Introduction

The World Health Organization (WHO) designated 2020 as the International Year of Nursing and Midwifery^1, which has served to analyze and discuss the contribution of nurses.. The Covid-19 pandemic continues to be a challenge for different health systems, as mortality figures continue to rise daily.. Because of the Covid-19 pandemic, nurses have faced one of the greatest challenges throughout history, being in the front line to mitigate the spread, exposing themselves to compromise their health status due to direct contact with positive patients and increased workload^2,4.

Within the International Council of Nurses Code of Ethics, it states in Art.3. The Nurse and the Profession "The nurse shall have the primary role in establishing and applying acceptable standards of clinical practice, management, research and nursing education. It shall actively contribute to the development of a core of professional knowledge based on research. Through professional organization, it shall participate in the creation and maintenance of socially and economically equitable and safe working conditions in nursing." Constitution of According to Law 57. Law of professional practice of nurses, in its Art. 7. Mentions that: are competences and duties of nurses, literal 1.: Exercise care, administrative, research and teaching functions in the areas of specialization and those related to their professional field, therefore, it is of great relevance the study of the subject^5.

Different studies have pointed out the great work of nursing in history, however, the Covid-19 pandemic was, is and continues to be a challenge. Since different work strategies have had to be taken and the nursing professional has stood out for the great physical and intellectual efforts surpassing human capabilities, with long working hours, psychological pressure and detachment from their social and family environments. Being able to identify each of the roles that has developed in the course of this health emergency^6,7.

Nursing professionals are an organized team that actively contributes to global health from health policy, health-disease dynamics, to the control of epidemics and emergency situations⁸. Therefore, when analyzing the situation of nursing, it can be seen that in the past it was little recognized in the development of its work and activities, remaining on the sidelines³. It´s important to highlight the role of nursing in facing this Covid-19 pandemic and through this to emphasize care as a fundamental axis of health care^9,10.

Other studies show that the role of the nurse before the health emergency has been overshadowed, however, during the Covid-19 pandemic, the nurse has played an important role, developing leadership and assistance in the services in charge^3,11, recognizing that they are at the heart of the different health systems playing a crucial role in health promotion, prevention and treatment of diseases and subsequent rehabilitation of patients^12,13.

In this context, nursing professionals have acquired a significant role in the health care team in coping with extremely dangerous and threatening scenarios, such as the pandemic caused by Covid-19, which has claimed thousands of lives of health care personnel during the performance of their duties^14,15.

Florence Nightingale, in her nursing model, emphasizes that within the role of the profession is the administration of work areas, education of new professionals and the individual, family and community, research as a fundamental axis of change from scientific evidence with statistics that prove it, providing care in an organized, practical and scientific manner¹⁶. In this sense, Nightingale's Theory of the Environment promotes and preserves the vital energy of patients by considering the effect of nature on individuals¹⁷.

Therefore, the objective of this article is to examine the role of nursing in the Covid-19 pandemic through a systematic review, which will enable health professionals, especially nurses, to familiarize and learn about the subject, answering the following research questions: What is the role of nursing in the Covid-19 pandemic? and What are the most prominent roles of nursing in the Covid-19 pandemic?

In relation to this, it establishes specific objectives: to describe the main roles of nursing in the Covid-19 pandemic at international, regional and local levels, to verify differences in the roles of nursing in the Covid-19 pandemic according to the area of work.

Methodology

Type of research

A systematic literature review was carried out, following PRISMA recommendations

Search strategy

An organized exploration of original articles was carried out through the following search engines: PubMed, SciElo, Google Scholar; using the combination of the Boolean operators AND and OR. For the search we used keywords such as: role, nursing, Covid-19, pandemic; in Spanish, English and Portuguese.

Inclusion Criteria

The selection of articles will be made as follows:

- Articles that are not from the year of publication sought will be excluded from the study.

- Thesis-type studies (undergraduate, graduate and doctoral), monographs and argumentative essays.

- Impossibility to retrieve the full text of the article.

