Survey Results: To Quarantine or not to Quarantine

[tnbutterfly - Mary]

To Quarantine or Not to Quarantine......That is the Question that we posed last Thursday. We just want to thank the 3800+ of you nurses who took the time to participate in the latest survey. Your voices have been heard and here is what you said about Kaci Hickox and other healthcare workers who have cared for Ebola patients.

Many posters felt that nurses who took care of Ebola patients should voluntarily quarantine themselves and not run the risk of infecting others....we should err on the side of caution. Some thought quarantine should be mandatory. Many comments were made that we don't know enough about Ebola, and that is causing a lot of discomfort. Some felt that quarantine was not necessary since she is asymptomatic, and some interesting comments pointed to hysteria and reactionism to the possible need for quarantine. Other comments included that the nurses should get paid for this time and several others weren't quite sure of the need for quarantine or not and wanted more information. Some felt "this nurse should be setting a good example for others."

There were 581 comments on this question

The second question garnered 441 comments.

Many comments were made to the effect that this nurse needed to more closely monitor her interactions with the media. Nurses usually have no public relations experience and for this nurse it was the cause of much negative publicity. "Kaci has turned this into a media frenzy." While many agree with her position, they feel she has handled this poorly.

Summary of comments

There were over 2300 comments:

Most responders said that until we know more we should quarantine with pay. Many felt that education and following CDC guidelines was the way to deal with healthcare workers exposed to Ebola. Another commonality was to provide more information to the public so that hysteria and panic was averted. Many posters felt that self-quarantine was the way to go and others felt that these healthcare workers should be monitored in a CDC facility.

[AmyRN303, BSN, RN]

"I think that many people seriously underestimate the threat in West Africa and at the same time greatly exaggerate the present threat to other parts of the world."

This, right here.

[BostonFNP, APRN]

I would be interested to see the results broken out by level of education. I know this is impossible because it wasn't built into the poll. Still, I think the results would be interesting.

Would have been a great demographic to include!

Sent from my iPhone.

[dizzygatorrn]

The fear and paranoia surrounding the Ebola virus has indeed gone viral. I can understand it from the general population who have just realized that Ebola exists, but I really thought that nurses would apply some critical thinking. What has happened to evidence-based practice? That actions should have a scientific rationale? I think the CDC's "Guidance for Monitoring and Movement for Persons with Potential Ebola Virus Exposure" is thorough and logical. In the almost 40 years that health care workers have returned to the US after treating outbreaks of Ebola and other hemorrhagic diseases, there have been zero cases in the general population. These professionals followed the CDC or WHO protocols and they have been proven effective.

80% of the respondents opined that any nurse or physician who cares for an Ebola patient in the US should be quarantined. I can't get my head around how this could possibly be implemented. The length of treatment for US patients has been 2-5 weeks. Let's say 4 weeks since the 2 weeks treatment length is so unusual that there have been articles about why did the Texas nurses got well so quickly. Add to that the 3 weeks quarantine. So we're looking at 7 weeks of lockdown somewhere. Would nurses be quarantined somewhere, isolated as a group? Would nurses who are single and live alone be allowed to go home? And if another patient is admitted, then the clock starts over? It sounds like entering a convent. Projections are 6 months to get Ebola under control in West Africa and possibly clusters of cases in major cities. Would hospitals really have enough staff willing to do that? I haven't heard where any of the hospitals currently treating patients have quarantined their staff, except possibly in Dallas where there were obviously problems that allowed contamination. Someone please tell me how you think this would work.

[imintrouble, BSN, RN]

I found the survey results interesting.

As far as education having an impact on answers, I'm sure it did. Just not as much as some might think.

I watched Ebola coverage on TV for days, and there were many advocating quarantine. I'm going to guess they were smart people since they were MDs and NPs.

If you followed the quarantine thread, you would have thought most members were against quarantine. But that's not what's demonstrated in the survey results.

It's troubling to me, and should be to all of us, that the majority of AN members did not share what they really thought or believed.

