"The importance of technology in caring for patients, one of nurses' core duties, has come to light amidst the COVID-19 crisis"

 Photo: Marc Fortes

Photo: Marc Fortes

Imma Alberch
Marc Fortes, nurse and manager of Infermera virtual


In honour of International Nurses Day, celebrated each year on 12 May, we sat down for an interview with Marc Fortes, an active nurse and coordinator of the Infermera virtual project, an initiative of Barcelona's nurses association (Col·legi d'Infermeres i Infermers de Barcelona, COIB). This innovative health education website, whose name means "online nurse" in Catalan, rests upon the same building blocks as the UOC's eHealth Center: a commitment to digital health and the drive to empower citizens.

Marc Fortes is a home care nurse specializing in technology and education for health who combines his nursing duties with management of the education-for-health website Infermera virtual, which offers citizens a range of resources and facts about health. Fortes, who collaborated on the Health Literacy MOOC coordinated by the UOC's Faculty of Health Sciences, also works at the TIC Salut Social Foundation, which is run by the Government of Catalonia's Ministry of Health. As if that were not enough, he is currently volunteering his time as a nurse to help contain the COVID-19 pandemic. 


How has nursing changed over the last century?

The foundation on which the profession is built remains the same, but nursing has had to evolve to welcome new technologies and, more than anything else, to adapt to changes in society. In order to provide people with top-notch care, nurses have always strived to take advantage of the best tools on the market. So, as our tools have evolved, so have we as professionals. 

Since the time of Florence Nightingale, considered the mother of modern nursing, caring for people has been an integral part of a nurse's duties. It's a vital aspect of our work because, although you can't always fix your patients, you can take care of them and make them feel comfortable. As the future approaches, technology will have a key role to play in this type of care, and nurses will have more than just two cents to give on the matter, since we're the experts. With everything going on today with COVID-19, caring for patients also means helping them make videocalls to their loved ones, for instance.

Unfortunately, governments continue to undervalue our profession, even though our patients hold us in high regard, above all other healthcare workers. Nursing has long been a woman's game, a fact which may very well have had a part to play in society's belittlement of our work. Society is on its way towards equality, however, so I think that this will phase out eventually. 

With all of these changes occurring, the nurses association in Barcelona (COIB) has designed a website called Infermera virtual. What was the idea behind it?

The 2005 Global Conference on Health Promotion came to the conclusion that we must do our best to harness new waves of technology to ensure that education for health reaches the entire population equally. It was no secret that information and communication technologies (ICT) were not equally accessible everywhere on the planet, although we could see them spreading like never before. That got us thinking that a project like Infermera virtual could help to provide a stepping stone towards more universal access to knowledge.

The COIB kick-started the project in 2009 by gathering information on numerous nurse-led initiatives that were developing small-scale online projects in Catalonia to prevent unnecessary patient visits. Infermera virtual meshed all these ideas together and went about producing substantiated health content that the general population could easily get their hands on and that nurses could use as needed. Besides our initial aim of making knowledge available to all, we also wanted to create a website that people could trust, which we achieved by creating proper content, offering scientific evidence- based information and designing resources that we knew were proven to work despite a lack of clear evidence on the matter.

Could you give us an example of these resources you say are proven to work?

When you care for patients, you have to address certain emotional aspects that are tough to measure. We look into them further and add them to our website. Given the current COVID-19 situation, for example, many patients are intubated and admitted to an intensive care unit. When they wake up, they can't see their families. Physiologically and biologically speaking, they will surely recover just as well with or without their family members by their side, but a videocall to their loved ones can really put them at ease. There's likely no scientific evidence to back that up, but it's the truth.

Tell us about the features of Infermera virtual and how it works.

It's an online collection of resources. In fact, I would even go as far as to say it's the most important repository of nursing knowledge in all of Spain. In keeping with our initial aim of achieving universal access to knowledge, it's open to all and free to use. We've organized the resources into information bundles, titled "What you need to know", which provide an overview of a range of topics, such as pregnancy and mourning. Since these can be rather long-winded, we utilize the information to make more user-friendly materials that focus on specific topics, such as guides, video advice and information graphics. Since these can then be easily shared on social media and recommended to patients, they help to make sure the information reaches everyone who needs it.

What kind of response has it received from professionals and the general population? 

