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  1. Jessica Quigley

    Nerve Racked Nurses During the Ebola crisis

    Nursing has always been known as a selfless profession. Those who decide to delve into the jungle of chaotic madness know that there are no real guarantees. Your day at work will be only as good as it can be at any given time depending on a variety of factors. Are you prepared? If so what does that mean? Do you have the skills necessary to assess the patient in the triage room down the hall? Are you geared up to battle any organisms you might encounter? Do you have knowledge and quick wit on your side when their time is running out? Will you leave emotions and fear at home and embrace practicality and protocol? For many nurses the recent Ebola crisis has left them questioning their loyalty to their profession, feeling discouraged by their organizations, and scared for their loved ones. A few weeks ago my 13 year old son called me at work to alert me that he had just read on the internet that it had finally happened: Ebola had caused the first Zombie Outbreak! He further went on to comment how he was happy I was safe at my hospital. After educating and reassuring him that there indeed was not a Zombie apocalypse occurring, I hung up with my son. It is then that a thought struck me. Was I safe at my hospital? Did I have the proper knowledge or equipment to assess and treat potential Ebola patients? What would I do in this situation? Knowing that like many hospitals at that particular time mine did not have an exact protocol yet for the Ebola outbreak, I quickly attempted to come up with a haphazard plan of what I may do. At the end of my 10 minute brainstorm I had produced quite a lot of anxiety and stress within myself. The results of recent surveys show that over 85% of nurses are still waiting to be properly trained to meet the needs of the Ebola crisis. Lack of communication related to facility policies, insufficient and /or improper supplies for personal protection, and ill equipped environments/ isolation concerns have left nurses without the necessary armor and ammunition to combat this terrifying outbreak. In light of the inadequate resources that nurses have been faced with, high levels of tension and fear continue to build. For some nurses it may be as minor as slight apprehension or second guessing their current level of safety in clinical practice. For others the scarcity of consistent information and a secure game plan, set forth by their facility, has caused them to experience emotional distress. Loyalty not only to their workplaces but also the commitment to above all care for our patients first has been tested. Nurses have gone public to voice physical concerns such as acute anxiety/panic reactions as well as chronic appetite and sleep changes/nightmares. Fatigue, lack of concentration, and changes in mood or temperament, were also likely to be common symptoms among those nurses feeling overwhelmed by the current Ebola crisis. What do our nurses need? Besides education and resources in the workplace, support by administration and colleagues is a must. Crisis Debriefing amongst workgroups is crucial. On site stress relief programs should be implemented to assist nurses in resolving any negative stress response and promoting positive work /life behaviors. Services such as Employee Assistance Programs must be made available to nurses that may develop more complicated/chronic symptoms. Support of Nurse Unions and Organizations is vital to the long term success of nurses staying positive and healthy during this and other similar catastrophic situations. Nurses need to be advocates for themselves and each other. Be cognizant of the signs of increased stress amongst co-workers and the steps you can take to help. It is often in these times that nurses are looked past, and it is assumed that they will forge on unaffected. It becomes so easy to forget that they too are along for the ride. Flight attendants have long told us to put the oxygen on ourselves before attempting to save anyone. The next time you are running for a tank, remember to take a few breaths or liters for yourself. Even the most experienced, prepared nurse can feel tension and stress when severe crisis such as the Ebola outbreak strikes. Facilities must take quick actions to ensure that the proper plans and resources are in place to protect nurses. When faced with high stress situations and unsafe working conditions, loyalties can be tested. Nurses must form strong unions amongst themselves and advocate for ways organizations can better help them to help others. References cdc.gov nationalnursesunited.org washingtonpost.com
  2. Lynda Lampert, RN

    Five Positive Impacts of the Ebola Crisis