Why is that?

[macawake, MSN]

If you followed the quarantine thread, you would have thought most members were against quarantine. But that's not what's demonstrated in the survey results.

It's troubling to me, and should be to all of us, that the majority of AN members did not share what they really thought or believed.

Why is that?

Almost 4,000 members completed the survey. How many post regularly in the various EVD threads? ~100?

(By the way, I'm curious how many of the respondents only joined AN recently?)

I don't think it's that strange that you see more posters who are against quarantines, than supporters. An argument against quarantines can be made with the assistance of available research and decades of empirical data.

Defending quarantines is much more difficult because there isn't any scientific rationale for placing asymptomatic individuals under quarantine. It's a position based on emotion (namely fear). So honestly, I don't think that it's much of a mystery that you see more posters sharing why they're against quarantines.

[StNeotser, ASN, RN]

I disagree.

The fact that nursing schools seem to graduate nurses who completely lack the ability to critically read and interpret research is hardly cause for celebration. In fact, the implications are downright scary.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

One of the question in this survey was: Would a state quarantine protocol for healthcare workers deter you from treating Ebola patients?

20.69% answered yes, 66.87% answered no and the remaining 12.44% don't know.

Well, that doesn't sound too bad... Right? Only approximately one out of five would hesitate to care for an Ebola patient.

Well...

As we've all seen, many posters have previously expressed the opinion that they won't care for Ebola patients. This was before quarantines were ever mentioned. Logically, if those people answered this survey, they will have checked "no" when answering this question. They weren't going to provide care for an Ebola patient earlier, and the quarantine issue doesn't affect that.

The only people who could answer "yes" to this survey question are the people who were previously prepared to care for Ebola patients. If that was for example 40% of the respondents, it means that 50% of those who were actually willing to provide care, would hesitate if quarantines were implemented.

(In my opinion the survey should have asked if the nurse/respondent is willing to care for an Ebola patient in the first place, and then ask a follow-up question to see if a quarantine would change that).

The survey question was I assume primarily answered by nurses (if the respondent was indeed a nurse) who works in their home country only. However organizations like for example MSF, have signaled that quarantines might negatively affect their ability to send healthcare professionals to West Africa.

I think that many people seriously underestimate the threat in West Africa and at the same time greatly exaggerate the present threat to other parts of the world. The threat to us would however increase vastly if the situation in West Africa would spin completely out of control. If you look back at how this outbreak has progressed since March (it actually started in December 2013 but wasn't recognized as an EVD outbreak until March), you will see that the situation is now dire. The oubreak is escalating.

International efforts are finally (!) ramping up in the eleventh hour. It is desperately needed in order to control this outbreak, and stop it at the source. Making it difficult for international aid organizations to send personnel to combat this outbreak, carries a very real and chilling risk. Making it more difficult for organizations to send healthcare workers for reasons that completely lack scientific rationale, is in my opinion lunacy and most definitely counterproductive.

i was a respondent in this survey. The reason I replied that I would hesitate to take care of an ebola patient if quarantine were mandated is because I've lived long enough in the USA to know that my employer isn't looking out after me. I am not sure I could sustain a three week quarantine on unpaid leave. I wish I could even think of volunteering to help people that needed it far much more than our citizens at home. I simply don't have the financial freedom to answer yes that I would be able to take that hit.

Yes I am a real nurse and one of my "what if you won the lottery" type answers is that I would spend a significant portion of my time for free flying out to disaster zones to provide nursing care. My life on this planet has to mean something and all the money in the world won't ever make me not a nurse. I'd just be able to nurse on my own terms.

[dizzygatorrn]

So we are discussing quarantine (total separation and lockdown somewhere) vs monitoring recommended by CDC for asymptomatic care givers (direct active monitoring, possible restrictions include: no commercial travel, no public places or gatherings, no return to work unless approved by health dept, may be in public at 3' distance from others, any travel coordinated with health dept). The recommendations have been revised as new information has become available.

