The COVID-19 Orientation for Frontline Healthcare Providers in the Acute Care Setting is designed to educate and prepare frontline healthcare workers for patient care amid the COVID-19 pandemic outbreak. It utilizes an all-inclusive, centered approach to the management of the disease by providing information about healthcare worker protection, care of the COVID-19-positive patient, and the activation and utilization of the global healthcare community to combat the pandemic.
In this course, we will review the care of these patients by discussing the screening, testing, treatment protocols, and complications of COVID-19 positive patients. We will discuss measures to limit healthcare workers’ exposure to the virus as well as strategies for managing moral distress and burnout related to the care of COVID-19 patients. We will also address the ethical dilemmas that providers may face when dealing with cessation of efforts and withdrawal of support of critically ill patients.
Finally, we will gain a global perspective on COVID-19 and attempt to understand the trajectory of the disease and the need to respect and learn from colleagues across the globe, including how to stay up to date in the knowledge of this quickly evolving pandemic.
By the end of this course, learners will be able to:
Describe physical and psychological protective practices for healthcare workers.
Identify factors that place patients at risk for contracting COVID-19.
Discuss the COVID-19 screening and diagnostic process.
Implement COVID-19 treatment protocols for hospitalized and critical patients.
Identify complications of COVID-19 and their treatment.
Recognize the factors that contribute to the decision to cease lifesaving measures in COVID-19 patients.
Identify methods to support and care for COVID-19 patients and their family members at the end of life.
Describe the importance of learning about COVID-19 from colleagues across the globe.
Compare and contrast clinical guidelines for protocols across multiple healthcare systems.
Evaluate your facility's protocol based on the treatment protocols of other facilities.
Recognize the importance of staying up to date on COVID-19.
Identify credible sources for ongoing COVID-19 information.
The competencies above were derived from a Delphi process with academic and clinical experts in healthcare working on the frontline of the COVID-19 Pandemic in North America, and informed by others with global experience. Their names, credentials, and affiliations are listed below.
We would like to thank the developers and reviewers of this course: J. Carlyle Schlabach, MD, Board Certified Family Physician, Kathleen Capone, MS, RN, CNE, Jacqueline Christianson, MSN, FNP-C, Madison Cox, MSN, RN, LuAnn Etcher, PhD, GNP-BC, CPG, Nicole Giancaterino, DNP, RNC-OB, CNE, Theresa Jones, Ph.D., MSN, BSN, AASN, RN-BC, Stacen A. Keating, Ph.D., RN, Vicky A. Keys, DNP, MSN, RN-BC, ACNS-BC, Hernani L. Ledesma Jr., DNP, EdD, MSIDT(c), MSN, MHA, RN, CNE, Stephanie Terry, Ph.D., RN, CNE, Bonnie Velez, CRNP, Family Nurse Practitioner, Chasya Wiseman MSN, RN, CMSRN, Lindsay Burner, DNP, FNP-C, Valeria Reynolds, MD, and Hugo A. Rojas Aldieri, MD, MSc.
This course is sponsored by:
Approximate time required to complete this course is 18 hours at an average rate of 144 words/minute for readings.
Some content is from the experiences of practitioners in the field as they develop treatment protocols and is not based on clinical trials or peer-reviewed evidence in all cases. Check with your institution for information regarding current treatment protocols. Whenever content of this nature is being used in this course you'll see a "From the Field" label before the content is shared.
COVID-19 Treatment Training Video
This introductory video training was created and presented by Jacqueline Christianson, MSN, FNP-C, and was begun as she was working on the frontlines of the COVID-19 pandemic in New York City as a registered nurse practitioner in April 2020, a NYC peak time of COVID-19. Please begin this course by viewing the video posted below as it provides an overview of the discussions in the course.
Module 1: Introduction- Healthcare Worker Protection
The following contains some information from the field.
The information surrounding personal protective equipment (PPE) is varied and ever-changing as knowledge of the virus evolves. PPE recommendations will also vary based on job function, location, facility policy, and available supply. Ideally, healthcare workers will wear a fit-tested N95 mask or powered, air-purifying respirator (PAPR) when they are working within a 6-foot radius of COVID-19-positive patients for extended periods of time. Even the N95 respirator mask is not 100% protective (the N95 filters out particles >0.3 microns, whereas COVID-19 is a 0.125-micron virus size), so it is important to utilize both engineering and administrative protection to the greatest extent possible. Surgical masks are indicated as PPE against COVID-19 as they offer some protection against the virus; the application of a surgical mask over an N95 mask reduces the risk of N95 mask soiling. Extension and reuse practices should be implemented to combat the shortage of this protective equipment. N95 respirator masks can safely be disinfected using low-temperature sterilization methods. Additional PPE, as indicated, includes face shields, shoe covers and hair covers/bouffant caps, fluid-resistant gowns, and gloves. Placing surgical masks on all patients during a pandemic should be considered.
