Nursing & Ebola Surveillance

allnurses Guide · Oct 3, 2014

I think OUR role as nurses is to find out whether our employer has an emergency disaster plan. Then we need to ensure all staff are educated on the plan.

We need to educate ourselves so we can educate the public ASAP.

RN Survey Says Hospitals Fall Far Short in Emergency Planning as First Ebola Case Reported in the U.S.
In the wake of the first confirmed case of a patient in the U.S. who has been infected with the Ebola virus, the largest U.S. organization of nurses today warned that U.S. hospitals are far from ready for the Ebola outbreak, are sorely lacking in other disaster planning, and everyone needs to do more to stop Ebola.
Several weeks ago, National Nurses United (NNU) began surveying registered nurses across the U.S. about emergency preparedness. In preliminary results from more than 400 RNs in more than two dozen states released today:
* More than 60 percent of RNs say their hospital is not prepared for the Ebola virus.
* 80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
* 85 percent say their hospital has not provided education on Ebola
* 30 percent say their hospital has insufficient supplies of eye protection (face shields or side shields with goggles) and fluid resistant gowns
* 65 percent say their hospital fails to reduce the number of patients they must care for to accommodate caring for an "isolation" patient
Just last week, more than 1,000 U.S. RNs, joined by nurses and other health workers from around the world, held a die-in on the strip in Las Vegas to register their concern about inadequate preparation in U.S. hospitals, as well as calling for a significant escalation in global efforts to stop the Ebola outbreak in West Africa...
... "This potential exposure of patients and healthcare workers demonstrates the critical need for planning, preparedness and protection at the highest level in hospitals throughout the nation," says Bonnie Castillo, RN, director of NNU's Registered Nurse Response Network, which is coordinating the RN response.
"The clock is ticking. It is long past time to act," Castillo adds. Preparedness for disease outbreaks is a long standing problem, note the nurses, citing the death of a U.S. nurse in a California hospital infected during the H1N1 outbreak in 2009.
NNU is calling for:
* All U.S. hospitals to immediately implement a full emergency preparedness plan for Ebola, or other disease outbreaks. That includes full training of hospital personnel along with proper protocols and training materials for responding to outbreaks, adequate supplies of all personal protective equipment, properly equipped isolation rooms to assure patient, visitor and staff safety, and sufficient staffing to supplement nurses and other health workers who need to care for patients in isolation.
* Significant increases in provision of aid, financial, personnel, and protective equipment, from the U.S., other governments, and private corporate interests to the nations in West Africa directly affected to contain and stop the spread of Ebola.
* Proper funding of international disaster relief and global health agencies whose budgets have been cut as a result of austerity measures implemented by the wealthiest nations.
* Stepped up action on the climate crisis which has contributed to the spread of disease outbreaks. Scientific American in 2008 named Ebola, which is directly affected by drought-related deforestation, as one of a dozen epidemics likely to be spurred by climate change...
http://www.infectioncontroltoday.com...in-the-us.aspx

chiandre · Oct 4, 2014

Today, my hospital's leadership decided to use the CDC Ebola Virus Disease Algorithm in case of any outbreak.

http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf

Just like the HIV epidemic, I am confident that this outbreak will be contained.

RNMA15 · Oct 7, 2014

Thanks for that article @ herring_RN, its quite eye opening, and hope this info will provide basis for improving preparedness.

RNMA15 · Oct 7, 2014

Great, @Chiandre, thanks for sharing that algorithm!

True, every infectious disease comes to some level of containment, eventually. However, how fast and efficiently it is tackled does affect the extent of "collateral damage," which often lasts much longer, even forever after.

