Ms. Eberl, you not only work for the Catholic University of Eichstätt-Ingolstadt, but also for a hospital in Munich. What was the working atmosphere like at the hospital during the past couple of weeks?
Currently, the situation at the hospital is stable. We experienced the greatest changes before the curbs on movement imposed by the government – when it became clear that we had to increase the number of available intensive care beds extremely quickly. We have converted entire wards to COVID wards and equipped them with additional ventilators. Like this, we were able to increase intensive care capacities by over 100 per cent. When the government imposed the curbs on movement, hospitals started to restrict access. This was a real cut. Scheduled surgeries were canceled immediately or reduced to an absolute minimum. Very few people were allowed to enter the hospital – for example for being able to visit people on their deathbeds.
One of our readers asked how many patients with a severe progression of the disease had to be moved to intensive care?
About one third of the patients who were treated in hospital for COVID. In some patients, the progression of the disease was very serious. Of course, we know respiratory failure from other situations. But the extent to which patients’ lungs were affected was more serious than usual. Therefore, the tendency was to intubate earlier than usual as well to be able to support the lungs more. In case of severe lung failure, patients had to lie in a facedown position over a longer period of time, and were sometimes even ventilated over several weeks. In the end, it was about saving lives by providing the best possible treatment.
How did all parties involved experience the situation?
During the first weeks, everyone was really worried. Especially in view of the reporting from Italy and Spain. The extreme rise in numbers sometimes even caused insecurity to turn into fear. People did not know: Will we be infected? What if many patients are admitted to hospital at the same time? Do we have sufficient capacities? This is why psychologists and pastors have supported us in the process from the very beginning. For doctors, the situation was also very stressful because they were unable to predict the course of the disease. In situations like this, it can be particularly challenging to keep calm despite the high level of tension. It is important to not let patients sense your worries, but still discuss your fears with colleagues. Here, the decisive factors for a good leadership and team culture become evident.
How has the nursing care profession changed during these times?
Everyone who is working with the patients must wear protective clothing. You could see that on TV in video footage showing intensive care units. It is very exhausting to work when covered in protective gear from head to toe. We were relatively quick in adapting to the circumstances by starting to communicate with the eyes. We have no possibility to take short breaks, as putting the protective clothing on and taking it off again is very time-consuming and we cannot just leave the isolation rooms. It was also very difficult for us that we had to reduce usual care standards. However, treatment for chronically ill patients must be kept up. And of course, acute cases such as heart attacks or strokes are also admitted to hospital. Here, we were and still are worried that those patients either do not go to A&E or see the doctor at all or too late, which then means that they cannot receive the treatment they need.
We repeatedly heard that there was not enough nursing staff available?
Yes, the past few months have shown the deficiencies of our health care system very clearly. The staff question is a very important issue. At the start of the crisis, we were for example able to recruit medical students. After a short qualification period, they could support us in our work. But of course, this does not compensate for the lack of qualified nursing staff. Especially in highly specialized fields such as oncology or intensive care units. Nursing staff in these areas complete an additional specialized two-year training after their general training period. During the corona pandemic, it becomes evident again that it is not sufficient to simply count the numbers. We need well-trained staff. We already knew that before the crisis and conditions will not be different after the crisis.
Currently, there is an ongoing public debate on how “systemically relevant jobs” can receive the recognition and respect they deserve. Are bonus payments the right way?
Specialized professions in the medical sector, nursing or physiotherapy are of crucial importance for health care provision. We all have a social responsibility. The question is whether “systemically relevant” is the right term. The decisive factor is: In order to ensure appropriate health care provision, we need different incentives in the long-term – and these must go well beyond bonus payments during a pandemic, as are currently being discussed for nursing staff. We need to win young people who want to be trained in the profession or study nursing. People who see that this is an interesting and safe job. They need to have the feeling that their work is appreciated. And health care institutions must make an effort to retain their employees. Health care provision must not be characterized by scarce time and staff shortage. Wherever nursing staff bears the responsibility for too many patients or care home residents and their relatives at a time, they are unable to provide the care that would be necessary in accordance with their ethical understanding of their profession.
What needs to change in future?
Health care policy and heal care and nursing care institutions must work towards providing better framework conditions together. However, we must not only focus on the institutions. Especially now, we also need to address the question of what happens in family systems in which the situation had already been difficult before? How can we reach families who need support? It is important to engage in outreach work before something happens. But we are also aware of the fact that families with members requiring care are hard to get hold of. Care is a taboo topic. Newer approaches such as “family health nurses” or “community health nurses” can help to strengthen health care provision and preventive health care in families and communities.
Let’s take another look at the future: Will the situation in hospitals continue to normalize?
Hospitals are currently very hesitantly approaching their path back to normality: We try to go back to the point when we were suddenly interrupted and continue from there. Hospital wards are gradually being reconverted into their original state. Canceled operations are taken up again. Of course, we are hoping that the numbers continue to drop. But this sense of normality is very fragile. Therefore, we remain prepared. We must be ready if there was to come a second wave of infection. And this will depend on whether people continue to adhere to the precautionary measures. Some are protesting against them as if they were not needed – and I consider this a very dangerous trend.
The interview was conducted by Thomas Metten.