As confirmed by the World Health Organization (WHO) in 2020, COVID-19 is an infectious respiratory disease caused by a new virus belonging to the family Coronoviridae. It has a large ribonucleic acid (RNA) genome and helical symmetry. Spikes found on their viral envelope are the main feature of these viruses, giving them a crown shape appearance. In addition, these spikes along with envelope proteins allow to anchor themselves to host cell receptors¹ .

Various coronaviruses such as Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and current COVID-19 have been known to cause common colds and more severe illnesses which have led to complications and the death of thousands of people. The 2002 SARS outbreak caused 8,300 reported cases and 785 deaths, while the 2012 MERS outbreak caused 1,879 reported cases at a mortality rate of 39%² . The WHO has carried out close monitoring to make daily reports of confirmed COVID-19 cases and deaths in different regions of the world³ . Considering that this disease has a reproduction rate of R0=2.28 caused by its rapid spread in comparison with other coronaviruses⁴ , the virus is easily transmitted via respiratory droplets (aerosols) and direct/indirect contact by contaminated fomites of those aerosols⁵ , together with the lack of compliance to biosafety protocols in the population, which have ultimately resulted in an uncontrolled spread of the virus.

This growing data has triggered a global crisis affecting different aspects of the population. In terms of health, while the WHO issued some infection prevention guidelines, each country decided to arrange its own control measures to prevent the virus’ rapid spread and hospital collapse. While some people may be asymptomatic, others may present mild or moderate symptoms that require home care or hospitalization in non-critical care areas, a large number of people presents a significant deterioration requiring ICU care, where ICU are deemed as areas with limited capacity due to the requirements of adequate equipment and trained staff, which ultimately lead to high costs related to patients’ stay⁴ .

In light of this situation, nursing has been taking up the challenge in different fields of work such as the community field where self-care measures have been promoted to empower the population. However, these measures largely depend on the adherence that each individual has to social distancing, hand washing, use of face masks, avoiding crowded places, among others⁶ . In addition, specific social isolation measures have been implemented for vulnerable populations who are at higher risk of dying from the disease such as the elderly, patients with chronic diseases, people with immunocompromising conditions due to secondary comorbidities¹ , all of who have been subjected to mandatory preventive isolation measures to avoid complications.

Regarding hospital areas, care dynamics vary depending on patient complexity as the infection can progress to severe disease, including dyspnea and chest discomfort, consistent with pneumonia in 75% of cases⁷ . The time period from the onset of COVID-19 symptoms to death ranges between 6-41 days with a 14-day median. This time period depends on the patient’s immune system and age⁸ . All these variables are aimed at critical care, in which healthcare professionals and patients face great challenges and vulnerabilities.

In this complex context, the role of nursing is full of challenges with a focus on dignified care across all healthcare areas. However, the greatest challenges lie in the transition towards inpatient care of patients with COVID-19. Firstly, there is a constant need for healthcare professionals to expand their knowledge in response to a virus that is evolving and transforming the way healthcare is usually perceived. Secondly, uncertainty and discomfort are present in patients, which makes it imperative to provide comprehensive care in line with this new reality, in which safeguarding lives and restoring health are paramount⁹ .

This situation has revealed the leading role that nursing plays through individualized and planned care, supported through the production and validation of nursing knowledge and professional practice in all areas, which aims at relevant quality care for patients, families, caregivers and communities⁹ .

From this perspective, nursing care is organized and guided by the Nursing Process (NP)¹⁰ , which was developed as a response to the need to guide nursing practice around critical thinking and clinical judgment in order to achieve the expected results, so that nursing professionals provide appropriate care and develop rational decision-making¹¹ . Although the NP is structured through different paths, sometimes healthcare professionals can only make it mentally. However, this process is supported by IT systems in some institutions, which provide a complete articulation to the Standardized Language Systems (SLS): NANDA-I nursing diagnoses¹² , Nursing Outcomes Classification (NOC)¹³ and Nursing Interventions Classification (NIC). Each of these taxonomies has a defined and organized participation with NP⁶ .

Integrating SLSs provides better visibility of care since diagnoses facilitate the consolidation of clinical judgment, outcomes lead to measure the impact of care and interventions are focused on prioritizing healthcare demanded by patients, thus achieving greater synergy that results in a practice focused on addressing needs, which also benefits the quality of care. A close relationship among SLSs is further outlined during planning, as shown in Table 1 , through main nursing diagnoses, outcomes and interventions in inpatient care of patients with COVID-19.

NANDA-I. NOC and NIC linkages in inpatient care of patients with COVID-19 consist of data collection showing the coordination of disciplinary knowledge with nursing classification in practice, thus making visible how useful these are in a systematic approach in providing care to this population in order to monitor the evolution of patient care through outcomes and interventions¹¹ .

Classification linkage shows that a large number of NANDA-I domains have been altered, suggesting that the presence of one or more diagnoses can be determined based on the patient’s commitment, which in turn leads to the selection of NOC outcomes and NIC interventions. The correspondence among classifications reveals the need for consistent care based on critical judgment and supported by philosophical, conceptual, theoretical and research production of the nursing profession.

In conclusion, although the evidence of NP-driven care based on classifications^{12 - 15} provides support for health care and work of nursing professionals, it also promotes quality and optimization of time, indicators, resources and the needs of individuals, which is ultimately at the heart of the profession where nurses aim to guide inpatient care of patients with COVID-19 from a critical thinking perspective, taking up-to-date information about the disease and contributing to the management of the pandemic impact for both healthcare staff and patients, from a physical, psychological and social point of view that will ultimately impact the overall health and well-being of the population.