TC3200 · Oct 9, 2014

So, the first US Ebola patient visits the hospital, informs the nurse he has recently traveled from West Africa- the epicenter of the deadly Ebola epidermic, and is sent home on antibiotics. According to Hospital sources, this information failed to reach all concerned. Random public reactions include calls to stop flights from the region. Some blame the hospital for missing the opportunity to contain the infection 2 days earlier. What do we learn about surveillance as nurses, global health, international travel & deadly infections. What is your individual role as a nurse in helping communities and individuals understand Ebola? Have you taken time to understand it enough?

Did the hospital even have enough grounds to detain or admit him at that first visit? Apparently not, or they would have done it or at least called the CDC for advice. Hindsight is always 20/20. I'm disturbed by just how much criticism is being leveled at the hospital and just how little is being leveled at the now-deceased Thomas Eric Duncan. Hospitals and medical personnel are not mind-readers. And they are hobbled by Administration's insistence on pleasing the patients and getting good customer satisfaction ratings. Thomas Eric Duncan knew EXACTLY where he was in the weeks prior to being admitted, he knew he'd been toting around a now-deceased pregnant woman age 19 who died of EBOLA! Ebola, no doubt about that whatsoever! Yet he failed to be completely open and totally honest with the healthcare personnel. If he'd called the hospital ahead, or, hey, even called the CDC about himself, and said "I really think I have ebola and here is why I think that..." his case would have been handled differently. But Duncan apparently danced around the issue and presented insufficient grounds for the hospital to either admit him and/or report him to the CDC. And y'know, considering that hospital was probably unprepared for this scenario and didn't have dedicated isolation facilities to handle it, I can see where the admins' push for customer satisfaction and the insider's information re. lack of appropriate facilities and also the realization that they don't want to expose all the OTHER patients there to ebola, made a perfect storm, a no-win situation. If they had insufficient grounds to call it ebola and to detain him, they had to let him go. And it's all because Duncan didn't tell the whole truth.

(Then when they had to admit him, they apparently created an isolation unit out of one entire floor?? That's what think I read, anyhow.)

Mr. Duncan seems to be a bit of a shady character. Supposedly he came to USA to marry his old girlfriend. Maybe I am projecting too much into the snippets reported in the news, but I suspect he was a bit of a shyster and he wanted to bail out of Liberia and find a place in the USA real fast. So he might have called up the mom of his now-grown son an given her a real song and dance just so he had a place to run to when he left Liberia. Heck, maybe Duncan knew he was going to die anyway, so he thought he'd come to America and take as many Americans as possible along with him!

Now, here's what I think: Now we have all started to see and further imagine what sacrificing too much control on the altar of customer satisfaction gets us. Hospitals, if they are smart, will use this ebola incident as grounds to jerk that power back into their own hands, protect their own valuable and skilled employees from death and physical harm that rolls in via jerks like Thomas Eric Duncan, and start running their medical facilities like disease-fighting institutions again, and tell patients "MY way or the highway. Take your pick. It's a hospital, not a hotel. Here are the rules. We make them; you don't."

One of the things that really ground my gears as student nurse, and that, bluntly, caused me to bail out of nursing, was what I still consider inadequate personnel protection and lack of regard for my own personal health and safety. If I had stayed the course and completed the program and become an R.N., I would be leaving the profession right about now because I do not place the patient satisfaction above my (and my friends and family) own personal health and safety. Nobody can look out for Number 1 like Number 1, Nurses. Remember that.

RNMA15 · Oct 12, 2014

Interesting take, @ TC3200! Personally, I wouldn't like to blame individual nurses or hospitals, or even the patient himself, because it does not help! If Duncan- whatever his personal life is- should take any blame, so should the Americans trekking to the danger zone knowing they might contract the disease and infect others when they come back, and so should the American citizen who introduced Ebola to Nigeria, potentially putting at risk Africa's most populous country!- it doesn't make sense, because people have the right to travel to & fro as they please, and they will. Duncan was not illegally in the country either, and its unclear that he even knew the woman he had helped in Liberia was a case of Ebola- It has been reported she was initially diagnosed as a Malaria case! He (Duncan) had secured the visa to visit the USA long before his contact with Ebola!