Module 1: Lesson 1- Physical Protection for Healthcare Workers
Physical protection for healthcare workers includes PPE for workers and patients, proactive engineering and administrative practices, and proper decontamination of inanimate objects. Ideally, virus filters should be placed on all endotracheal tubes and BiPAP machines. Strong consideration should be given regarding the risk of staff exposure when intubation, BiPAP, and any aerosolizing procedure treatments are utilized.
From the field: Some hospitals are considering deferring these treatments if staff protection is not available.
Approximate time required for the readings for this lesson (at 144 words/minute): 75 mins5 URLs, 1 Quiz
Module 1: Lesson 2- Mental Health in the Midst of COVID-19
With the heavy burden that the pandemic is placing on healthcare workers, post-traumatic stress disorder and emotional and physical exhaustion are realities. This lesson explores methods to manage the stress that healthcare workers experience and strategies to deal with medical and personal demands.
Approximate time required for the readings for this lesson (at 144 words/minute): 74 mins3 URLs, 1 Quiz, 1 Forum
Module 2: Risks Factors for Contracting COVID-19
There are many challenges to studying risk factors for contracting COVID-19 in the context of a public health crisis. In this lesson, you will learn about these risk factors and how are they classified as modifiable and non-modifiable.
For more information on modifiable risk factors, view our course on Lifestyle Medicine by clicking here.
Module 2: Lesson 1- Risks Factors for Contracting COVID-19
Approximate time required for the readings for this lesson (at 144 words/minute): 15 mins2 URLs, 1 Quiz
Module 3: Introduction- Screening and Testing
In this module, we will discuss testing associated with COVID-19. We will review the need for evaluation, screening, and testing used to diagnose and guide the treatment of COVID-19 patients, along with trends in test results.
Module 3: Lesson 1- Screening and Evaluation
The need for COVID-19 testing is determined on a case-by-case basis. Testing should be considered for individuals who exhibit signs and symptoms of the disease and those who have been in contact with a COVID-19 patient. The signs and symptoms of COVID-19 include fever, cough, shortness of breath, fatigue, loss of taste or smell, gastrointestinal (GI) symptoms, and hemoptysis. COVID-19 patients may also appear asymptomatic. Screening and testing for COVID-19 should occur based on local health advisement agencies and clinician judgment. Priority testing information is provided in this module.
Approximate time required for the readings for this lesson (at 144 words/minute): 18 mins2 URLs, 1 Quiz
Module 3: Lesson 2- Additional Testing
Patients who test positive for COVID-19 will require additional diagnostic testing to guide their treatment plan.
Common findings from the field:
X-ray and CT scans, even of the abdomen that show only the lung bases, show fluffy, diffuse opacities consistent with atypical viral pneumonia. In a setting of pandemic, assume that COVID-19 is the cause until proven otherwise, even if a patient is not symptomatic with COVID-specific symptoms.
Ferritin, fibrinogen, lactate dehydrogenase (LDH), and C-reactive protein (CRP) are seen to be elevated due to the hematologic component in this disease.
Procalcitonin and prolactin are elevated in patients with bacterial co-infection.
White blood cell (WBC) count is normal or low in COVID-19-only patients, but sometimes elevated in patients with co-infection.
Alkaline phosphate, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) are elevated, but bilirubin level usually is not.
Creatinine is often elevated.
Pseudo-diabetic ketoacidosis in type 2 diabetics is common and presents as a very elevated blood glucose, mildly elevated beta hydroxybutyrate, normal or nearly-normal anion gap, minimal urine ketones, and pseudohyponatremia.
Elevated troponin with normal electrocardiogram (EKG) has been noted in myocarditis. Sometimes mild, non-STEMI EKG abnormalities or new atrial fibrillation/flutter with rapid ventricular response is noted in suspected cardiac emboli.
CT scanning is usually avoided unless absolutely necessary; use of intravenous contrast should be extremely limited due to common acute kidney injury (AKI) associated with COVID-19.
Approximate time required for the readings for this lesson (at 144 words/minute): 17 mins2 URLs, 1 Quiz
Module 4: Introduction- Caring for the COVID-19 Patient
This module examines the treatment protocols for patients across the entire COVID-19 spectrum, including medication and supportive care.
The following contains information from the field.
Patients with mild symptoms should stay home, avoid others, and employ proper hygiene and decontamination of surfaces. Shortness of breath may require hospitalization and oxygen supplementation. Oxygen delivery devices such as high-flow nasal cannula, CPAP, and BiPAP can be helpful to avoid or delay ventilator dependence.
