pattithenurse
Member
-
Joined
-
Last visited
-
-
-
-
-
Where are We Now? Here we are rounding the bend of October 2021. About 20 months into a global pandemic, healthcare has been in a strange place. While many in healthcare have worked tirelessly caring for COVID-19 patients, those with other health issues other than COVID have been put on the back burner. Although some practices have been open to all or most patients for a while, there are still some areas where finding a physician who will see you in person has been a feat. From my own personal experience, I have not been able to see my PCP for almost two years, as he is still concerned about the number of COVID-19 patients he has been treating and how many have died. He has been seeing me remotely only. When an issue arose last year with my blood pressure, which I had never had an issue with before, I was told to go to the Emergency Room at my local hospital. I was much more concerned entering an ER full of sick people than I was seeing my primary care physician in his office fully masked, seeing the risk of getting infected much lower than sitting amongst a room full of sick people. Needless to say after over two hours I called my PCP and asked him to “just call me in a prescription for something” because I could not handle another minute in this ER where no one was leaving, yet more people kept coming in. That’s typical of course in any Emergency Room, but the idea of being less than six feet from sick people in an indoor space during a second wave of the pandemic, well, that was just unnerving, to say the least. People have put off getting the medical attention that they really have needed in the past two years because of fear of contracting COVID-19. It’s a tragedy that cancers have gone undetected, heart attacks and strokes ignored, and life-saving surgeries put on the back burner. Preventative care has been just about thrown out the window. School Children and COVID-19 I am a school nurse in the city of Boston. When our students were able to return to school at least a few days a week in cohorts last year, some medical practices were still seeing pediatric patients only remotely, so a physical exam consisted of not much more than subjective data. There were no vital signs performed and vaccines were given out at separate nurse visits only. Many of these separate appointments were missed. Some students were still not being seen at all. Parents were afraid to bring their children anywhere, including to medical or dental appointments, even if they were available. So far this school year, most students have been in school full-time and mostly uninterrupted. When schools reopened, the Delta variant caused many worries about how it would play out with crowded classrooms and minimal social distancing. According to the New York Times October 7, 2021, a majority of the nations’ 50 million public school students have been in classrooms full-time and mainly uninterrupted this fall whether students are masked or unmasked, teachers vaccinated or not. Infection rates have actually declined 35 percent nationally through the month of September (NT Times, October 7, 2021). Most students have resumed in-person physical exams and routine vaccine administration. Many of our students 12 and over have received COVID-19 vaccines as well. Mitigation Strategies In Boston, Massachusetts schools, our mitigation protocols have included mask mandates for all staff and students, continued weekly pooled testing for all students whose parents have consented as well as “test and stay” for students who have been determined to be close contacts of a COVID-19 positive person. Test and stay consists of rapid antigen testing daily for one week at school for all students who are either part of a positive pool or who have been determined to have been in close contact with a positive person while in school. This has omitted the need for entire classes to be quarantined and keeps kids in school and learning. All staff working in the school must provide proof of vaccination for COVID-19 or proof of a negative PCR test weekly to stay at work or be placed on unpaid administrative leave. It is surprising to me how many staff working in schools are hesitant to vaccinate, even at the risk of losing their jobs or the need to go through the hassle of weekly testing and documentation of proof of negative COVID-19 status. Even more startling is the fact that staff are willing to risk their health and the health of others in a setting where social distancing is next to impossible. Schools are now at 100% enrollment with all restrictions lifted except masking. Persistent online disinformation has been one of the biggest obstacles throughout the vaccine rollout including unproven claims of infertility, altering of one’s DNA, and microchips being added to the vaccine. Some have religious beliefs and many just completely distrust the government or don’t believe in the science of vaccines. Let History Do the Talking Edward Jenner began his successful use of cowpox material to create immunity to smallpox in 1796. Louis Pasteur’s 1885 rabies vaccine was next to make an impact on human disease. Antitoxins and vaccines against diptheria, tetorifice, anthrax, cholera, plague, typhoid, tuberculosis and more were developed throughout the 1930s. By the mid-twentieth century, methods for growing viruses in the laboratory led to rapid discoveries including the creation of polio vaccines. This was followed by vaccine development for other common childhood diseases such as measles, mumps and rubella, which greatly reduced the burden of disease. Here we are now in 2021, still battling this pandemic. People are still dying. Some are wishing to change their minds about getting the vaccine once they become very ill, but by then it is too late. The miracle of science has given us a vaccine to prevent and even eradicate COVID-19, yet so many in America are hesitant to receive the life-saving vaccine. In a national climate fueled by politics, conspiracy theories, social media and other fears about the seemingly rapid development of a vaccine, we have become a divided nation. Why can we not look to history and science to make decisions about our health rather than seek out misinformation and folklore on the internet to keep us ever doubting this miracle of medicine? A lot has changed since the 1930s when technology was not where it is today. We never doubted the validity of