    Actually, some good has come out of the Ebola scare, and nurses can use this opportunity to educate the public about disease. It may never infect a lot of people in America, but it can lead to positive impacts that will affect the country for a long time. Attention Brought to the State of Healthcare in Africa Africa is a hotbed of infectious disease. AIDS has run rampant there for years, and most of the first world has ignored it. Now, Ebola is devastating a few small countries in West Africa, and they have the focus of the world on them. The people in these countries usually live in squalor with very little concern for the hygiene that is so common in more advanced countries. If the news has done anything, it has made people aware of the problems in Africa, and this is a positive impact. Americans and other members of the global community should know the horrors of Africa and take steps to do something about them. People are dying and suffering. It isn't just about protecting our borders from disease, but about helping those who don't have the resources we have. If Ebola opens the eyes of the sleeping public to the health care problems of Africa, then perhaps those people didn't die in vain. Opportunity to Educate Patients about Disease Transmission Ebola is causing panic because the general public does not understand disease transmission. Fortunately, it is only communicated via bodily fluids, such as blood, saliva, urine, semen, and so on. If it was airborne, the panic would be more understandable because it would have the ability to transfer from one person to another very quickly. And we have experience with containing airborne diseases, such as TB and H1N1, that the general public may not know about. This gives nurses and other health care providers the ability to teach the public about how diseases are transmitted. Doctors can go on CNN and spread the word about how bacteria and other infectious agents are spread. This will help to decrease panic and give the public an idea of how diseases really work. Even as a floor nurse, you can use this panic as a teaching point to illustrate to patients how important it is to maintain hygiene and prevent the spread of other infections. An Increased Awareness Disease Prevention Hand washing, covering your cough, and maintaining good disease hygiene are important points to know in preventing the spread of infection. Unfortunately, not enough people know about how to prevent it, and that leads to diseases, such as the flu, cold, and pneumonia, transmitting rather quickly through populations that live in close proximity. The outbreak of Ebola may encourage patients to seek ways to protect themselves from germs, and this can help in the prevention of many other diseases. If more people wash their hands, then the transmission of disease would greatly decrease. Due to panic over Ebola, the public will be more interested in the steps to take in preventing disease, and this gives nurses the prime opportunity to teach. For those at risk of disease transmission, such as the very young and the elderly, this could help to prevent devastating diseases that could save lives. Public Awareness of the Risks Healthcare Workers Endure We've all heard the stories of the nurses quarantined for possible Ebola. Considering that nurses always use universal precautions, the risk of transmission is rather low, though possible. That said, though, the public doesn't realize what we go through as health care providers. It isn't only Ebola that we face, but TB, MRSA, C-Diff, and any number of other infectious diseases. Nurses are at risk, and no one seems to know or appreciate that. With the craze over Ebola, however, the public can come to appreciate what we do and the risks we take for their health. Is it any wonder that nurses were at the center of the Ebola outbreak? We are literally on the front lines of infectious disease, and not many in the public realize that we put our health on the line. This is another education point about the selflessness of nurses and can possibly increase the appreciation of what we face every shift. Proof of America's Ability to Contain a Potential Pandemic Regardless of your feelings about the government, the reaction to Ebola was aggressive and effective. It didn't spread beyond a handful of people, and this is a great example of how the country is prepared for issues, such as pandemics. It can help the public feel more confident in the government's response should a more aggressive disease become a problem in the country. Now, the government has dropped the ball on many occasions, but in this instance, the response was up to standards. The CDC and the agencies that dealt with this crisis kept the disease under wraps, and that should give both health care providers and the general public some measure of confidence in how the government reaction to infectious disease is controlled. It is peace of mind to realize that perhaps a pandemic would not so easily take hold in the US, and that can help to soothe panic in the future.