The literature review was carried out in three phases: first the search in the first national and international scientific databases, followed by the selection of data through the application of inclusion and exclusion and finally the reading, analysis and review of complete studies.

Results

A total of 1243 scientific papers on the Role of Nursing during the Covid-19 pandemic were identified. Following the selection of the papers, as shown in Figure 1, a total of 30 articles were included for the analysis of this review.

Figure 1.
Selection process of published papers on the Role of Nursing during the Covid-19 pandemic.

Figure 2. Process of selection of published papers on the Role of Nursing during the pandemic by Covid-19 for discussion.

Title	Author	Place and year	Objective	Study sample	Type of study	Conclusion
The role of Nursing in front of COVID-19	Diaz, et al., 2.	Cuba. 2020	They analyze the main aspects related to the situation of nursing in the the situation of nursing in the region of the Americas and Cuba, its contribution to the response to the pandemic, its leadership in the surveillance and health the pandemic, its leadership in the surveillance and health care of the population, as well as the prevention and and health care of the population, as well as prevention and health education related to this disease.	n = 4 workers	Descriptive study	As can be seen, nurses stand out in the front line of the fight, characterized by their aseptic characterized by their healthcare competencies that allow them to take the lead in the surveillance and healthcare and health care of the population, as well as prevention and health education of the population. and education for the health of the population, from a holistic dimension of each person. The value of the work they perform is internationally recognized, promoting respect for the professionalism, dignity respect for the professionalism, dignity, rights and values of the nursing staff, together with all members of the health together with all the members of the work team.
Multi-country Analysis of Nursing Care Management During the Pandemic by COVID-19	Arévalo, et al.,8.	Cuba, 2020	To analyze the strengths, weaknesses, opportunities and threats of the nursing care management developed during the first months of the pandemic by COVID-19.	n = 2 workers.	exploratory, multi-country study.	The SWOT analysis shows varied realities. The country that identified the most strengths was Brazil and the greatest number of weaknesses was reported by El Salvador.
Nursing reflections in times of covid	Morales, et al., 16.	Colombia, 2020	Describe nurses' experiences in times of pandemic.	n = 3 workes	Descriptive study	The nursing professionals called to provide first-line care to people with COVID 19 are scientifically prepared personnel, with a comprehensive vision that makes them leaders to face all situations with ethics, from different points of view: administrative, research, teaching, clinical and community care.
Nurses' experiences in performing their professional role.	Zaragoza, et al.,18.	Mexico, 2020	Describe the experiences of nurses in the performance of their profession.	n = 9 workes	Qualitative, descriptive phenomenological research design.	Male nurses still face several challenges on the road to full recognition of their professional work.
Management of ICU nursing teams during the Covid-19 pandemic.	Raurell, 19.	Spain, 2020	To learn about experiences in different autonomous communities and the results were very different	n = 6 workes	Descriptive study	All nurse managers agree that operating room and anesthesia nurses have been recruited for the ICU. ICU operating room and anesthesia nurses have been recruited for the ICU, as non-urgent surgical activity in the hospital was cancelled. in the hospital.
Gestión de enfermería durante la pandemia de Covid-19	González, et al.,20.	Cuba, 2021	To highlight the importance of nursing management at the Center for Medical and Surgical Research, emphasizing the work of the supervisors during the pandemic.	n = 6 workers.	Descriptive study	La gestión de Enfermería en el CIMEQ ha sido una digna protagonista durante la pandemia de COVID-19. Aún en situaciones epidemiológicas especiales se ha demostrado la capacidad de crecerse ante las dificultades y que la institución y el país tienen un fuerte estandarte que siempre cumplirá con la esencia de esta profesión: brindar cuidados de salud en cualquier circunstancia.
Contents related to nursing professionals during the COVID-19 pandemic on the Youtube™ platform	Carvalho, et al.,21.	Brazil, 2021	To characterize the content of Youtube ™ videos related to nursing professionals during the COVID-19 pandemic.	n = 4 workers.	Qualitative study	Working conditions of nurses in different countries, recognition of the importance of the professionals during the pandemic and demands of the category to improve working conditions were the main contents found on YouTubeTM.
