Nurses play a key role in meeting various human health challenges —An exclusive interview with Xinjuan Wu, President of the Chinese Nursing Association

Xinjuan Wu, President of the Chinese Nursing Association

Since the outbreak of coronavirus disease 2019(COVID-19), the vast number of nurses have gone all out to fighting against the epidemic under the leadership of the Party Central Committee with the core of General Secretary Xi Jinping, and they have attracted wide attention from the public. 2020--the International Year of the Nurse and the Midwife--is a crucial year for Nursing, which marks the 200th anniversary of Florence Nightingale's birth, the founder of modern nursing. The theme for International Nurses Day in 2020 is Nurses: A Voice to Lead – Nursing the World to Health. In the special period of responding to the epidemic, how do Chinese nurses practice this theme? How to quickly mobilize nurses from different hospitals across the country to combat with the virus? How to take care of patients with nursing professional knowledge and expertise? For the answers, the Chinese Nursing Journals Publishing House（CNJPH） interviewed Professor Xinjuan Wu, President of the Chinese Nursing Association (CNA), Editor-in-Chief of Chinese Journal of Nursing, Director of the Nursing Department of Peking Union Medical College Hospital, who was awarded the Florence Nightingale Medal in 2011.



CNJPH: As a leader of the second batch of the national medical team from Peking Union Medical College Hospital to Hubei Province, what are key points to guide the nursing practice in caring for patients with severe COVID-19? What is the challenge to lead the nationwide nurses to fight against the epidemic together?

Xinjuan Wu: As the national medical team from Peking Union Medical College Hospital, we have been taking charge of the ICU in Zhongfaxincheng campus of Tongji Hospital affiliated to Huazhong University of Science and Technology in Wuhan. There are 32 beds in the ICU, with most of patients undergoing invasive mechanical ventilation and some of them undergoing ECMO or bedside blood filtration treatment. As COVID-19 is a novel infectious disease, the treatment experience was insufficient at the beginning. In order to fully rescue patients and improve the success rate of the treatment, we summarized the previous successful experience, combined with the characteristics of COVID-19 patients, and promptly formulated the Standard Operation Procedure for COVID-19 Patient Transferring into and out of ICU. It was shared by our WeChat official account very soon to provide a guideline for all the nurses. We organized and published Practical Nursing Handbook for COVID-19 Patients, in which the main part of nursing care of severe patients had been taken as a main basis of the Nursing Standard for Severe and Critical Patients with COVID-19 issued by the National Heath Committee. These books were presented to the frontline, providing valuable guidelines for nurses.

The CNA has been playing an important role in guiding nurses to fight against the epidemic. In order to encourage about 4 million nurses to engage in prevention and control of the COVID-19 epidemic, the CNA issued a proposal of “scientific and active response to prevention and control the epidemic” to nurses all over the country through the official website and the WeChat official account, and sent a condolence letter to the Hubei Provincial Nursing Association. At the most critical moment in fighting against the epidemic, many members of professional committees of the CNA and other backbone forces successively went to Hubei Province, and engaged in the frontline combat COVID-19. While in charge of clinical nursing services, the nursing experts drafted and edited a series of guidelines and expert consensuses on key points of nursing care for COVID-19, reused medical devices disposal process, and etc. These publications had met the urgent needs of the frontline and are highly praised by the majority of nursing colleagues.



CNJPH: In 2003, you took part in the fight against Severe Acute Respiratory Syndrome (SARS), led the nursing work for more than 300 SARS patients, and created the miracle of “zero” infection of nurses in the whole hospital and other achievements. Is there any useful experience from response to SARS enlightening you to fight against the COVID-19 epidemic?

Xinjuan Wu: COVID-19 is another public health emergency after SARS in 2003. Although the scope of SARS and the number of patients were far less than this panidemic, some successful experience of fighting against SARS is of great significance for us to quickly formulate the epidemic response strategies. For example, at the beginning of COVID-19 epidemic, we quickly established a reasonable nursing management framework, implemented unified command, deployment and action for epidemic prevention and control, and realized the overall scientific management in nursing human resources, medical materials, safety assurance and other aspects to comprehensively guarantee nursing quality and safety. In terms of command and coordination, we immediately carried out ideological mobilization in the whole hospital, broke the boundaries of departments, and quickly set up a multi-disciplinary and multi-echelon emergency nursing team. Most of these backbone forces have nursing experience in critical care or from the respiratory department, the infectious department, etc., which fully guarantees the quality of nursing. The head nurse of ICU was assigned as the team leader. A model of 4 to 6-h shifts was applied, and nurses in a shift was arranged according to their working ability and professional background. Medical staff should protect themselves well while treating patients and take enough rest after hours working. In order to strengthen the awareness and protection ability of prevention and control of everyone, online self-learning and offline centralized training and assessment were both carried out. In actual, special safety supervisors were assigned into the wards to check whether every one wore and took off personal protective equipment correctly and whether the protective work had been conducted in a correct way. Considering the heavy workload, high risk of infection and high psychological pressure of the front-line medical staff, the hospital provides logistical support services for everyone, from daily necessities to medical supplies, in order to release their stress. There is much experience that can be used for references; on the whole, it is necessary to give close attention to four elements--human, material, training and system, to ensure all the procedures scientific, standardized, orderly and efficient.