  3. tnbutterfly - Mary

    CDC Unveils New PPE Guidelines for Ebola

    On Monday evening, October 20, the US Centers for Disease Control (CDC) unveiled new PPE recommendations for healthcare workers who will be dealing with Ebola patients. The new guidelines reflect the protocol practiced in Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center. The new guidelines focus on specific personal protective equipment for health care workers and "offers detailed step by step instructions for how to put the equipment on and take it off safely." While the main change is no exposed skin, there are two options for respiratory protection. At a media telebriefing, CDC Director Tom Frieden said of the initial Ebola recommendations released on August 1, 2014: "The bottom line is that the recommendations didn't work for that hospital," "[T]he new PPE recommendations are designed to increase the margin of safety for frontline health workers and reflect an expert consensus." The enhanced guidance is centered on three principles: All healthcare workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systemic manner No skin exposure when PPE is worn All workers are supervised by a trained monitor who watches each worker taking PPE on and off. Principle #1: Rigorous and repeated training Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step donning and doffing of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations. Principle #2: No skin exposure when PPE is worn Given the intensive and invasive care that US hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn. CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single use disposable full face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes: Double gloves Boot covers that are waterproof and go to at least mid-calf or leg covers Single-use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without an intergraded hood. Respirators, including either N95 respirators or powered air purifying respirator(PAPR) Single-use, full-face shield that is disposable Surgical hoods to ensure complete coverage of the head and neck Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability, healthcare personnel familiarity, comfort and preference while continuing to provide a standardized, high level of protection for healthcare personnel. The guidance includes having: Two specific, recommended PPE options for facilities to choose from. Both options provide equivalent protection if worn, donned and doffed correctly. Designated areas for putting on and taking off PPE. Facilities should ensure that space and layout allows for clear separation between clean and potentially contaminated areas Trained observer to monitor PPE use and safe removal Step-by-step PPE removal instructions that include: Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment [*]Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE. Principle #3: Trained monitor CDC is recommending a trained monitor actively observe and supervise each worker taking PPE on and off. This is to ensure each worker follows the step by step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real-time and immediately address. PPE is Only One Aspect of Infection Control It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including: Prompt screening and triage of potential patients Designated site managers to ensure proper implementation of precautions Limiting personnel in the isolation room Effective environmental cleaning Think Ebola and Care Carefully The CDC reminds health care workers to "Think Ebola" and to "Care Carefully." Health care workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, unexplained hemorrhage. If the patient is under investigation for Ebola, health care workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and to ensure standardized protocols are in place for PPE use and disposal. Health care workers should not have physical contact with the patient without putting on appropriate PPE. CDC's Guidance for U.S. Healthcare Settings is Similar to MSF's (Doctors Without Borders) Guidance Both CDC's and MSF's guidance focuses on: Protecting skin and mucous membranes from all exposures to blood and body fluids during patient care Meticulous, systematic strategy for putting on and taking off PPE to avoid contamination and to ensure correct usage of PPE Use of oversight and observers to ensure processes are followed Disinfection of PPE prior to taking off: CDC recommends disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment. Additionally, CDC recommends disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE. Due to differences in the U.S. healthcare system and West African healthcare settings, MSF's guidance recommends spraying as a method for PPE disinfection rather than disinfectant wipes. Five Pillars of Safety CDC reminds all employers and healthcare workers that PPE is only one aspect of infection control and providing safe care to patients with Ebola. Other aspects include five pillars of safety: Facility leadership has responsibility to provide resources and support for implementation of effective prevention precautions. Management should maintain a culture of worker safety in which appropriate PPE is available and correctly maintained, and workers are provided with appropriate training. Designated on-site Ebola site manager responsible for oversight of implementing precautions for healthcare personnel and patient safety in the healthcare facility. Clear, standardized procedures where facilities choose one of two options and have a back-up plan in case supplies are not available. Trained healthcare personnel: facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment. Oversight of practices are critical to ensuring that implementation protocols are done accurately, and any error in putting on or taking off PPE is identified in real-time, corrected and addressed, in case potential exposure occurred. Source: Centers for Disease Control and Prevention
  4. ElizabethStoneRN

    Ebola: What About The Children?