The nurse’ s work in the context of COVID-19 pandemic	Rejane22.	Brazil, 2021	To reflect on the work experienced by the nurse in the face of the COVID-19 pandemic in a public hospital in Rio Grande do Norte.	n = 3 workers.	Reflective essay	It is necessary to value the work of nurses in all its attributes, as well as to strengthen interdisciplinary work processes, which collaborate to overcome the crisis.
Taking advantage of COVID-19's unexpected leadership in the frontline	Newell,23.	Atlanta, 202o	Recounting the experience as a service leader in the Covid-19 pandemic.	n = 1 workes.	Narrative study	What I discovered during that turn was the army of unexpected frontline leaders, who redeployed their skills and leaned into the crisis, without excuses.
Nursing Paradigms in times of COVID-19	Torres,24.	Cuba, 2020	You can read or see testimonials from these professionals, patients and the public about the value of these personnel.	n = 4 workes	Narrative study	Reference is made to the perception of nursing by citizens, in which it is described that the public confuses the roles of nurses: citizens trust nurses, but do not necessarily respect them and do not understand their work.
COVID-19: a challenge for global science	Velázquez, 25.	Cuba, 2020	Strengthening for Cuban science due to its multidisciplinary character, since it has scientists from different institutions throughout the country.	n = 2 workes	Narrative study	These are times to join forces, talents, to be in solidarity, to support each other, to reach out, to eliminate differences and inequalities, to invest more and more in science, to take care of the human being who executes it, to give him/her the weapons to become the shields to defend humanity from this calamity and others in the future.
Community Nursing Care Process for Patients with Covid-19	Rodríguez, et al., 26.	Ecuador, 2021	Developing a model of community nursing care for patients with COVID-19	n = 1 workes	An analysis of the social factors is carried out and the Hanlon Method is applied.	In order to control the COVID-19 pandemic, it is essential to carry out diagnostics and nursing interventions to increase the level of education of the community for the adequate application of prophylactic measures.
Analysis of the work activity of health professionals in training in the Region of Murcia in the face of the COVID-19 pandemic.	Sánchez, et al., 27.	Spain, 2021	Analyze the Spanish state of health emergency	n = 1 workes	Descriptive study	The lack of access to protection material by more than half of the study population, together with difficulties in accessing updated information from the administration, are some of the results obtained after analyzing the responses. In general, there is a majority of residents who continue with their care work, who maintain the number of monthly shifts, who think that they receive adequate official training and that an appropriate contingency plan is being implemented.
Psychometric assessment and nursing intervention for fear of Covid-19	Ramírez, et al., 28.	Ecuador, 2020	To determine the fear of COVID-19 in pre-professional interns of the undergraduate nursing program and to generate a nursing care plan.	n = 4 workes	A quantitative, prospective, descriptive-correlational, cross-sectional study with a non-experimental design.	The emergence of COVID-19 and its pandemic nature has exacerbated fears worldwide. Unfortunately, fear can magnify the harm of the disease itself.
Challenges for Chilean nursing in the context of pandemic according to the guidelines of the International Council of Nurses.	Caballero, 29.	Chile, 2021	Describe the challenges of nursing in the context of the pandemic.	n = 1 workes	Narrative study	Undoubtedly, the Chilean Government must invest in nurses, in their training, and optimize the contributions of nurses to health policies and to the provision of safer and quality health services; nurses have a great opportunity today to take a firm step, with scientific evidence, to lead the world towards health.
Nursing workers in the Covid-19 pandemic and social inequalities.	Baldini, et al., 30.	Brazil, 2020	Relate the social inequalities of nursing workers.	n = 1 workes	Descriptive study	The in-depth understanding and management of reality that we have outlined here requires nurses to nurses to organize themselves in order to: demand ethical-political commitment from public universities and research institutions for the development of studies in this area; demand from unions, associations and professional councils the organization of debates on job loss, social security rights and current forms of exploitation at work, as well as the organization of political struggles in defense of the worker and for better working conditions; convening and joining civil society organizations for debate and the establishment of forms of collective struggle against social, class, gender and racial inequalities; as well as developing actions with SUS users to ensure its full operation and the fulfillment of the right to health for the entire Brazilian population.

