassionate touch from a caregiver or a visit from a loved one, according to Galeski, who also is an instructor and preceptor coordinator at Frances Payne Bolton School of Nursing.
Now, she explained: “We help the one family member who is allowed to be at the bedside at the end of life to gown into full [personal protective equipment] and stop them from taking their mask off when they are sobbing. We check on family members in the parking lot and keep them informed. We call the brother who is out of state. We hold the phone when the kids are saying goodbye. I have even translated by videoconference to a sister in Germany.”
In early 2019 when the World Health Organization declared 2020 as the Year of the Nurse and the Midwife to celebrate their service and encourage pursuit of the profession, no one could have predicted the extreme changes and challenges nurses would face, or the vital role they would play in helping stop the spread of a worldwide viral outbreak.
But the declaration proved prescient, as nurses around the globe, including at Case Western Reserve University, quickly adapted—whether on the frontlines, in labs or in classrooms—to combat COVID-19 and continue all aspects of their critical work.
A COVID-19 Education
In early March, Case Western Reserve announced a shift to remote learning; what was intended as a brief hiatus from on-campus learning turned into a semester-long shift—and, for many aspects of university courses, one that continues today.
“We had to do a hard pivot in March,” said Carol Musil (NUR ’79; GRS ’91, nursing), dean of the Frances Payne Bolton School of Nursing. “It was a challenge. Our students chose [this school] because of our hands-on curriculum and rigorous clinical experience. We faced some hard truths with remote learning, but I couldn’t be more proud of how the students, faculty and staff persevered through those early days.”
Some class changes were easier than others: Lectures, with some technical support, could transition to Zoom; exams, thanks to online-proctoring systems, could continue as planned. But how do you move the hands-on courses critical to students’ future career success into a virtual environment?
For second-year Master of Nursing (MN) students in a critical care simulation lab led by Donna Thompson, it required a shift in perspective. Typically, they spent 16 hours per week in the nursing school’s Center for Nursing Education, Simulation and Innovation using the ambulance and helicopter simulators. But in the days leading up to the start of remote learning, Thompson, an instructor and clinical coordinator, rewrote and filmed scenarios using faculty and clinical instructors as the critical team members. The students, then, viewed the online simulations and supplemented with case studies and discussions.
“As nurses, we pride ourselves in being creative problem solvers and adaptable in an ever-changing environment,” Thompson said, “and that is exactly what our students are showing us they can do.”
In the summer, remote classes continued and some MSN students returned to clinical sites. And in the fall when some in-person classes resumed—with seats physically distanced, classroom capacities drastically reduced and masks worn at all times—Frances Payne Bolton School of Nursing students were among the limited undergraduates granted on-campus housing because of the critical nature of completing their 1,300-plus clinical hours.
Junior nursing student Emily Van Pyrz said clinicals helped her maintain a sense of normalcy during an on-campus experience that otherwise looked very different from her first two years at Case Western Reserve.
“While other students had no in-person classes or other reason to leave their room, I have the privilege to go out in the field,” she said.
Others continued with their capstone projects—community-based practicums that help seniors analyze concepts of health and health care, health policy and finance, culture and ethics—albeit with different protocols or even goals than in a typical year.
Hayley Devine, a senior nursing student, worked with the CWRU Partners in Health Lead Screening project, which aims to screen pre-K and kindergarten students in the Cleveland Metropolitan School District.
But the district was remote this fall, meaning the nursing students couldn’t go into the schools to facilitate the screenings.
“Instead, we did a lot of behind-the-scenes work, including notifying families of results from past screenings, following up with families of children with high lead levels and creating a resource guide to address barriers that can prevent the resolution of elevated blood lead levels,” Devine said. “This experience taught me the importance of being adaptable and continuing to put the patients and community first, even if it may look different than it did before.”
Other students received training while also keeping their peers healthy: As Case Western Reserve prepared to bring back faculty, staff and students to campus, a group of BSN students designed contact-tracing procedures for the university as part of their senior capstone project. They created tools for University Health and Counseling Services staff members to identify potential points of contact and how best to serve the campus population.
“Students are a unique population and age group. Many are going to be residential or living around campus,” said Sara Lee (MED ’01), MD, executive director of University Health and Counseling Services. “There’s interactions involved in classroom settings, individuals they may live with and who they socialize with.”
Contact tracing is an instrumental element of the university’s virus-management strategy, which includes masking, physical distancing and practicing good personal hygiene, Lee said.
Having students help design the contact-tracing procedures ensured the right questions were being asked of the intended population—and aligned with the profession’s mission to deliver comprehensive patient care, said Emily Weaver (GRS ’09, NUR ’13), a family nurse practitioner in University Health and Counseling Services who was the group’s capstone advisor.
“Nurses are trained to look at a person holistically and ask, ‘What are the other factors that affect an individual’s health?’” Weaver said. “I also think nurses have this role where they have the ability to speak and understand a medical language and vocabulary and then be able to translate that to the people in front of them in a way that’s comprehensible and helpful.”