We are focused on Barcelona province because we're part of the COIB. We work with primary healthcare centres and hospitals and we also prepare continuous training programmes to update nurses on the latest tools and advancements in the field. When we visit centres, the professionals there seem thoroughly grateful and say they find the tool interesting and useful. Oftentimes, health professionals from other disciplines, such as doctors, social workers or physiotherapists, also get in touch to let us know that they are fans of the repository, as it has helped them on many occasions to provide answers on matters that they are less familiar with. We also know that the website is really successful in Latin America, where universities and hospitals alike have been taking advantage of our resources and letting us know about it. The website currently receives around 110,000 visits a month and we have a total of 29,000 followers on the different social media platforms we use, namely Twitter, Instagram, YouTube and Facebook.

We don't provide technical content, because our target audience are everyday citizens, but the information we do provide can be of use to nurses. Giving patients step-by-step instructions on how to self-administer heparin is so much easier if you can show them an information graphic that visually depicts the process. We are experts in education for health and put a painstaking amount of work into creating these resources. It's important that they be easy to understand and leave no room for confusion, which I'd say is an interesting added value of our project.

Have you noticed any changes in the population's use of the website since the COVID-19 outbreak began?

Yes, visits to the website have spiked, I'd say by as much as 30%. My guess is that people have more time to seek out this type of information and are more aware that they are part of the solution. Our mantra of "bolstering people's autonomy so that they can make decisions about their health" seems to be taking effect. People are realizing how important it is to stay informed and remain alert. On another note, there hasn't been an increase in the number of queries we're receiving via the website and social media. It's surprising because we did expect an upsurge, but it's also true that other official apps and information channels have popped up. Everyone's lunged at the opportunity to provide information about COVID-19. 

What does Infermera virtual offer in terms of COVID-19? 

We decided to focus more on the youngsters out there, so we put together a child-friendly guide to SARS-CoV-2. It seems to be working well: since we put it up on the website, it has made its way across a good part of the globe. We also created a game for children aged six and up called Missi Gulnac, which families can download from the website, print out and play at home. We wanted it to be a fun way for kids to learn about health. Plus, it's a collaborative game, meaning all the players work together towards a shared goal, rather than competing against one another. Besides that, we've also started a free consultation service for the elderly and their caretakers, and we've added and are regularly updating a FAQs section and a repository focused on COVID-19. 

In your opinion, are bachelor's degrees in Nursing doing enough to prepare students to work in online environments?

Absolutely not. I think bachelor's degrees need to be reworked from the ground up. While it's true that some universities, perhaps private ones more than others, place some importance on technology, the general university landscape is behind the times. Professors have yet to accept the potential of ICT, so when nursing graduates get their first job and are expected to use these tools, they really hit the ground running. In the same way that students learn how ventilators and monitors work, it would be nice if they spent some time discovering information and communication technologies and what they can bring to nursing.

What challenges to you foresee nurses facing in the future? 

I wholeheartedly believe that the future will see nurses receive the social recognition they deserve, and that this will ignite real change. We are also up against the challenge of breaking new ground on projects that no one else is working on, such as telecare. I think that we will be the ones at the helm of these projects and that it will be up to us to make sure they are based on our comprehensive understanding of people, including their many different facets and what we like to call their "everyday activities".

Our view of people is holistic and comprises four dimensions: biology, psychology, society and spirituality. To maintain a balance between the four dimensions and, thus, a good quality of life, people must carry out eight everyday activities: breathing, eating and drinking, moving, resting and sleeping, eliminating, working and having fun, avoiding danger and, finally, communicating healthily. Any telecare and telemedicine tools that emerge in the near future should incorporate this comprehensive understanding of people that nurses have. It's one of our most important challenges. 

Do you think that the COVID-19 crisis will compel society to take better stock of the work nurses do at health centres? 

This will be true for people who have seen our work up close, I suppose, but that has always been the case. When people suffer a health problem and see that their nurses are the ones helping them along their path from sickness to health, they can't help but hold us in high regard. I bet that the same will happen with COVID-19. If all those well-intentioned people who step out onto their balconies at 8 pm to clap, which I am deeply grateful for by the way, do not see us in action first-hand, they are likely to forget about everything that we've been doing. Things will go back to the way they once were, I'm afraid, although I do hope I'm mistaken. 

This year is the International Year of the Nurse and the Midwife and, if I'm being blunt, we've been dealt a rather lousy year to celebrate, working non-stop and losing colleagues to the pandemic. As a nurse, I think we need to demand further recognition from both the government and the media. We do truly meaningful work and it would be nice if the media covered it, as it would raise our profession's profile. Despite everything, even if we don't get the recognition we deserve, we will continue to care for people every hour of every day, as we have always done.