vaccines then when many childhood diseases led to debilitating deformities and abnormalities or even death. School Nurses in the Spotlight of COVID-19 School nurses have been working hard and overtime consistently to make COVID-19 testing and contact tracing a success in schools while state guidelines for reducing transmission in schools have loosened. School nurses are the primary site facilitators for COVID-19 testing including symptomatic, routine pooled testing and Test and Stay. Massachusetts school nurses are reporting concerns about the health and safety of students with nurses working two jobs simultaneously possibly causing the potential for medication and treatment errors and missing acute health conditions or emergencies. This causes physical and emotional stress and burnout, resignations, early retirement, leaves of absence and taking sick days. It has become difficult to find substitute nurses willing to work with these new responsibilities in place. Some districts are even having difficulty hiring qualified school nurses who have mandatory Department of Elementary and Secondary Education licensure requirements. As a school nurse in Massachusetts, I feel the burden of this responsibility. It can be draining and exhausting. Needing to take a mental health day has been deemed nearly impossible by the lack of substitute staffing. Anxiety levels are high among many students in my K-8 school. For our most vulnerable kids already experiencing anxiety, continued mask-wearing and adherence to school protocols regarding COVID-19 are pushing their stress levels even higher. I want to be there for every one of them. I teach them stretching exercises to do in class to reduce headaches and neck and back tension, which affects every grade level. We do deep breathing exercises next to the open window outside of my office. We talk about the importance of drinking lots of water, eating breakfast and lunch, getting enough sleep, spending time in nature and staying away from screens as much as possible. These are things we talk about every day, even without a pandemic. Sometimes the conversation turns to how COVID-19 has affected us during the past almost two years. But what is always evident to me is that our youth are living in and accepting a pandemic and doing it with more grace than many of their adult counterparts. I’ve watched my four-year-old granddaughter (now 5 and in kindergarten) don a mask every day without a single complaint other than why she couldn’t have chocolate doughnuts for breakfast. An Autumn of Hope As school nurses, we need to stand strong. This is our time to show how important our jobs really are. Many of us have felt unappreciated by the medical community. We are the ones who sit in our offices waiting to put on a bandaid or take a temperature. Or so it seems to some. We have always had to justify our purpose in school buildings, particularly when nurses have been required to cover multiple schools. Now we are on the cutting edge of turning the tide on COVID-19 through educating the youth that we care for. Let’s give them the knowledge and tools they need to affect a change in the direction of this disease. Let’s persevere with confidence in the work we do every day to keep students healthy, at school and learning. They are our future and change truly starts with them. Resources: National Association of School Nurses Massachusetts School Nurse Organization New York Times The History of Vaccines / An Educational Resource by the College of Physicians of Philadelphia.
-
Draining
-
-
-
Great article Era! I love how you focused on this important element of healing. As a school nurse, I see how noise affects our students, causing everything from headaches to severe anxiety. We have many students with Autism Spectrum Disorder who are very noise sensitive. We have a "sensory room" which is padded, both for safety of the student and also as a noise barrier. Also, many neurotypical students come the to nurses' office just to spend some much needed quiet when the classrooms or cafeteria are just too rowdy. And I love your writing! Patti
-
-
-
-
-
I have been a school nurse for almost 30 years. During this time I have worked in several different school buildings, some very nice and some not so nice. In one of the schools where I was once assigned, in the small nurses' office, there was a lone broken window with a slab of metal and wood covering it to keep out the drafts. At the top of the slab of metal and wood was a small vent window with a handle that could be accessed using a large pole with a hook at the end of it. It was the only slice of daylight that entered the office and with the pole I could pull the small, hinged window open and access some fresh air. Outside of my nurses’ office was an outer area with two cots and two small bathrooms. There were no windows in either the outer area or the bathrooms, and at times it would get very stinky in that area where students would be trying to rest when they were feeling ill or waiting for a parent to come pick them up. Being a nurse and a mother, I was very particular about opening windows from time to time to “change out the air” and “get rid of all the cooties,” even on the coldest of days. The small vent in my office was utilized at least once a day to do just that, and more if a sick child had just left or the air freshener didn’t quite cut it at eliminating any foul odors in the area. I worked in this “cave” for well over a year until the school invested some money in new windows for the school building. I was so excited when I opened my office door one morning to find a brand new, large vertical window that let in plenty of sunlight and exposed a view of a lovely flowering tree outside. I was beyond delighted until I noticed that this was a fixed window that did not have a vent to open to allow fresh air in. I immediately went to my principal to politely ask why I was not given a window that could open. I stressed the importance of having at least a modicum of fresh air in the office to help get rid of germs and allow for comfort of the students in my care. She was remarkably quite amenable to my suggestions and asked that I draft a letter to the district operations department stating my case for installing a replacement window with a vent. My letter discussed Florence Nightingale’s Environmental Theories regarding the need for fresh, circulating air. I offered vignettes of Ms. Nightingale’s