CNJPH: We read about With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care from Florence Nightingale Pledge. How do you think about Florence Nightingale's spirit reflected in the fighting against COVID-19 epidemic? Are there any details you would like to share?

Xinjuan Wu: Until February 29, except for the local medical staff in Hubei Province, 42,000 healthcare professionals across the country have rushed to the front line of anti-epidemic without hesitation, including 28,600 nurses, accounting for 68% of the total number of medical teams. They play roles as mothers, daughters or sons, wives or husbands in their families. However, when the country has a call and the people have a need, they leave their families to the front line without hesitation. They had made contributions to promoting the recovery of patients and increasing the cure rate. They are interpreting and acting Florence Nightingale's spirit with their behaviors.

Among the most beautiful heroes in harm's way, Qi Li and Ying Xia impressed me most, two of them are head nurses of the medical team from Peking Union Medical College Hospital. Hearing about the notice of supporting Wuhan on Chinese New Year's Eve, they volunteered to register quickly and went to Wuhan on the first day of the Chinese New Year with their colleagues. Following the work handover, they made great efforts to transform a general ward into an ICU according to the standard of isolation for COVID-19 patients within 48 hours. They took charge of working process formulation, overall coordination, material management, and personnel protection training, and provided nursing care for critical patients as role models. When a cured patient was discharged, he said affectionately, “those who say the stars are bright are those who have not seen the eyes of the nurses and doctors, and their eyes have brought great hope to me.” I think this is the most beautiful affirmation for the great love of nurses.



CNJPH: Under the theme for International Nurses Day 2020: Nurses: A Voice to Lead – Nursing the World to Health, the year of 2020 is a crucial period. From your perspective as President of the CNA, what further efforts should Chinese nurses make to highlight the importance of nurses in nursing the world to health?

Xinjuan Wu: Nurses are the main forces to provide continuous and high-quality healthcare covering the whole life cycle. As the saying goes, “30% of treatment, 70% of care”, the patient rehabilitation cannot be achieved without a large amount of nursing work, no matter how excellent medical techniques are applied. When fighting against the epidemic, nurses have to contact with patients very closely every day in a long time, and they have been facing with great risk of lives, providing various nursing interventions including routine bedside care, skin protection, oral care, nutrition support, as well as professional airway management, ECMO care, ventilation in the prone position, bedside blood filtration and other therapeutic nursing, as well as close monitoring of patients' vital signs and disease changes, and close attention to patients' breathing, circulation, etc. In addition, we should always keep attention to the emotional changes of patients, help them conduct emotional counseling, so that patients can establish confidence to overcome the disease. Nurses’ excellent professional skills, psychological support, strong sense of responsibility have been highly recognized. Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General paid tribute to Chinese nurses working on the frontline to stop the COVID-19 outbreak. He called on all countries to invest in nurses and midwives as parts of their commitment to health for all. The International Council of Nurses and other nurses' associations also sent videos and letters to the CNA, praising the courage and responsibility of Chinese nurses, and expressing their support and respect.

At present, the number of nurses in China is growing, accounting for nearly 25% of the total number of nurses in the world, and the professional quality and service ability continue to improve. With the acceleration of the aging process of population and the change of disease spectrum in China, the fields of nursing service will gradually extend from hospitals to communities and families. Nurses will also play an increasingly important role in chronic disease management, rehabilitation nursing, health education, hospice care and other aspects, which also puts forward higher requirements for the ability of nurses. Nurses in China should constantly strengthen their own capacity, and develop to the “specialty, essence and top” of nursing professionals, to further meet the diversified and multi-level health service needs of the people, and become the backbone forces of healthy China construction.



CNJPH: As the organizer and a member of the written committee of Holistic care for patients with severe coronavirus disease 2019: An expert consensus (Hereinafter referred to as the Consensus), what do you think of the significance of nursing research in anti-epidemic?