    A wake up call spurs many questions With the recent news of a 5 year old in New York being tested for EVD, many questions are now raised for emergency nurses nationwide, because the evidence-based recommendations and decision rules that we take for granted don't exist to guide the treatment of a child with EVD. How likely is it that this child in New York, or another child in the U.S., will have EVD? Would a child present with the same symptoms as an adult? How would treatment need to be modified for pediatric patients, who are already at a higher risk for hypovolemia and electrolyte abnormalities, two of the most common complications of EVD? And how in the world would we as nurses provide developmentally appropriate support and care for a child if they required strict isolation and had to be separated from their family? Pediatric emergency nurses embrace the concept of family at the bedside and involve them in patient care, even during critical situations. Pediatric patients with infectious diseases that require isolation are almost always isolated along with a family member. However, it is currently not clear as to whether parents or caregivers would be placed in isolation with a child infected with EVD.1 Forcing family members to be separated from a terrified, ill child is something I hope I never to have to do. It is something I'm not sure I could do. In light of this current outbreak of EVD, which the World Health Organization (WHO) has declared to be a Public Health Emergency of International Concern2, I decided that I wanted to see what I could find online regarding EVD in children. How common is EVD in pediatric patients? The "data" that we have grown to rely upon in healthcare is scarce for EVD, because until now, EVD outbreaks have only occurred in isolated, resource-poor areas with very little capacity for data collection or research. The current outbreak, which is the largest in history, actually began in a pediatric patient. "Patient zero" (the initial case) for the current outbreak of Ebola is believed to be a 2 year old child who died in Guinea in December 2013.3 In past outbreaks and in the current one in Guinea, based on available data, children and adolescents have accounted for a relatively small number of infected individuals, ranging from 9% to 18% of total confirmed cases.4 One factor believed to contribute to this is the fact that children in this outbreak were often kept away from sick family members. Caregivers for those who were infected were almost always adults, both at home and in the hospitals. However, among those children who did contract EVD in at least one earlier outbreak, those It is not uncommon for infectious diseases to vary in severity depending on the age of the patient.6 One example of this is tuberculosis, which affects children and adolescents to a milder degree than it does adults. Based on the available literature, this may be the case with EVD. Many children, for example, seem to be spared from the hemorrhagic manifestations of EVD. In the 2000-2001 Ugandan outbreak, the largest outbreak on record to that date, 100% of the children infected had fever but only 16% had hemorrhage.4 This is less than half the typical rate of hemorrhagic manifestations in EVD-infected adults (30-40%).7 Nursing Considerations Children with EVD initially present with similar symptoms as adults with EVD. These symptoms may include fever, headache, abdominal pain, myalgias, vomiting and diarrhea, similar to many other common childhood illnesses. This highlights the importance of obtaining a travel and possible exposure history on every patient, including children. Health care professionals should continue to maintain a high index of suspicion for EVD when evaluating ill children from the high risk regions, but remember to also consider the other common diseases which are endemic in West Africa such as malaria, measles, and typhoid fever4. Fortunately, we are learning more about EVD with every case that is diagnosed in the United States, because our nation has the resources to collect extensive data. Healthcare and professional organizations are already utilizing this data to produce the most up to date guidance for front line emergency healthcare providers. A new, concise CDC algorithm, "Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present With Possible Ebola Virus Disease",8 was developed by an American College of Emergency Physicians (ACEP) expert panel which included representation by the Emergency Nurses Association (ENA), my professional organization. We don't have all the answers, especially when it comes to pediatric EVD care, but we already have access to more information than just one month ago. If a child presents to my emergency department with symptoms and risk factors for EVD, I will now feel a little more informed, and a little more confident that we are not simply "winging it". Most of the resources below are available online, free of charge. Elizabeth Stone Griffin, MSN, RN Pediatric Emergency Nurse References / Resources 1. Byington, C. Ebola and children: identifying and meeting their needs. AAP News, originally published online October 17, 2014. Accessed from AAP News on October 28, 2014 2. World Health Organization. WHO statement on the Meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa. WHO | World Health Organization 3. Baize S, Pannetier D, Oestereich L, et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med. 2014;371(15):1418-1425. 