‫وكالة الخدمات العالجية‬

‫اإلدار العامة لشؤون التمريض‬

‫إدارة التعليم والتدريب التمريض ي‬

Caring for Patients with COVID-19 Respiratory-

related Symptoms
The essential clinical nursing skills and techniques to care for
respiratory patients with COVID-19

Description: Target Audience:

ER & Critical Care Nurses
This blended nursing course will provide the Delivery
knowledge and skills of how to properly and safely Blended (E-Learning & Face-to-face)
care for patients with Covid-19 related symptoms. Duration:
The course will provide the frontline trainees 3-5 Days E-learning + 2 Days Clinical Training
through the ”OpenWHO platform” in user-friendly Level:
formats with the required knowledge about Intermediate
respiratory illnesses, standard precautions, how to Language:
examine common factors that cause each organ to English
become diseased, and the nursing roles during Date
disease manifestations. By the end of the course, Self-paced
the trainees will verbalize and demonstrate the task Assessment
and the skills that nurses must perform to care for Online & Competency-based Assessment
Covid-19 patients. Certification
Certificate of attendance/ completion

Purpose of Program

The purpose of this blended learning course is to enable critical care nurses to apply evidence-
based knowledge and skills to enhance their nursing practice in taking care of patients with
COVID-19 Respiratory-related Symptoms.

Learning Outcomes

• Take a comprehensive history and assessment of a Covid-19 and respiratory health impact
this is having on their day-to-day life
• Differentiate between a range of common acute and chronic respiratory signs and
symptoms based on knowledge of the anatomy and physiology of the respiratory system
• Translate evidence-based management principles to nursing interventions of common
respiratory illness
• Alleviate respiratory distress through direct interventions and by providing education to
enable self-management

Learning Objectives
At the end of the program, the participants will be able to:

• Provide the properly care for the respiratory patients.

• Define the physiology of the respiratory system.
• Recognize the acute respiratory infections (ARIs) and airway management.
• Assess respiratory physiology, ventilation, lung function and relationship between
ventilation and perfusion.
• Evaluate alternate approaches to planning and implementing health education and
promotion interventions, policies and strategies to promote respiratory health, care and
management.

1
 ‫وكالة الخدمات العالجية‬
‫اإلدار العامة لشؤون التمريض‬
‫إدارة التعليم والتدريب التمريض ي‬

• Take care of mechanically ventilated patient.

• Taking an arterial blood gas sample, analysis, monitor and interpret.
• Apply the infection prevention for corona virus COVID-19.
• Provide care for patients with severe acute respiratory infection.
• Provide complete care for patient with extracorporeal membrane oxygenation (ECMO).
• Demonstrate how to wean from ECMO, Decannulation process.

Course Content (Please visit OpenWHO at: https://openwho.org)

PART I: E-learning
Chapter 1: COVID-19: Operational Planning Guidelines and COVID-19 Partners Platform to support
country preparedness and response
Available at: https://openwho.org/courses/UNCT-COVID19-preparedness-and-response-EN

Module 1: Mission and purpose of this program (incl. COVID-19 knowledge):

This module provides a description of the purpose and context for this learning package, leadership words
and relevant COVID-19 knowledge.

Module 2: Country-level preparedness and response:

This module provides an introduction to Operational Planning Guidelines to Support Country Preparedness
and Response, and access to relevant information and documentation.

Module 3: Pillars of the public health response:

This module is technical deep dive into each of the 8 pillars of the public health response as described by
the Operational Planning Guidelines to Support Country Preparedness and Response.

Chapter 2: Infection Prevention and Control (IPC) for COVID-19

Available at: https://openwho.org/courses/COVID-19-IPC-EN)

Module 1: Preparedness, readiness and IPC:

This module provides an overview of Infection Prevention and Control measures for preparedness and
readiness.

Module 2: The novel coronavirus (COVID-19): epidemiology, risk factors, definitions

and symptomology:
This module provides an introduction to the novel coronavirus (COVID-19).

Module 3: Standard precautions, transmission-based precautions & COVID-19 specific

recommendations:
This module reviews various precautions which should be taken to prepare for and respond to COVID-19.

Chapter 3: Health and safety briefing for respiratory diseases – ePROTECT

Available at: https://openwho.org/courses/eprotect-acute-respiratory-infections

Module 1: Acute Respiratory Infection (ARIs) of public health concern - Introduction:

Overall learning objective: To describe basic information about acute respiratory infections including
transmission, symptoms, treatment and prevention.

Module 2: How to protect yourself against Acute Respiratory Infections (ARIs):

Overall learning objective: How to manage the risk from ARIs.

Module 3: Basic hygiene measures:

Overall learning objective: To describe basic hygiene measures to protect against ARIs.

Module 4: Wearing a medical mask:

Overall learning objective: To describe when and how to wear a medical mask.

