The main objective of this article is to share the experienceof nursing staff during the COVID 19 pandemic in a Primary Care Centre of the Toledo province the care and attention given to population follow the foundations of the nursing theories Florence Nightingale, Concepción Arenal and Hildegard Peplau. Then through holistic care, nursing staff calm fear and alleviate the pain of suffering person by bringing human warmth, solidarity and fraternity. The year 2020 was not only the International Year of Nursing and Midwifery, but it was also the year of COVID-19 pandemic and bicentenary birth of Florence Nightingale and Concepción Arenal. The Foundation of Humanist women for holistic care of the suffering person and especially of the vulnerable patient remain valid today.
Contemporary Nursing, as a health profession, began its journey thanks to Florence Nightingale (1820-1910) , who in turn founded the concept of holistic care of the individual . However, the patient-nursing professional relationship began to be established through Hildegard Peplau's Theory of Interpersonal Relationships (1909-1999). This theory analyses the "personal growth" shared by both the patient and the nurse, based on the structured interpersonal relationship in the healthcare process . In Spain, Concepción Arenal was the driving force behind professionalized nursing care . That is why Concepción Arenal is considered the first visiting nurse in Spain , although her work is little recognized among health workers . The year 2020 will be remembered for the onset of a pandemic, who’s epidemiological epicentre was located in the city of Wuhan (China) in late 2019 and the causative agent is a variety of coronavirus called Sars_Cov_2 . Today, the COVID-19 pandemic continues to collapse the health systems of countless countries, creating an imbalance in the holistic well-being of many groups of people and leading to an increase in mortality in all age groups . Likewise, the year 2020 declared by the World Health Organization, the International Year of Nursing and Midwifery will be remembered with special relevance, due to the involvement of nursing staff in the holistic care of all people affected by Sars-CoV-2. Nurses cared for the most dependent and vulnerable people based on the teachings transmitted by Nightingale . Therefore, it is fair to emphasize that holistic care of the person was carried out in hostile wards of hospitals, in desolate stays of health canters and/or in homes, following the theoretical foundations developed by these nursing theories, whose postulates take special significance, in the field of community care . Therefore, the objective of this article is to know the experienceof a nursing staff during Covid 19 in Primary Care at rural level (Area No. 1 of Toledo), following the model of holistic care proposed by health theorists such as Florence Nightingale, Hildegard Peplau and Concepción Arenal.
This article consists of a narrative research, developed with a qualitative aspect, which involved in socio-sanitary sciences. This methodology is associated with the qualitative approach, as well as the performance of fieldwork and, therefore, the ethnographic description that uses narrative resources . Epistemologically, it is a way to know knowledge within the social sciences, as well as health. Narrating or recounting an experience is one more element in the whole process, constituting a research method . Nursing reflects on the care carried out during the COVID 19 pandemic from the perspective of Nightingale and Arenal. This issue involves addressing the concepts of paradigm according to its model, which generate nursing interventions that reinforce and balance the scientific methods withhuman. In this sense, Arenal promotes and conserves the patient's vital energy. Considering the action that nature exerts on individuals, placing them in the best possible conditions to act on it (Figure 1).
Source: Prepared by the authors
Figure 1: Paradigm of Concepción Arenal
Implementing, the teachings inherited from Florence Nightingale and Concepción Arenal during the pandemic, has made it possible to take care of people and demonstrate the technical-assistance nurse preparation in the face of a pandemic like that of COVID-19. During the development of our daily activity in the health centre, community, groups, family and individual are the axis of our care, being their training, as well as their participation an indispensable axis in nursing care at the level of Primary Care. Under this premise, and by observing the patient with COVID-19 symptoms, we have appreciated despair, distrust and panic in both verbal and non-verbal communication, before an unknown disease.The fear generates in Patient’s decrease ventilatory capacity, discomfort, and even causes suffocation, which results in immediateadmission to the hospital. However, when the person, feels that he is heard empathicallyand his opinion is respected, he feels accompanied, cared for and protected (holistic care), these attitudes calm his despair, transmit confidence, managing to relax and allow the air to expand his lungs.
