This guide is created for teams who care for COVID-19 patients in acute and long term care settings. The goal of this guide is to support unit-based education, develop COVID core competencies to care for patients with increasing acuity, with a focus on key elements of a patient-centred plan of care.
It is important for each practitioner to remain up to date on their COVID-19 competencies in order to have the required knowledge, skills, and abilities to provide care within the unit they work (i.e. acute COVID unit, critical care, RCU). This guide provides an overview of COVID-19, current treatments, key elements to be considered, and additional resources. This knowledge is important for all practitioners within an acute care COVID unit. It also provides knowledge and procedural skill videos that can be used to adjunct in-person simulations. There is a section for practitioners who will care for higher acuity patients either within an Intermediate Care Unit (IMCU) or beginner practitioners within Critical Care environments. Please ensure you have reviewed content assigned by your Clinical Nurse Educator (CNE).
The introduction and overview information below and on the COVID-19 Patient Care page applies to all care areas. As care needs escalate, the level of care may change (e.g. transfer from COVID unit to critical care), and care interventions may change as appropriate.
Disclaimer: This information is consistent with evidence-informed research and standards of practice at the time of publication. However, in view of ongoing research, changes in public health/government regulations, and the constant flow of information relating to practice, team members should regularly consult clinical practice reference sources, including the COVID-19 Hub.
The content in this guide should not replace specific decisions for individual patients, nor substitute shared decision-making between patients/families and physicians/other health care professionals.
Coronaviruses are a large family of viruses that usually cause mild to moderate upper respiratory illnesses, like a common cold.
SARS coronavirus (SARS-CoV) occured in 2002, and caused Severe Acute Respiratory Syndrome (SARS). SARS virus disappeared in 2004.
Middle Eastern Respiratory Syndrome (MERS) appeared in 2012, and is caused by the MERS coronavirus (MERS-CoV) (National Institute of Allergy and Infectious Diseases, 2021).
The virus SARS-CoV-2 appeared in late 2019, and causes COVID-19 (WHO, 2021).
Genetic variations of a virus are common and expected. SARS-CoV2 will naturally develop mutations. There are a number of variants the Canadian government is monitoring. A variant is a concern when it affects:
Please review the following PowerPoint presentation by Dr. Lisa Barrett on COVID-19 variants. It contains significant information on how these variants are changing the course of this disease and, in turn, our ability to recognize and treat these viruses.
COVID-19 spreads from an infected person to others via respiratory droplets or aerosols that are created when an infectious person coughs, sneezes, sings, shouts, or talks.
The infectiousness of droplets varies; droplets may come in direct contact with the mucous membranes (person’s nose, mouth or eyes), or they may be inhaled via nose, mouth, airways and lungs.
SARS-CoV2 virus may also spread when a person touches a surface or object (fomite) that has the virus on it and then touches their mouth, nose or eyes with unwashed hands.
Transmission may occur from individuals who do not have signs or symptoms of infection (pre-symptomatic or asymptomatic).
Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact (i.e. within 6 feet for 15 minutes or longer) with a patient with confirmed SARS-CoV-2 infection, regardless of whether the patient has symptoms. Persons frequently in congregate settings (e.g. homeless shelters, assisted living facilities, college or university dormitories) are at increased risk of acquiring infection because of the increased likelihood of close contact. Those who live in or have recently been to areas with sustained transmission may also be at higher risk of infection.
All persons can reduce the risk to themselves and others by wearing a mask, practising physical distancing, washing their hands often, and following other Public health recommendations.
Vaccinations, following public health guidance, and following IPAC guidance are the best strategies to prevent the spread of COVID-19 (Government of Canada, 2021b).
Health care workers who have direct contact with patients who have COVID-19, or are under investigation for COVID-19, are being prioritized to receive a vaccination. Public health guidance and IPAC guidance continue once you are vaccinated; you implement these measures to prevent the spread of COVID-19 to others. Please note: vaccination does not negate the health care provider or public's responsibility to maintain all IPAC principles, and strict adherence to public health measures (masking, social and physical distancing, hand washing, etc.).
How to protect yourself and others from COVID-19. Steps you can take to stay safe, help prevent the spread of COVID-19 and protect your community:
Health care workers must:
Canadian Institute for Healthcare Improvement. (2021). COVID-19 cases and deaths in health care workers in Canada — infographic. https://www.cihi.ca/en/covid-19-cases-and-deaths-in-health-care-workers-in-canada-infographic
Government of Canada. (2021a). Coronavirus disease (COVID-19): Outbreak update. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
Government of Canada. (2021b). Coronavirus disease (COVID-19): Prevention and risks.https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html
Government of Canada. (2021c). Hospitalizations, intensive care unit (ICU), mechanical ventilation and deaths. Retrieved March 3, 2021 from https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html#a7
Government of Canada. (2021d). Infection prevention and control for COVID-19: Interim guidance for acute healthcare settings. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/infection-prevention-control-covid-19-second-interim-guidance.html
Government of Nova Scotia. (2021a). Coronavirus (COVID-19): Avoiding infection. https://novascotia.ca/coronavirus/avoiding-infection/
Government of Nova Scotia. (2021b). Coronavirus (COVID-19): Case data. https://novascotia.ca/coronavirus/data/#overview
Lycan-Lang, E. (2020). Nova Scotia’s first COVID-19 vaccinations begin today. Halifax Examiner. https://www.halifaxexaminer.ca/featured/nova-scotias-first-covid-19-vaccinations-begin-today/
National Institute of Allergy and Infectious Disease. (2020). Coronaviruses. https://www.niaid.nih.gov/diseases-conditions/coronaviruses
Nova Scotia Health. (2020a). COVID-19 symptom monitoring for inpatients in acute care. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=77460
Nova Scotia Health. (2020b). COVID-19 symptom monitoring for residents in LTC. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=80537
Nova Scotia Health. (2020c). Novel coronavirus COVID-2019 - Overview and personal protective equipment requirements. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=76267
Nova Scotia Health. (2020d). Point of care risk assessment. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=76565
Nova Scotia Health. (2020e). Universal pandemic precautions. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=83021
World Health Organization. (2021). Timeline: WHO’s COVID-19 response. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#event-5