Xinjuan Wu: Xiaowei Ma, Director of the National Health Committee, stressed many times in working group meetings that we should grasp the main clinical contradictions in fighting against COVID-19 and put the treatment of respiratory system and critical care nursing in a very important position. In order to ensure the standardization and homogenization of clinical holistic nursing work and protect physical and mental health of patients, the Consensus is jointly formulated based on discussions and summarization of experts. As new problems and new challenges are encountered at the beginning of the epidemic, we accelerated the clinical nursing research at frontline in view of the urgency of the situation, and then we drafted, edited and published the Consensus as early as possible to guide the clinical nursing care for critical patients with COVID-19. To summary and publish clinical nursing experience is very important. Nursing research is not only about nursing service, but also about nursing management and protective strategies. Since the publication of the first special issue on responding to COVID-19 in the Chinese Journal of Nursing, over 2000 articles were received, which fully shows that nurses are actively participating in the treatment of patients while improving their ability to solve problems and innovate with scientific thinking. Publications of research and experience on treatment and nursing care of COVID-19 patients, especially the experience on increasing cure rate, reducing mortality and effecting infection prevention and control measures, will be of benefit to not only nurses in China, but also the fighting against the epidemic in the world.



CNJPH: A series of journals of the Chinese Nursing Journals Publishing House planned a special nursing issue of COVID-19 at first time, and opened a fast pass of manuscripts processing for nursing staff. What are your expectations for nursing science journals as an editor-in-chief in this anti-epidemic?

Xinjuan Wu: Nursing science journals provide clinical nurses, nursing managers, nursing educators and other relevant personnel with platforms for mutual learning and sharing. The Chinese Nursing Journals Publishing House currently edits and publishes four journals. The latest scientific and technological achievements and progress on the epidemic have been selected and published in special issues for the nationwide nursing staff to learn and apply to clinical nursing practice, which can benefit to the front-line epidemic prevention. The publication and circulation of academic papers can promote the learning and communication of nursing staff. At present, the nursing team in China continues to grow, and there is a great demand for academic communication and exchange. General Secretary Xi Jinping advocates that the science workers should write and publish articles on the land of the mother country, and apply scientific and technological achievements in our great modernization. As the top core journal among the national nursing journals, Chinese Journal of Nursing also hopes to receive more high-quality manuscripts to promote the exchange and sharing of everyone. According to the statistics of Chinese scientific and technological journal articles in 2019, a total of 10 out of 27 nursing science and technology journals in the country were included in Chinese Science and Technology Journal Citation Report 2019 (Core Edition). As a whole, the number of nursing journals in China is relatively small, and they are mostly comprehensive journals. I hope that nursing journals can continue with the quality construction of journals, constantly improve the academic quality and standardization of articles, develop to be more specialized, promote the publications and dissemination of excellent nursing papers, and play the leading role of journals in the development of disciplines. We shall all work together to create world-class nursing journals and improve the international influence.



CNJPH: Through arduous efforts, the situation of epidemic prevention and control in China continues to improve. The International Nurses Day 2020 is coming. What would you like to say to Chinese nurses?

Xinjuan Wu: In the Spring Festival of 2020, a war without gunpowder broke the peace of family reunion. In the face of the sudden epidemic, nurses all over the country gathered their strength, and went to the frontline of anti-epidemic without hesitation, showing the professional spirit of bravery, firmness, dedication, optimism and fearlessness. Here, on behalf of the CNA, I would like to pay a high tribute to the nursing colleagues in Hubei Province and nurses participating in the fighting against the epidemic all over the country! Medical experts said, how important doctors are, how important nurses are! You have proved the value of the nursing profession with practical actions, delivered hope and confidence to patients with meticulous care and concern, and become parts of the backbone forces of the epidemic prevention and control system. The year of 2020 marks the 200th anniversary of Florence Nightingale's birth and is also the International Year of the Nurse and the Midwife. In this year of great significance, you have inherited and practiced Florence Nightingale's spirit, healing the wounded and rescue the dying, and making selfless contributions with courage to fighting against the virus. You have also conducted heroine's spirit and professionalism to make the society, the people and the world know more about the role and power of nurses. The more critical the moment is, the more it will test our original aspiration to the mission of caring people. Now it's the decisive stage of epidemic prevention and control. I hope that all nurses in the country will persist to work together and make contributions to winning the battle! We firmly believe that no winter is insurmountable and no spring will not come. The country and the people are always our strong backing. The CNA will join hands with you to overcome the difficulties!