accomplishments during the Crimean War as she boldly advocated for supplies for her nursing team to care for ailing soldiers and the results of her concern for sanitation, hygiene, clean water and fresh air. Well, I can never be sure if it was my words or just the fact that the “powers that be” didn’t know what to do with all this information, but the following Monday I arrived at work to find that a new window had been installed in my office complete with a vent at the top to allow the fresh air in! I felt victorious, knowing that my persistence paid off, just as it did for Florence and her nursing team. The Impact of Florence Nightingale’s Environmental Theories on the Current Pandemic Florence Nightingale is considered the first nursing theorist. She believed that environment had a strong influence on patient outcomes and that people are essentially “in connection” with their environments. Proper nursing care according to Nightingale was to put the patients in the “best conditions for nature to act upon them.” Paramount to these conditions were fresh air, sunlight, warmth and cleanliness. In 1859, Florence Nightingale was the first to conceptualize nursing’s work into a theoretical framework. Although Nightingale’s Environmental Theory was presented over 160 years ago, many elements of her assumptions are still practiced today. Nightingale challenged nurses to create environments where the health of populations was a realistic expectation. She was also the first to propose that nursing required specific education and training. Evidence-Based Design Nurses play a crucial role in applying their research and data through evidence-based practice to influence the design process in hospitals and healthcare settings that promote positive patient outcomes. As nurses, we apply evidence-based design practices through case studies on reducing infection rates, particularly during the current Covid-19 Pandemic. In the Spring of 2009, the Swine Flu swept through the country causing some excitement as school nurses scrambled to find N95 masks and other PPE and closely monitored emerging cases within school buildings. I had just completed my Master’s thesis on “Pandemic Preparedness in Schools” just one year prior and I was aware of what could happen should the virus spread and mutate into something more deadly. There were many students as well as staff who were sickened with the virus and there were temporary closings of some schools for a few days or up to a week to allow for social distancing and stopping the spread of infection. Luckily, Summer break was on the horizon allowing for the social distancing needed. Later there was Ebola and then Zika Virus, both of which gave pause to again plan for isolation and mitigation strategies should these diseases become serious global threats. What I had learned from writing my paper on pandemics was that it was only a matter of when and not if something close to the unusually deadly 1918 influenza pandemic, (where it was estimated that about one-third of the world’s population became infected), could happen again. Fast forward to February 2020. Covid-19 crept into the country, seemingly slowly, yet all at once. Cruise ships. Nursing Homes. West Coast. East Coast. Europe. The entire world. Shutdowns. Lockdowns. Toilet paper shortages. Supply hoarding. Essential workers. And so it went on. We needed to find ways to Flatten the Curve, Stop the Spread. And how do we do this? Florence Nightingale knew. Care for the sick while establishing mitigation strategies such as thorough handwashing, personal protective gear, quarantines and isolation of infected persons. School nurses have worked tirelessly over the past year preparing and allowing for the safe return of students to school. We have collaborated with facilities management to provide adequate ventilation systems including HEPA filters in every classroom and office area. Medical waiting rooms have been established with an emphasis on social distancing and proper isolation procedures for sick students. PPE for nurses, such as gloves, gowns, face shields, surgical and N95 masks have been procured and hand washing stations have been installed at key places throughout buildings. School nurses have assumed roles as teachers and counselors, reassuring staff and students and providing up-to-date knowledge and information about current national and local protocols and procedures, mitigation strategies, contact tracing, travel guidance and Covid testing sites. Nurses have acted as Covid-19 test site coordinators in schools by implementing weekly in-house PCR testing for staff and running weekly Pool Testing for students to provide district-wide surveillance of Covid-19 infection rates among student populations. We have advocated for and provided information regarding Covid-19 vaccines for our staff and helped them to weigh the safety and efficacy of the vaccines vs side effects by keeping our knowledge current through many professional development offerings and other training. Overall, school nurses have served as key players as part of a multidisciplinary team approach to design safe and healthy school environments for our staff and students during this pandemic. In 1860, Florence Nightingale published “Notes on Nursing: What it Is and What it Is Not.” She discussed her environmental theory, citing a multi-faceted approach to healing stressing the importance of fresh air, natural light, clean water and sanitation, a healthy, varied diet along with environmental stimuli such as colorful flowers and plants to keep the mind stimulated. Her theories aim to provide the best possible chance of recovery for patients. Nightingale believed in treating the whole person, taking into consideration not just the body, but the mind and spirit as well. It is my belief that Ms. Nightingale, our first mentor and founder of nursing practice would be impressed with how the nurses of our generation have stepped up and shown their worth by being fearless warriors in the fight against Covid-19. She would marvel at stories of nurses acting not only as the trained medical professionals that they are, but also as teachers, counselors, listening ears, hand-holders, family caretakers, and overall guardian angels in this time of a global health crisis. References Gonzalo, Angelo. "Florence Nightingale: Environmental Theory." www.nurselabs.com Nightingale, Florence. "Notes on Nursing: What It Is and What It Is Not."
-
