The COVID-19 pandemic and changes in nursing care between 2020 and 2021 in a municipality in the Brazilian Amazon

Abstract

Introduction: Although they are directly involved in the treatment of patients with coronavirus disease-19 (COVID-19), the possibilities and limits of nursing professionals in the face of the disease were not well defined. Since the beginning of the pandemic, nurses are reviewing procedures and changing their assignments during the treatment of patients with the disease. Objective: This study aimed to analyze the variation in nursing care in the care of patients with COVID-19 in the two semesters of 2020 and later the years 2020 and 2021 in the public health network of the municipality of Marabá, located in the southeastern region of Pará. Methods: This is an applied and descriptive research, whose approach was based on a retrospective observational study. Data from the medical records of patients hospitalized in the public health network of the municipality of Marabá, in the southeastern region of Pará, were cataloged. First, 499 records of patients with COVID-19 confirmed by laboratory tests in 2020 were analyzed, which were divided into two groups: the first group consisted of the records of patients hospitalized between March and June (1st semester, n = 327) and the second group composed of the files of patients hospitalized between July and October 2020 (2nd semester, n = 172). In a second moment, 572 medical records from 2021 were cataloged, totaling 1,071. Data from 27 nursing prescriptions were compared, which were divided into 5 groups of variables: 4 variables of the neurological system; 4 variables of the cardiovascular system; 4 respiratory system variables; 4 digestive/urinary system variables; and 11 variables of the musculoskeletal system. Results: Analyzing the two semesters of 2020, it was observed that 16 nursing care (59.3%) were statistically higher in the 2nd semester and eight nursing care (29.6%) were statistically lower in the 2nd semester. In addition, three nursing care (11.1%) did not show significant differences between the two semesters of 2020. In that year, the percentage of nursing care increased from the first to the second semester, from 52.8 ± 17.6% to 62.7 ± 5.1% (P <0.001); the greatest changes occurred in relation to the musculoskeletal system, which changed from 37.3 ± 22.9% to 53.3 ± 7.7% (P <0.001). As for the comparison between the years 2020 and 2021, it was observed that, in relation to the neurological, cardiovascular, respiratory and digestive/urinary systems, there were 14 of the 16 nursing care significantly higher in 2021 (P <0.0001 for all), except for the 'upper airway aspiration' care which was significantly lower (P <0.0001) and the 'vital signs monitoring' care which was performed in 100% of the participants in both years. Regarding the musculoskeletal system, in 2021 there were seven significantly greater care and four care showed no significant differences. It was observed that, in 2021, the values were significantly higher than in 2020 for all organic systems (P <0.0001). In the total of 27 nursing care evaluated, the year 2021 presented a percentage of care performed by nurses significantly higher than the year 2020 (69.2% ± 9.4% versus 56.2% ± 15.3%, P <0.0001). Conclusion: In the initial months of the COVID-19 pandemic, nursing care was less intense, which may have been a consequence of the lack of knowledge about the disease. Over time, there was an increase in nursing care for all organ systems. This points in the direction that the improvement in nursing care was strongly influenced as knowledge about the pandemic was acquired.