4. Peacock G, Uyeki TM, Rasmussen SA. Ebola Virus Disease and Children: What Pediatric Health Care Professionals Need to Know. JAMA Pediatr. Published online October 17, 2014. doi:10.1001/jamapediatrics.2014.2835. 5. United Nations International Children's Emergency Fund. UNICEF Guinea: Humanitarian Situation Report, 29 August 2014. September 5, 2014. UNICEF Guinea: Humanitarian Situation Report, 5 September - Guinea | ReliefWeb. Accessed October 28, 2014 6. McElroy AK, Erickson BR, Flietstra TD, Rollin PE, Nichol ST, Towner JS, et al. Biomarker correlates of survival in pediatric patients with Ebola virus disease. Emerg Infect Dis [internet]. 2014 Oct [obtained 10/27/2014]. Biomarker Correlates of Survival in Pediatric Patients with Ebola Virus Disease - Volume 20, Number 10—October 2014 - Emerging Infectious Disease journal - CDC doi: 10.3201/eid2010.140430 7. McElroy, A. and Spiropoulou, C. Correspondence. Journal of Infectious Diseases Advance Access published September 24, 2014. Accessed online 10/28/2014: Reply to Fedson 8. Centers for Disease Control and Prevention. Identify, isolate, inform: emergency department evaluation and management of patients with possible ebola virus disease. Accessed online 10/28/2014: Redirect| Ebola Hemorrhagic Fever | CDC
  5. With all of the negative news surrounding Ebola, it is hard to find any positives that are being reported. I found some light when I read a story from Cheryl Rand, a Registered Nurse who works in the BioContainment Patient Care Unit at the Nebraska Medical Center. Cheryl was part of the original committee that developed policy and procedures for the BioContainment Patient Care Unit eleven years ago. What is a BioContainment Patient Care Unit you might ask? This very specialized type of medical unit is currently only located in four hospitals in the United States. The hospitals that contain BioContainment Patient Care Units are: Emory University Hospital in Atlanta, Georgia National Institutes of Health in Bethesda, Maryland St. Patrick Hospital in Missoula, Montana Nebraska Medical Canter in Omaha, Nebraska According to Dr. Phillip Smith, the Medical Director for the BioContainment Patient Care Unit at the Nebraska Medical Center, the unit was originally designed for agents of biological terrorism. Specifically, Dr. Smith mentions: weaponized Ebola, weaponized plagues and Small Pox. Even though this was the original intent for the creation of this unit, they are also able to handle medical conditions like SARS and the Avian Flu. Those are some horrific diseases, but Cheryl states that when she gets asked if she feels safe working on the BioContainment unit, "Without hesitation" she reports, "Yes. I feel very safe." This statement is then followed with, "We have the proper procedures and protocols in place that have been developed, tested and rewritten (as needed) for our utmost safety." Along with this Cheryl also gets praise from her family saying that they are "very proud of what I do" and from those who do not work in the BioContainment unit, she also receives "thanks" from. Cheryl states that all of this "really makes me feel good about coming to work." As a nurse, the words that Cheryl has to say about how she feels safe working in the BioContainment unit are extremely reassuring. This eases my mind and gives me hope that yes, this can be done properly and yes, you can feel safe if properly trained and all of the proper policies and procedures are in place. With all of that being said, now as nurses, we have to hit the ground running and get to work. Become energized through Cheryl's story and use that motivation to create more light and positive news in this time of doom and gloom. We cannot change and have no control over the events that have already occurred, but we can ensure that the same mistakes do not happen again. I believe as nurses we can make this happen, but I think we might need a little help from our inspiring nursing colleague in Nebraska. Cheryl, I have a call to action for you. Is there any way you can help your fellow nurses out by sharing the exact policies you have helped create for the Nebraska Medical Center's BioContainment Patient Care Unit? Nebraska Medical Center, can you help Cheryl out with this and give her a platform to help educate the nurses of America? I believe that all of the nurses and hospitals in America would benefit from knowing the exact, in black and white, policy and procedures that the hospital has written for the care of an Ebola patient. This would allow hospital committees to have a concrete road map for implementing proven policy and procedures. Along with giving nurses and healthcare professionals the ability compare and contrast the new CDC guidelines to those outlined for the BioContainment Patient Care Unit staff. This side-by-side analysis would allow for identification and further corrections of any gaps in the new CDC guidelines. Through this process, it would give reassurance and restore some faith to healthcare professionals that the highest level of protection and education is being recommended. With all of that being said, I want to thank Cheryl, the Nebraska Medical Center's BioContainment Patient Care Unit staff and all of the healthcare professionals at all of the hospitals that are ready and willing to help those who are battling Ebola. In my book, all of you are heroes and professionals that I look up to. Keep up the strong work; none of it is going unnoticed. Michael M. Heuninckx RN-BSN To read the original article featuring Nebraska Medical Center's BioContainment Patient Care Unit Nurse, Cheryl Rand, please read: Omaha Nurse Who Wrote Policies for Biocontainment Unit Initially Nervous about First Ebola Patient For the entire interview with the Medical Director of the BioContainment Unit at Nebraska Medical Center, Dr. Phillip Smith, watch the following YouTube video:
  6. Jacqueline.Damm

    What Ebola Has Done for Nursing

    When the accusatory headlines rang out about Dallas the nursing population of the World ignited into a burst of support. As nursing students we began our career instilled with a sense of protection and pride that reaches further than our daily patient assignments. This incredible characteristic presents as a suit of armor enabling us to educate, medicate, encourage and assist in the healing of those who come into contact with our holistic focus. As soon as our integrity becomes threatened or questioned, that armor shifts into a wild beating heart open and exposed to the World unashamed of that resounding pride. Ebola has presented numerous concerns for the nursing population and the World at large. The story that isn't being told rings with positivity and unity, power and enforcement. It all began with a voice brave enough to contest to accusations when our popular media had no other goal than to slander the nursing profession in a time of need. Few disgruntled voices have grown into an international outcry from nurses across the globe thus awakening all open minds to the shortcomings in healthcare. The battlefront has been preaching these issues for many years but it has taken the unfortunate situation of an epidemic to finally give heed to desperate need and a call to arms. The nursing profession may go as far as to thank the media for their accusations concerning Nina Pham. Without the media's poor attention to the details of the situation, knowledge of access to materials in the hospital, or staffing and budget cuts, we never would have had a catalyst "appropriate enough" to request proper protection of staff. The badgering and bullying facing one of our own stung our nursing pride so deeply and with such voracity that it took less than 24 hours for an apology to be written and televised. Why an apology? Because the nursing population would not allow for the improper presentation of facts in a situation that could have been avoided had there been appropriate access to protective equipment and education. Our World has come to realize that nurses will stand their ground, yell from rooftops, hold international teleconferences and write major political entities on any issue facing their practice. We have a strong bond between mind, body and spirit of which makes us incapable of staying quiet when the need is strong. As professional nurses we have the ability to look at each other's situation and sympathize. For those outside of our scope of practice, recent events have forced people to open their eyes and truly see what it means to be a constituent of the healthcare community. As nurses we have always had each other to lean on in times of difficulty and crisis. What has always been important, if not more now, is having the support of those who write policies, professionals outside of healthcare and any other ear that is inclined to hear our pleas. All things considered, Ebola in the personal and international sense has given us the gift of a platform to stand on and a means of sharing testimonies to invoke change and growth. Historically, nursing has always been a powerful career that requires those strong in heart, mind and spirit. We have known from the very beginning that there will always be a battle to fight in the form of our own rights as well as advocacy. As much as it is our job to care for our patients, we cannot care for them appropriately without the means of doing so for ourselves. As the World expands in commercial growth, populations rise and transportation means increase between great nations, cases such as Ebola are going to become more prevalent. This is ultimately the expectation of a planet that is in forward motion, because with growth it is inevitable. Ebola has done more than caused rampant illness, death and policy changes. It has given nurses a voice that has been heard. We now know that multiple voices standing together as one has more power and pull than one or few alone (with no further support). Through this disease we are learning to tap into our pride, stand together as one, be pro-active about encouraging change, using the platforms given to us and taking charge when we know that an overhaul of the system is needed. This will not be the last time that we will need to be loud and proud of our accomplishments or our expectations. As devastating and debilitating as Ebola has presented it's reach we are blessed to have this time to truly be a team with a common goal and a vision for the betterment of our patient's lives as well as our own. Our fight will never be in vain as long as we strive for what's right and we expect the same, if not more, than what is expected of us. May the road ahead be full of obstacles in order that we may pave a path of integrity and strength. Full speed ahead my friends, full speed.