2
 ‫وكالة الخدمات العالجية‬
‫اإلدار العامة لشؤون التمريض‬
‫إدارة التعليم والتدريب التمريض ي‬

Chapter 4: COVID-19: How to put on and remove personal protective equipment (PPE)
Available at: https://openwho.org/courses/IPC-PPE-EN

Module 1: How-to-guide for putting on and removing PPE according to droplet/contact

precautions for COVID-19:
This module offers a video how-to-guide on putting on and removing PPE according to droplet/contact
precautions for COVID-19, as well as two poster resources. By the end of this module, participants should
be able to demonstrate the correct way to put on personal protective equipment according to the WHO-
recommended method for COVID-19 droplet/contact precautions.

Module 2: How-to-guide for putting on and removing PPE according to

airborne/contact precautions for COVID-19 aerosol generating procedures:
This module offers a video how-to-guide on putting on and removing PPE according to airborne/contact
precautions for COVID-19. By the end of this module, participants should be able to demonstrate the correct
way to put on personal protective equipment according to the WHO-recommended method for COVID-19
airborne/contact precautions.

Chapter 5: Clinical Care Severe Acute Respiratory Infection.

Available at: https://openwho.org/courses/severe-acute-respiratory-infection

Module 1: Introduction to COVID-19 and IPC:

This module covers a clinical update on COVID-19 as of 30.01.2020, and infection prevention and control
(IPC) for patients with Severe Acute Respiratory Infections (SARI).

Module 2: Clinical Syndromes and Pathophysiology of Sepsis and ARDS:

This module covers clinical syndromes and the pathophysiology of Sepsis and ARDS.

Module 3: Triage:
This module covers triage and early recognition of patients with SARI. It includes two role-playing scenarios.

Module 4: Monitoring:
In this module, participants will learn about monitoring patients with SARI.

Module 5: Diagnostics:
In this module, participants will learn about differential diagnosis, specimen collection and diagnostic tests
for SARI.

Module 6: Oxygen Therapy:

This module covers oxygen therapy.

Module 7: Antimicrobials:
This module covers antimicrobial therapy and its modification after diagnostic test interpretation.

Module 8: Sepsis:
In this module, participants will learn how to deliver targeted resuscitation for Sepsis and septic shock.

Module 9: Mechanical Ventilation:

In this module, participants will learn how to deliver lung-protective ventilation for invasive mechanical
ventilation for Acute Respiratory Distress Syndrome (ARDS).

Module 10: Sedation:

This module covers invasive mechanical ventilation for ARDS, managing pain, agitation and delirium.

Module 11: Best Practices to Prevent Complications:

This module covers the best practices to prevent complications.

Module 12: Liberation from Mechanical Ventilation:

In this module, participants will learn about liberation from Mechanical Ventilation.

Module 13: Quality in Critical Care:

This module covers quality in critical care.

Module 14: Pandemic Preparedness and Ethical Considerations:

In this module, participants will learn about pandemic preparedness and ethical considerations.

3
 ‫وكالة الخدمات العالجية‬
‫اإلدار العامة لشؤون التمريض‬
‫إدارة التعليم والتدريب التمريض ي‬

PART II: Clinical Training

Chapter 1: Nursing Management for Acute Respiratory Failure (Training Materials are provided by the
designated clinical instructor)

Module 1: Acute Respiratory Failure (2 hrs.)

What causes the respiratory system to fail and why? Understanding the pathophysiology can enhance your
clinical reasoning skills and guide best-practice management decisions. Here we examine the
pathophysiology of common causes of acute respiratory failure,

Module 2: Oxygen Therapy (2 hrs.)

This module will give an overview of oxygen therapy, including indications and use, basic principles in
providing oxygen therapy including physiology, oxygen delivery systems, and interfaces. Additionally, this
module will provide the nurse the knowledge of how to assess the adequacy and effectiveness of oxygen
therapy, specific considerations for the use of oxygen therapy.

Module 3: Arterial Blood Gases - Basic Interpretation (1 hrs.)

ABG analysis is complex and daunting for many nurses, however, through an understanding of the science
we can demystify it. This session will include facilitated practical ABG analysis to consolidate your learning.
Such as: Dalton’s Law of partial pressures, Normal ABG values, pH of the blood and the influence of
acidosis on gas exchange, etc.

Module 4: Invasive and Non-invasive respiratory support (3 hrs.)

Train nurses how to establishment and maintenance of the airway, and list the indications for an artificial
airway including endotracheal intubation. In addition to train them how to describe the indications for airway
intervention with special emphasis on the indications for intubation, and describing the indications for BVM
ventilation, and oral-pharyngeal and nasopharyngeal airways. Moreover, an important objective is to
develop their skills to do proper preparation for intubation. Describe or demonstrate the act of laryngoscopy
including proper patient positioning and the sequential steps in using a laryngoscope. In addition, the
nurses will be trained how to provide non-invasive respiratory support according to target saturation rates
(as per physician orders or hospital protocol) to achieve normal or near normal oxygen saturation levels for
acute and chronically ill patients.