The point of interest here is that this case has brought to our attention just how unprepared the system was for this well media-hyped possibility! In a globalized world, diseases are going to cross borders, and we need to learn from this experience just how deadly things can turn out. If anything, the "migration" of Ebola has exposed just how unprepared the world is for deadly epidemics, and just how inadequate our healthcare systems are in the face of 21st century realties, even as we gasp at the broken systems in the epicentre!

As a Global Health & Medical Anthropology enthusiast and student (and Med-Surg nurse) I see an opportunity for nursing to play a bigger role in modern day global health than we are. The importance of our role has clearly been hilighted in both the USA and Spanish Ebola cases' management. What I find most astounding is the silence from the nursing profession- the scholars, the professional and academic pros have been eerie absent from the debates in which their own have been centre & front! As far as I see, whether it be in west Africa, Spain or USA, nursing is the most "endangered species" within the global broken healthcare systems in this epidemic, and we should have a voice…. Well- leave it to CDC!

RNMA15 · Oct 13, 2014

Finally, Nursing speaks, and CDC apologizes=thats what I am talking about! We need some visibility, and support from our "Generals!"

Nurse union defends Dallas Ebola patient | MSNBC

PrayeRNurse, ASN, RN · Oct 14, 2014

I think all nurses should be offered Ebola training. Today if you are headed to Africa to care for patients you receive training from the CDC. If you are a nurse in the states it seems more difficult to find. I am a nurse who provides care in the community with no training from a hospital. If Ebola spreads like the news just reported every nurse in America should have the training.

Side note; my local news has labeled the American nurse a hero! I agree.

elkpark · Oct 14, 2014

Did the hospital even have enough grounds to detain or admit him at that first visit? Apparently not, or they would have done it or at least called the CDC for advice. Hindsight is always 20/20. I'm disturbed by just how much criticism is being leveled at the hospital and just how little is being leveled at the now-deceased Thomas Eric Duncan. Hospitals and medical personnel are not mind-readers. And they are hobbled by Administration's insistence on pleasing the patients and getting good customer satisfaction ratings. Thomas Eric Duncan knew EXACTLY where he was in the weeks prior to being admitted, he knew he'd been toting around a now-deceased pregnant woman age 19 who died of EBOLA! Ebola, no doubt about that whatsoever! Yet he failed to be completely open and totally honest with the healthcare personnel. If he'd called the hospital ahead, or, hey, even called the CDC about himself, and said "I really think I have ebola and here is why I think that..." his case would have been handled differently. But Duncan apparently danced around the issue and presented insufficient grounds for the hospital to either admit him and/or report him to the CDC. And y'know, considering that hospital was probably unprepared for this scenario and didn't have dedicated isolation facilities to handle it, I can see where the admins' push for customer satisfaction and the insider's information re. lack of appropriate facilities and also the realization that they don't want to expose all the OTHER patients there to ebola, made a perfect storm, a no-win situation. If they had insufficient grounds to call it ebola and to detain him, they had to let him go. And it's all because Duncan didn't tell the whole truth.
(Then when they had to admit him, they apparently created an isolation unit out of one entire floor?? That's what think I read, anyhow.)
Mr. Duncan seems to be a bit of a shady character. Supposedly he came to USA to marry his old girlfriend. Maybe I am projecting too much into the snippets reported in the news, but I suspect he was a bit of a shyster and he wanted to bail out of Liberia and find a place in the USA real fast. So he might have called up the mom of his now-grown son an given her a real song and dance just so he had a place to run to when he left Liberia. Heck, maybe Duncan knew he was going to die anyway, so he thought he'd come to America and take as many Americans as possible along with him!
Now, here's what I think: Now we have all started to see and further imagine what sacrificing too much control on the altar of customer satisfaction gets us. Hospitals, if they are smart, will use this ebola incident as grounds to jerk that power back into their own hands, protect their own valuable and skilled employees from death and physical harm that rolls in via jerks like Thomas Eric Duncan, and start running their medical facilities like disease-fighting institutions again, and tell patients "MY way or the highway. Take your pick. It's a hospital, not a hotel. Here are the rules. We make them; you don't."
One of the things that really ground my gears as student nurse, and that, bluntly, caused me to bail out of nursing, was what I still consider inadequate personnel protection and lack of regard for my own personal health and safety. If I had stayed the course and completed the program and become an R.N., I would be leaving the profession right about now because I do not place the patient satisfaction above my (and my friends and family) own personal health and safety. Nobody can look out for Number 1 like Number 1, Nurses. Remember that.