  7. Ebola. The very name of this evil virus is striking anxiety in the bravest of nurses. Nurses everywhere are facing the question of "what will I do when it comes here?" We ask ourselves if we would accept the assignment of caring for the patient, or refuse it. We consider the cost of risking our lives to care for the sick - and - what about my children? What about my loved ones? If I accept this assignment, am I putting my family at risk? I have heard an array of comments on the subject from nurses - and all of their concerns are valid. I have heard more than a handful of nurses' state they would ask for a new assignment - or quit. I have heard the opposite end of the spectrum as well, where nurses will accept the assignment IF. The 'IF' is a pretty big IF. IF the nurse is properly trained, IF the hospital has the PROPER PPE, IF the nurse will receive hazard pay, IF the nurse will be given a room on the floor with the patient for the next month - because they certainly do not want to take anything home to the family. All very valid requests. If you are given an assignment to care for a patient, but do not have the proper PPE, have not been properly TRAINED in donning and doffing the CDC PPE, or if you have an underlying issue - such as pregnancy or decreased immune system, you may consider Safe Harbor as your reason to refuse the assignment. So, what are our rights on refusing an assignment? What are our responsibilities to care for a patient? The Nurse Practice Act (NPA) relates to safe practice of nursing through regulations as determined by the Board of Nursing. When a nurse is given a license, the nurse must clearly understand her/his own competencies. If a nurse is not competent to care for a certain type of patient, the nurse then has the responsibility to obtain training/education for assignments in the field where they are working. The nurse must realize that working in an area they are not competent in can put the patient at risk for harm, and the nurse places his/her license on the line. If the nurse has not been properly trained in donning and doffing the APPROPRIATE PPE the CDC recommends in caring for a patient with Ebola, you may have a case to refuse your assignment. If your hospital does not HAVE the proper PPE, equipment, isolation room, etc., to care for your patient in a safe environment, you may have justifiable cause to refuse your assignment. When is refusing to care for a patient considered abandonment? This is AFTER you have made contact with a patient, or after you have accepted an assignment. For instance, if you are an ED RN and a patient comes in and you begin caring for the patient only to find out the patient has Ebola, and then you refuse to care for the patient any longer - this is abandonment. If you abandon your patient, you can lose your license to practice nursing. Most hospitals are asking for volunteers to care for any patient who may present with Ebola. A core group is properly trained in PPE donning/doffing. Most hospitals are utilizing ED and ICU RNs for their 'Ebola Task Force'. The hospital I work for also will allow the trained volunteers to live at the hospital in the same unit that has the patient in isolation, and will provide meals and scrubs. Many nurses I talk to are worried about caring for these types of patients, and I completely understand their concerns. However, I have also found that there are nurses who are ready to face the challenges that are ahead of us and do all they can to care for the patient. I personally believe that caring for any patient with any illness is my responsibility and part of the oath I took when I dedicated my life to caring for people. I know I am not alone when I say I will do whatever it takes to save a life.
  8. Brenda F. Johnson

    Not So Sweet; Fruit Bat Harbors Ebola

    The idea of a killer virus penetrating the doors of our hospitals, offices, and clinics is a terrifying prospect. As scary as this seems, it has become our reality. Jumping continents, ebola has extended itself into the borders of America striking fear into most of us with just the possibilities the virus represents. Africa and Asia now share the fight with us to stop ebola before it becomes an epidemic. Through the abundance of media coverage we hear and see many stories informing us about the Ebola Hemorrhagic virus including the faces of ebola victims that are etched into our hearts. Though fresh on our minds, EHV research has been underway for many years trying to find out who and what harbors the virus in order to find a way to control it. Nothing has been confirmed but studies indicate that the Rousettus Fruit bats could be the culprit. In 1976 the first cases of EHV emerged in two places; Nzara, Sudan and Yambuku, Democratic Republic of Congo - which is how the virus got it's name because it was near the Ebola River. More recently, in March of 2014, West Africa had a devastating eruption killing more people than previous outbreaks combined. Poor health care and lack of access to it in these remote areas accentuates the problem. Being zoonosis, the virus can be transmitted from animals to humans. In 2003 the National Geographic reported that ebola was found in dead animals (bush meat) which is a large part of the diet in the Congo. However, scientists have had a difficult time catching up to the virus because it kills so quickly. From deep in the forests of Africa to Texas, ebola has spread it's deadly RNA across the world bringing with it it's deadly adeptness. A study recognized by National Geographic unveiled the disturbing news that there are 341 mutations of the ebola virus, proving it can adapt to differing environments making it more transmittable. Bats Conservation Africa (BCA) admits that bats carry viruses such