Chapter 2: Mechanical Ventilation (Training Materials are provided by the designated clinical instructor)
Module 5: Dealing with ventilators, parameters, and troubleshooting (5 hrs.)
Identify differences between normal ventilation and mechanical ventilation. Discuss key variables related to
mechanical ventilation including but not limited to PEEP, pressure support, tidal volume and minute
ventilation. Describe the different modes of mechanical ventilation. Discuss various physical therapy clinical
implications related to mechanical ventilation and the weaning process. Outline appropriate clinical
decision making for mobilizing patients on different mechanical ventilation settings.

Module 6: Monitoring and Assessment of Respiratory Conditions (3 hrs.)

This final interactive session will tie the last two days together with assessment tools and techniques.

PART III: Clinical Exam & Competency-based Assessment

KNOWLEDGE DOMAIN:
• Policies:
▪ Oxygen Therapy Hospital Policy (Adult).
▪ Delivery of Supplementary Oxygen: Flow Rates and Predictive Percentage of Oxygen Delivered.

• Essential Key Points:

Device Flow Rate liters/minute Max Percentage
Nasal Cannula 1-6L/min 21%-44%
Simple Face Mask (SFM) 5-12 L/min 35%-60%
Nonrebreather Mask (NRB) 10-15L/min 95%-100%
Venturi mask (VM) 4-8L/min 24%-40%
10-12L/min 40-50%
Cool Aerosol High FiO2 (CAHiFi) 6-15L/min 28% to maximum of <80%
High Flow Nasal Cannula (HFNC) 1-60 L/min 21-100%

• Related Lippincott procedures/skills checklists:

▪ Oxygen administration # 3469612
▪ High flow nasal cannula #3469611

4
 ‫وكالة الخدمات العالجية‬
‫اإلدار العامة لشؤون التمريض‬
‫إدارة التعليم والتدريب التمريض ي‬

SKILLS DOMAIN:
1. Identifies the indications for mechanical ventilation.
2. Lists the steps in preparing for intubation:
i. Notifies physician and respiratory therapist.
ii. Assembles the necessary equipment.
3. Determines the patient’s ventilator settings on a given ventilator and verifies
against the physician’s orders:
i. FIO2, tidal volume, rate, and mode.
ii. Identifies additional settings according to patient orders.
4. Describes the various modes of ventilation and their implication.
5. Describes at least two complications associated with patient’s response to
mechanical ventilation and their signs and symptoms.
6. Describe the causes of given ventilator alarms and nursing measures taken to
trouble shoot given alarm.
7. Describe some preventative measures taken aimed at prevention of ventilator-
associated complications.
8. Given a nursing intervention in the care plan of the ventilated patient, be able to
explain the rationale.
9. Verbalizes the standards of care according to care plan and documents pertinent
information including the following: type of airway, position and size; type of
ventilator and settings; breath sounds and pulmonary assessment; interprets
ABG results; weaning attempts and patient tolerance.
10. Verbalizes ventilator standards IAW Infection Control Manual Guidelines and
Respiratory Therapy in Intensive Care Units SOP.
11. Emergency equipment available in patient room: ambu bag, mask, appropriate
size suction catheter and no outdated equipment.

ATTITUDE DOMAIN:
1. Engages the patient/family in understanding the procedure, oxygen safety, and
goals of oxygen therapy
2. Acknowledges patient/family feelings regarding oxygen delivery devices
3. Demonstration of patient and family education

Roles and Duties Required after the Course

The primary goal of the current respiratory nurse course is not only to plan and implement
treatments for patients with a respiratory illness but also in preventing these respiratory problems
from developing or worsening. Other duties include:

• The nurse should be responsible of care provision with safe use of appropriate personal
protective equipment (PPE) and relevant COVID-19 knowledge.
• Manage patients with respiratory illnesses and Covid19-related symptoms under a
supervision of an ICU registered nurse.
• Perform diagnostic testing and emergency procedures on patients who have suffered from
heart attacks, shock or from drowning.
• Manage medications, airways and breathing treatments.
• To be a competent nurse in administering oxygen therapy.
• To be capable in educating patients and families on maintaining respiratory health, such as
smoking cessation and utilizing a regular exercise regimen.
• Collaborate with other healthcare professionals including therapists and physicians.

‫وكالة الخدمات العالجية‬

‫اإلدارالعامة لشؤون املستشفيات‬
‫إدارة التعليم والتدريب التمريض ي‬

© 2020 MoH General Department of Nursing. All rights reserved