新型冠狀病毒肺炎疫情下的回顧與護理省思

Reviewing and Reflecting on Nursing During the COVID-19 Pandemic

全球疫情仍持續延燒著， 截至2020年11月11日止，已在全球189個國家／地區確診病例， 累計51,510,611人確診超過1,275,211人死亡，全球致死率2.48%（衛生福利部疾病管制署，2020b）。因此各國陷入封城危機， 日常充滿混亂、不安與重整。最常以「前所未有」（unprecedented）和「不確定」（uncertain）來描述這種流行病特徵（Davidson et al., 2020）。為了防止病毒傳播，世界各國政府已採取健康措施（例如隔離，戴防護面罩，封城鎖國）產生了心理社會（情緒困擾、焦慮、自殺）和經濟影響（Lima et al., 2020; Montemurro, 2020）。儘管台灣地理位置與中國非常接近，但與許多國家相比，台灣確診感染人數相對少（截至11月11日止584人確診， 7人死亡；衛生福利部疾病管制署，2020b）。由於台灣經歷17年前SARS的慘烈突擊，政府對COVID-19能及早因應，做好周全準備與超前部署，制定相關防疫政策，包括：邊境管制、檢疫隔離措施、口罩政策、宣導教育（戴口罩、勤洗手、保持社交距離），也掌握旅遊史、職業別、接觸史及是否群聚（TOCC: travel history, occupation, contact history, cluster）可早期偵測及發現個案，即時安置個案與暴觸者（衛生福利部疾病管制署，2020a；Yang et al., 2020），提供第一線人員適當防護裝備、教育訓練，快速、公開、透明的資訊與防疫指引，使護理師能獲得適當個人防護裝備，接受感染預防與控制教育訓練及演練，具備足夠的專業知識與技能，提供病人安全的照護（陳等，2020；黃、陳，2020； Yang et al., 2020）。同時，也挑戰著護理教育者， 如何在不可抗之疫情下，停課不停學和計畫有意義的替代臨床經驗（Morin, 2020），重新定義如何評值學生之表現，以確保教學品質及學習成效。此外，「災難護理」是廿一世紀護理人員必備的專業知能，護理人員應有緊急救災的專業能力，因此，有關感染控制、災難和備災的核心概念宜納入課程與宗旨。最後，在台灣的我們雖有驚無險地共同經歷挑戰，日常也不再理所當然。當我們回顧此經驗時，我們將從這些經驗中學到什麼，以及這些學習可能帶來的變化？這些變化，將帶給我們護理更多省思與挑戰。

We remain in the midst of the global COVID-19 epidemic. As of November 11th, 2020, cases of COVID-19 have been confirmed in 189 countries/ regions around the world, with a total of 51,510,611 confirmed cases and more than 1,275,211 deaths, with a global fatality rate of 2.48% (Taiwan Centers for Disease Control, Ministry of Health and Wel-fare, ROC, 2020b). Therefore, countries are facing lockdown crises and their populations face daily lives full of chaos, anxiety, and reorganization. The characteristics of this epidemic are most often de-scribed as ''unprecedented'' and replete with ''uncer-tainty'' (Davidson et al., 2020). In order to prevent the spread of this virus, health measures such as quarantine, wearing protective masks, and enforced lockdowns have been adopted by governments around the world, producing psychosocial (emotional distress, anxiety, suicide) and economic side-effects (Lima et al., 2020; Montemurro, 2020). Despite its close geographical proximity to China, Taiwan’s number of confirmed infections has been relatively small (584 people diagnosed as of November 11th, with 7 total COVID-19-related fatalities; Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020b). Taiwan’s tragic experi-ence 17 years ago with the SARS epidemic helped prepare the government to respond rapidly to the COVID-19 threat, make thorough preparations and advanced deployments, and formulate relevant an-ti-epidemic border control measures, quarantine and isolation measures, mask-wearing requirements, and public education strategies. Actions such as mask wearing, washing hands frequently, and practicing proper social distancing by the public and the gov-ernment maintaining a master travel history, occu-pation, contact history, and cluster (TOCC) database have proven effective in detecting and diagnosing cases early (Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020a; Yang et al., 2020). Furthermore, providing first-line per-sonnel with appropriate protective equipment, edu-cation, and training as well as timely and transparent information and epidemic prevention guidelines have kept nurses supplied with appropriate personal protective equipment, infection-prevention and con-trol education, training and exercises, and sufficient professional knowledge and skills to provide care safely to patients (Chen et al., 2020; Huang & Chen, 2020; Yang et al., 2020). Concurrently, it has been a challenge to nursing educators regarding how to suspend classes while not stopping academic edu-cation and to plan meaningful, alternative clinical experiences during the pandemic (Morin, 2020) and how to redefine and evaluate student performance to maintain teaching quality and learning effective-ness. In addition, “disaster nursing” is a critical area of professional knowledge for nurses in the 21st century, and all nurses should have an appropriate level of competence in professional disaster nursing. Therefore, core concepts related to infection control, disasters, and disaster preparedness should be incor-porated into the curriculum and objectives. Finally, although we in Taiwan have faced the COVID-19 challenge in an environment in which the pandemic risk has been relatively well controlled, our daily lives are no longer taken for granted. When we look back on this experience, what will we learn from these experiences and how will this experience change how we approach healthcare and pandemic threats in the future? These changes will bring us more thoughts and challenges in nursing.