Promoting Public Health
The past year has brought a renewed interest and emphasis on public health, adding terms like contact tracing and epidemiology to the vocabulary of the general public. And since the start of the COVID-19 pandemic, researchers at Frances Payne Bolton School of Nursing have worked to raise public understanding and awareness and combat disinformation.
“Viruses spread mainly by tiny droplets made when people cough, sneeze or talk,” said Shanina Knighton (GRS ’17, nursing), PhD, a clinical nurse scientist and infection preventionist at the School of Nursing. “People can encounter spreadable germs by being in close contact with someone who is sick or by touching a surface or object that has virus droplets on it and then touching their own mouth, nose or possibly their eyes.”
Knighton’s research focuses on hand hygiene, and specifically the habits of hospital patients. In research published in February, she and researchers from Frances Payne Bolton School of Nursing and the Louis Stokes Cleveland Veterans Affairs Medical Center found that many patients assume hand-hygiene products available in hospital settings were meant for health care workers—not for them.
As the pandemic progressed, Knighton produced a series of sharable infographics that outlined steps people can take to reduce the spread of the virus, covering everything from proper care and usage of face masks to effective handwashing techniques and safe use of assistive devices, such as walkers or canes.
“Prevention is better than treatment,” Knighton said. “As a scientist, I caution those only thinking of now. We don’t know if studies 20 years from now with indicate a higher risk of mortality or chronic conditions discovered or unheard of as a result of COVID. Practice prevention now to reduce potential consequences later.”
Continuing Research During a Pandemic
While Knighton quickly shifted her work to understand and help stop the spread of the novel coronavirus, the pandemic abruptly changed nearly all research at the university, whether or not studies related to COVID-19.
As a research-forward school—ranked 10th in National Institutes of Health funding among U.S. nursing schools—Frances Payne Bolton School of Nursing faculty and staff had to quickly reassess their strategies, recalibrate their tools and redeploy assets to continue their research remotely or even pursue new opportunities.
“As COVID started to evolve and become a situation we had to adjust to, it became clear that it wasn’t just going to impact us personally, but research and science across the world,” said Ronald Hickman Jr. (CWR ’00; NUR ’06, ’13; GRS ’08, nursing), associate dean for research and the Ruth M. Anderson endowed chair at the nursing school. “This has made us resilient and adaptive as a research community. Our experience with COVID will forever change how we adjust in the future.”
While studying stress on caregivers of technology-dependent children, for example, Valerie Boebel Toly (NUR ’90; GRS ’09, nursing), associate professor and chair of the Arline H. and Curtis F. Garvin Professorship in Nursing Excellence, had to innovate a remote data-collection strategy, mailing wristband devices and sleep log booklets and then developing a protocol and instruction video to assist participants with self-collection of hair cortisol samples.
And as the global pandemic evolved, School of Nursing researchers adapted their work to answer questions about the virus.
Assistant Professor Scott Emory Moore, for one, joined researchers at Indiana University to look at self-management and self-care behaviors and the impact of public health safety interventions such as lockdowns and stay-at-home orders.
Some nurse-scientists joined hundreds of faculty and staff on the university’s COVID-19 Task Force to seek innovative research related to the coronavirus. Over the summer, Associate Professor Amy Zhang and Research Assistant Robin Rentrope each earned funding from the task force to work on interdisciplinary projects related to underserved cancer patients and mental health during the pandemic, respectively.
“The COVID-19 Task Force has been a vehicle that has brought clinicians and scientists across all disciplines into a shared space to better human health and to gain wellness,” said Hickman. “From a research standpoint, everything has been fast paced, but it is remarkable how researchers pivoted and have begun collaborations that may not have existed prior to the pandemic.”
Sharing Nursing Stories
The COVID-19 Task Force has shown the critical importance of interprofessional work—and of having nurses on teams.
As a PhD student and nurse researcher, Megan Foradori said the pandemic has been a public and powerful reminder of nurses’ intellect and commitment to patients at the bedside and beyond.
“I was so touched by the beautiful tributes to nurses, physicians, and all health care providers I saw—from the video clips of clanging pans in New York City to the social media posts of tearful thanks for helping family members connect with hospitalized loved ones on their darkest days,” she said. “The work continues, clearly, but I've never been so proud of nurses and nursing and all those who are fighting the good fight for patients everywhere.”
Long before the first COVID-19 cases were confirmed in the U.S., Frances Payne Bolton School of Nursing joined with two dozen Northeast Ohio organizations to celebrate the Year of the Nurse and the Midwife—honoring the incredible work of more than 10,000 nurses in the region and promoting the nursing profession, Musil said. Each day of 2020, a local nurse’s story was posted to the Northeast Ohio Year of the Nurse website (yon2020neo.com), sharing everything from their inspiration to become a nurse to the realities of the profession during the COVID-19 pandemic—like Galeski, the palliative care nurse practitioner.
“The Year of the Nurse and the Midwife will be remembered,” Musil said, “as a year when nurses rose up globally and made a difference they never could have anticipated.”