Found this interesting tidbit on cdc.gov:

Use of Public Health Orders

Equitable and ethical use of public health orders includes supporting and compensating persons who sacrifice their individual liberties and freedoms for public good. Specifically, considerations must be in place to provide shelter, food and lost wage compensation and to protect the dignity and privacy of the individual. Persons under public health orders should be treated with respect and dignity. Considerable, thoughtful planning is needed to implement public health orders properly.

So no more unheated tents in parking lots. Perhaps Gov Christie can get some FEMA trailers. It looks like the state or health dept will be on the hook for providing compensation. I notice compensation was included in NJ's statement. That should be better for employers.

[TiffyRN, BSN, PhD]

Interesting results from an NBC News/ Wall Street Journal poll of the public regarding quarantines for health workers:

More than seven in 10 Americans support mandatory quarantines for health professionals who have treated Ebola patients in West Africa, even if they have no symptoms, according to a new NBC News/Wall Street Journal poll.

It's quite interesting to compare it to the same poll taken here at AllNurses:

8 in 10 support quarantines for those who have treated patients in Africa.

In the WSJ poll,

"those with lower levels of education are more likely to support quarantines (80 percent of those with a high school education or less are in favor) than those with college or post-graduate educations (63 percent are in favor.)

Of course the outcome of a poll is influenced by many factors, including polling technology, how the question is worded, the perception of who is asking the question, when and how the polling sample is drawn, and who agrees to take the poll and who decides not to.

But even so, these results are fascinating but not surprising:

The poll results here mirror the results in the WSJ poll for the general public with a high school education.

NBC/WSJ Poll: 71% Back Mandatory Quarantines for Ebola Health Workers - NBC News

Would I be "run out of town" for suggesting the AN poll be redone with several questions that would give the pollsters the ability to correlate level of nursing education with beliefs about mandatory quarantines?

I believe my Advanced Theory professor might term that "operationalizing" belief in EBP. . .

So we theorize that certain levels of education produce nurses with true understanding of research and EBP. Beyond conducting a simple survey involving the question "Do you believe in the precepts of EBP?", how can we truly operationalize the belief in EBP? I should post that in my next discussion, see if I get bonus points.

[GrumpyRN, NP]

Alas, that was thirty years ago, and no, most of the current crop of nurses weren't around to learn anything from it.

https://allnurses.com/general-nursing-discussion/what-worst-hardship-886581.html (post #1)

I read that GrnTea, thank you for it, a lot of very sad stories from that time. It is easy to forget the hysteria and the fear and you seemed to be in the middle of it. We had enough problems over here but nothing compared to San Francisco.

We had a dedicated 'AIDS' unit and the hospital chaplain put in a complaint when he found that gay couples were allowed to be together. The nurse and doctor in charge of the ward basically told him to p off. We had a good infectious diseases doctor at that time who would touch sores on patients to show he was not afraid of them. The patients who were gay were given a hard time by the straight patients who caught HIV from injecting drugs - they felt they had 'good' AIDS and the gay men were 'dirty'.

So from that can we PLEASE use some evidence based practice and not gut or fear reactions. If you are getting your health care advice from FOX or any other media you really need to rethink your education.

[SandyB]

Emotions often win over science so I'd like to see more discussions on where and how a quarantine should be handled. If the USA gets more cases, it will happen.

What dizzygatorrn posted from the CDC makes sense. A tent is not treating someone with respect. NJ totally screwed that up.

[GrumpyRN, NP]

And this is what happens when you combine fear and ignorance;

Kentucky teacher resigns amid Ebola scare - CBS News

[TiffyRN, BSN, PhD]

We need a thread on most ridiculous Ebola overreaction. I've seen so many stories. The best so far was som teacher who was self-quarantined at home because she. . .

Wait for it. . .

VISITED DALLAS!!!!!!!!!!!!!!!

No contact with any suspected cases, no travel on the same planes, and trust me; likely no public transportation cause I think Dallas has like 2 city buses (kidding, but seriously virtually no public transportation compared to most big cities).