Discussion

The role of the nurse is based on providing comprehensive quality care to the healthy or sick person and accompanying him/her in the process of healing and rehabilitation of health, and if necessary at the time of death. This care is of quality for the person, family and community².

At the beginning of the health emergency caused by Covid-19, all health systems suffered a challenge that led to changes due to the high demand of patients, the lack of material resources and the lack of health professionals due to the high demand of patients. This lack of professionals occurred because of the lack of knowledge about the new disease and the lack of protective clothing, many of them acquired the disease and even died from it¹⁸.

Therefore, it is necessary to emphasize that the role of nursing strengthens and articulates the collaboration networks of the different health services, ensuring the quality of services and guaranteeing the organization and performance of resources. Being an inter and multidisciplinary professional in teaching, research and assistance and management in daily work, a professional practice characterized in the updating of knowledge is established. Being a transcendental work, not only for being in 2020 and recognized by the WHO the year of Nursing and Midwifery, but for his hard work in the direct care of patients who presented symptoms and developed the disease by Covid-19^19–21.

It is worth mentioning that this group of professionals are the ones who provide direct patient care, staying 24 hours a day, feeling the situation and reality of the different areas and levels of care; being this occasion where new skills of professionals and nursing students are achieved, since, due to the confusion caused by the Covid-19, the behaviors of responsibility, empathy and solidarity with patients, family and community are strengthened^16,23.

Rejane²², in a study, two categories are made to analyze the work of nursing in the face of the Covid-19 pandemic. Recognizing the leadership and management of nursing; noting that nursing leadership has been highlighted in different investigations in which they emphasize the initiative and effective work in the face of the pandemic. As well as the work of management have been through unquestionable challenges that cause stress and psychological fatigue, despite all the inconveniences encountered, the nurse dedicates actions to the promotion and prevention of the precise care to intervene and mitigate the virus in patients with positive diagnosis.

The activities carried out by the nursing personnel during the pandemic have been arduous and worthy of recognition, since these procedures have been carried out from the first level of care to the assistance in the Intensive Care Units, where the most outstanding roles have been: assistance, management and teaching^8,24. They are direct workers in patient care and are also collaborators of scientific laboratories that help in the research of this new virus²⁵. Also, teaching and research activities have been developed where the nursing staff has created training programs, workshops, protocols and models of nursing care processes, being instruments that serve to create diagnoses of interventions to improve patient care and provide an accurate education to the population^19,26.

The development of the pandemic generated by Covid-19 has aggravated mental health and has altered the well-being of health professionals. As a consequence, fear of the new disease, social distancing, lack of protective equipment, workload, high mortality rate, concern for their health status and that of their family members, economic situation, among others, being necessary to invest in mental health services^27–30.

Conclusions

The present bibliographic review allows us to affirm that the pandemic caused by Covid-19 placed the health systems in different challenges, where the nurse played a transcendental and recognized role, standing out for being the heart and fundamental pillar in the different levels of care, demonstrating their security and leadership by being in a front-line scenario. Evidencing with this that nurses maintain firm the model that Florence Nigthengale left us, being the light of hope, support and comfort for many patients who have found themselves in critical moments during their hospitalization process.

Verifying with this that the role of nursing is updated every day, each professional implement knowledge, techniques, methods and procedures that have scientific bases; and we remain in constant updating for the improvement of patients. Developing administrative, managerial and assistance functions in each department in which they develop their work.

It is important to emphasize that health professionals, especially nurses, deepen research on the subject providing knowledge on scientific bases that help to solve future searches that contribute to the community.

References

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