So, even if your body isaffected by the SARS-CoV-2 virus, its physical, emotional, intellectual and spiritual component must be kept high. At that time, the person trusts the community nurses, accepting the treatment prescribed by his doctor, as well as the care and health advice that he will have to carry out in his home so that the patient stays in home with greater comfort and without effect Individual health. Following the paradigm of Florence Nightingale and her Theory of the Environment , the purpose of nursing professionals will be to influence the environment of the person to solve the affections that manifest the individual and that aggravate their holistic well-being. Likewise, and according to the theoretical postulates of Concepción Arenal, the person is valued individually, supervising their diet to avoid deficient or overeating states. Sometimes, we need to refer to social services, because there are vulnerable families and people with limited financial resources, situations that can make it impossible to achieve good personal hygiene, to provide adequate food or to fix their home, elements that Nightingale defended as indispensable of a person's environment.
In turn, Arenal  expressed his concern about the housing conditions of the patients, recommending natural light and fresh air in all rooms of the houses where possible, affecting the ventilation for at least 20 minutes, a fact relevant in the current situation of pandemic, especially in those rooms where several members of the family have been concentrated to carry out their day-to-day work, study, etc. We even incite and supervise the confinement of people who have been diagnosed with COVID 19 and have been prescribed isolationabout the concept of health; Concepción Arenal defines it as the feeling of feeling good, as well as the ability to make the maximum use of the persons faculties . It has been evaluated by us daily through new technologies. Every day we make a phone call to fragile or vulnerable patients with or without COVID pathology 19. Through the telephone interview, we assess and evaluate the person, to recognize warning signs such as fever, diarrhoea, anosmia, ageusia, fatigue, cough, ventilatory capacity, emotional stability, nutritional habits and sleep rhythm. In short, we monitor the patient in order to assess the degree of improvement or worsening, which may motivate a referral to your doctor or recommend going to the centre for an in-situ assessment. The same is due to the theoretical nurse Hildegard Peplau , in whose conjectures he chose to describe the process of nursing relationship in four stages (orientation, identification, exploration and resolution), proposing how the nurse identifies the needs or disorders of the person, so that the person evolves to take full advantage of this relationship, with the goal of obtaining the best possible benefits. Thus, during this pandemic, nurses demonstrated, through holistic care of the individual, it is possible to detect their real problems about their health and care for the person in all its dimensions (bio-psycho-social), managing to act on the social determinants of Lalonde's health, such as lifestyle and environment . The primary care nursing staff has even acted on the health determinant of the health system, through telephone calls as a strategy to make the person feel connected with their reference health professionals and in turn cared for within a safe environment.
We have met individuals during isolation, on multiple occasions, who are living alone, have comfort. The nursing staff, through the telephone call, through voice and active listening, value and perceive the alarm signs of the patient, but at the same time, comfort and care for the patient through the prescribed health advice. In addition, the community environment has a role not only in the patient, but in the patient's caregiver. It is essential to take care of the caregiver, so that informal care is carried out efficiently. Therefore, we put into practice the humanistic model that Arenal bequeathed us, because through active listening we comfort and alleviate the suffering of the person, managing to change the environment of vulnerability in which isolated people find themselves. We even alleviate the hopelessness that the pandemic is causing, because the person in the solitude of the home, between his memories and his absences, with the virus stalking his family, friends or neighbours, taking away his loved ones and unable to give the last goodbye to the next of kin, feels panic to be confined by this disease.
At this moment the humanistic and holistic model bequeathed by Florence Nightingale, Concepción Arenal and Hildegard Peplau, nursing theorists whose teachings take on infinite value is recognized, thanks to their foundations it is possible to mitigate the pain of the suffering, treating the duel of a broken family in front of an empty chair, in the heat of their home, which will never be the same. The year 2020 was not only the International Year of Nursing and Midwifery, but it was also the year of COVID-19 pandemic and the birth of bicentenary Florence Nightingale and Concepción Arenal.
Our sincere thanks to all patients and their families, teachers and their wisdom, in the times when the shadow of the pandemic has darkened the brightness of our planet. In turn, these lyrics serve as recognition to these illustrious thinkers, for being our light among the cold and dark rooms of health canters, where personal protective equipment is our best allies and the affection towards our patients the best medicine.