These hospitalized patients become fluid-overloaded very easily. One hospital’s protocol states that fluids should be reserved and used sparingly for true diabetic ketoacidosis (DKA) patients (i.e., with an abnormal anion gap) or AKI patients, no more than 500-1,000 mL at a time. The typical sepsis fluid protocol that includes a 30 mL/kg bolus is not being used on these patients. Be sure to check with your institution for its recommendations and keep in mind that fluid volume overload is a significant problem.
Finally we will discuss common complications of COVID-19. Field workers have noted multi-system organ failure, progressive respiratory distress (including ARDS), barotrauma, pseudo-DKA in diabetic patients, cytokine storm, and cardiac arrest. Johns Hopkins lists hematological, neurological and secondary infections as the major complications.
Module 4: Lesson 1- Pharmacological treatment
The Johns Hopkins guide to pharmacological treatment of COVID-19.
Approximate time required for the readings for this lesson (at 144 words/minute): 15 mins1 URL, 1 Quiz
Module 4: Lesson 2- Oxygenation and Ventilation
This lesson reviews oxygenation and ventilation management of the COVID-19 patient and provides training on ventilator management.
The following contains information from the field.
Staff overseeing COVID-19 patients requiring mechanical ventilation are reporting the following ventilator settings: high positive end-expiratory pressure (PEEP), usually 10-15; tidal volumes as normal; respiratory rate (RR) as normal; and inspired oxygen fraction (FiO2) titrated to keep oxygen saturation (SpO2) as high as possible but <100%.
In the hospital, efforts to provide patient care and minimize staff exposure include only one physician, one nurse, and one respiratory therapist per intubation.
Patients are being proned for 16 hours to enable lungs/alveoli to function.
Nurses are keeping drips for sedation, paralytics, pressors, etc. outside of patients’ rooms in order to minimize exposure.Approximate time required for the readings for this lesson (at 144 words/minute): 120 mins3 URLs, 1 Quiz
Module 4: Lesson 3- Rapid Sequence Induction Medications
This lesson provides in-depth information and quick guides for rapid sequence intubation.
Approximate time required for the readings for this lesson (at 144 words/minute): 88 mins3 Files, 1 Quiz
Module 4: Lesson 4- Comprehensive Treatment Protocols
In this lesson you will review the COVID-19 treatment protocols for multiple healthcare systems. Please review each of them by comparing and contrasting them with each other and with the COVID-19 treatment protocols at your workplace.
Approximate time required for the readings for this lesson (at 144 words/minute): 90 mins3 URLs, 1 Forum
Module 4: Lesson 5- Complications of COVID-19
Approximate time required for the readings for this lesson (at 144 words/minute): 115 mins4 URLs, 1 Quiz
Module 4 Assessment: Case Studies
In this section, you will engage with four real COVID-19 patients through case study. Through synthesis of the information in the previous modules and your prior education and experience, you will analyze diagnostic testing, prioritize decision making, and implement medical interventions to ensure the best outcome for these patients.4 Quizzes, 1 Forum
Module 5: Introduction- Consideration of Effort Cessation
Many factors must be considered when providers face a decision of whether or not to cease the implementation of life-saving measures in critically ill and coding COVID-19 patients. These factors include, but are not limited to, the prognosis, suffering, quality of life, and dignity of the patient, along with the safety of the staff caring for the patient. This module offers resources to support clinicians in providing end-of-life care.
Module 5: Lesson 1- Consideration of Effort Cessation
Approximate time required for the readings for this lesson (at 144 words/minute): 96 mins1 URL, 1 Quiz, 1 Forum
Module 6: Introduction- A Global Perspective on COVID-19
In this module, learners will gain a global perspective on COVID-19 by understanding the trajectory of the disease and the need to learn from colleagues in other countries who have already experienced the surge of cases.
Module 6: Lesson 1- A Global Perspective on COVID-19
Approximate time required for the readings for this lesson (at 144 words/minute): 35 mins2 URLs, 1 Quiz, 1 Forum
Module 7: Introduction- Resources to Stay Current
Please review these resources to gain an up-to-date view of the pandemic. Refer back to these resources as needed. They are updated on a regular basis and will, therefore, not be included in assessments.
Module 7: Lesson 1- Resources to Stay Current
Approximate time required for the readings for this lesson (at 144 words/minute): 120 mins2 URLs, 1 Forum
- Final Exam Final Exam
- Discussion Forum for Course Improvement Discussion Forum for Course Improvement
- Course and Self Evaluation & Certificate Course and Self Evaluation & Certificate