Wow, you certainly have a lot of thoughts about this. Too bad that several of them are counterfactual.

In the first place, Mr. Duncan couldn't have just hopped on a plane and come to the US. It takes months for US visas to be worked out. His trip to the US must have been planned long in advance, and coincidence that the Ebola outbreak had started at about the same time. He and his girlfriend had been involved for decades (they have a college-age son), and multiple people have reported that he was, in fact, coming here to plan their wedding.

It has also been widely reported (now that the initial panic is starting to die down) that there is no evidence that he knew he had been exposed to Ebola before leaving Liberia. He helped a pregnant woman in his neighborhood to the hospital and back home again when she wasn't admitted, but multiple witnesses have reported that there was no knowledge at that time that she had Ebola; her acute problems were believed/assumed to be complications of her pregnancy, and no one was concerned about Ebola until after she was dead (and Mr. Duncan had already left the country). He was not sick at the time he got on the plane, and, in fact, passed the mandatory health screening in the Liberian airport prior to being allowed to board.

Even if your suspicions were true, do you really believe that, if he knew he had been exposed to Ebola, he would voluntarily choose to expose his fiancee' and his own child?? If he were really attempting to simply escape Liberia, he could have done that without exposing his family members and loved ones. It's been reported since his death that, once he was diagnosed, he said that, if he had known, he never would have exposed them, he would have just stayed in Liberia and taken his chances (of course, you can choose not to believe that, either).

As for him being a "jerk" and a "shady character," all the reporting I've read of accounts by people who actually knew him have said just the opposite; that he was a warm, kind, caring person who went out of his way to help others.

I've gotten say, you sound pretty paranoid about this. I'm glad to hear you've decided against nursing as a career.

What We Know About Thomas Eric Duncan, The First Ebola Patient Diagnosed In The U.S.

MedChica · Oct 14, 2014

I havent taught anyone anything. I have refreshed my memory on the disease, though.

Nursing unions are FINALLY maling themselves seen. 'Bout time.

I cant stomach the media and I'm over this govt so I'm usually uninformed (LOL) and completely indifferent about it. I've been paying a bit more attn lately.

Ive read suggestions of a "buddy system" in one article and aa few echoes in the comment sections. I dont know how anyone expects that to happen. I don't know how a journalist cld suggest it with a straight face.

Most facilties don't have the staffing for that. Where I am, most of the hospitals run skeleton crew like the LTCs. Weve had 3 LVNs in the last two months from one hospital in particular. They come to LTC thinking that itll be easier but its kinda same - cept the pts are less critical, the pt load is heavier, you have to manage other depts and practically "parent" the bulk of your aides.

Either way, it's an opportune time to bring this up again now that the union has the media's full attn and public support is on our side (or will be).

Nurseeverywhere, CNA, LVN · Oct 14, 2014

@Tc3200 I agree with you that he is to blame for bringing Ebola here. Whether he could jump on a plane or it took him months to receive the pass to board a plane and come here, he shouldn't of. Plain and simple. Yes the hospitals are unprepared also. But really I question whether or not he knew he was at risk. Will we ever know? Probably not. All we can do is figure out how to keep it from spreading. I am a pre nursing student but this will not deter me from my dream career!