as ebola, marburg and shironi. But they also say it is unlikely that bats are responsible for the outbreak. Conflicting reports strongly suggest the fruit bat is not only a reservoir, but the culprit for past and current outbreaks. Researchers investigated the remote village in Eastern Guiana, Meliandova, tracking the source of ebola to migrating colonies of fruit bats. These bats travel long distances and in large groups. This would explain outbreaks simultaneously long distances apart. Infected bush meat of dead animals are picked up and sold to local buyers. Not only are the bats sold and eaten in this manner, but also, gorillas, pigs, chimps, monkeys, and porcupines. These animals are put into spicy soups, grilled, and smoked. The National Institute of Virology South Africa conducted a study showing that fruit bats in the Tadarida family pass ebola through their stool. Though no exact evidence can be offered that the fruit bats are the cause of the ebola outbreak; they carry the virus and infect other animals with their bite, being eaten or from contaminated partially eaten fruit, and their feces. Getting rid of the bats may seem like a feasible solution but they are needed for the environment to pollinate plants and eat bugs. Research has given us direction, and hopefully will soon be able to give us some solid facts on how EHV is harbored in the environment. references.txt
  9. When we see a disaster of the magnitude of Harvey, we all want to help. Especially if we are nurses. After all, that is what we do! But what can we really do? Should we drop everything here and go, or do we simply send money and supplies? What is the best response? Yesterday, I talked with a friend whose husband is an inpatient at a tertiary care center in the Houston area. He is still receiving the needed care, but she told me that after 5 days of the hospital being essentially isolated, supplies were beginning to run low and staff was thin. "Everyone is doing the very best they can, but it is certainly not normal here." Facing lower supplies of food, the hospital is focusing on the patients first, feeding them whatever they need to get better and feeding patient's families and the staff less. "It is more like a mass feeding situation," my friend said. "It is what we would expect and it is what is needed right now. But everyone is praying that the rain will stop and the sun will come back to dry all this out." After our conversation, I felt both reassured and challenged. "I want to do something," I kept thinking. But what? My questions led me to stop and examine motivation and means. In their book, Helping Without Hurting, Corbett and Fikkert talk about not duplicating services and working in the area with whatever is already in place, instead of "re-inventing the wheel," as the saying goes. Sometimes our motivations are good: relieve suffering, help fix things, be present to others, but our underestimation of the challenges can make us more of an impediment than a blessing to those that are already hurting. We ask ourselves the pertinent questions: Am I focusing more on me and what I feel I can contribute or more on the people in the area and what their needs are? Sometimes the answer to this question can inform our actions in a meaningful way. It can help us decide how and when to proceed to active, boots on the ground participation-or not. By connecting for organizations that already have an effective structure in place to absorb and maximize the use of volunteers, we can be more confident that our desires to help translate into actual benefits to the victims. The second area we examine is our means. Besides connecting to an existing organization, are we in excellent health of mind, body and spirit? Are we trained to help in disaster areas? Do we have the necessary means of support, including a place to live and basic necessities? By rushing into an area where infrastructure has taken a massive hit, we weave into the fabric of the area and automatically become another person who requires support-especially if we become ill or have an accident. In our vision of helping the best we can, we must take a step back and look at what we can do given our abilities and the limitations of the location. The last thing we want to be is a burden. So given these consideration, do we go or send boots? Often, the initial response that is most appreciated is money. Sadly, clothing and actual boots make for distribution nightmares. While flood buckets (see description: Cleaning Kit - UMCOR) are helpful during the immediate aftermath of the storm, long term reconstruction from a massive disaster such as Katrina or Harvey, truly takes years. While writing checks and giving to the American Red Cross or other charities is not very exciting, a sacrificial, thoughtful monetary gift can be a real blessing to people who are rebuilding their lives. If you have family or friends who were personally affected, making a commitment to send a check once a month for a year can do wonders to boost moral and let them know that you haven't forgotten after the first month or so. It is worth considering ways that we can extract some of the most affected from the area to support them away from the disaster zone while the area recovers its infrastructure. You may be part of a church or synagogue or mosque that will be willing to open its doors to those in need for a longer period of time. While that type of commitment is time consuming and physically draining, it can pay off big dividends to all. Our particular community absorbed several people who ended up leaving the New Orleans area after Katrina. Some of them became close family friends and integral parts of our local economy and fellowship. The key to a successful response to any disaster, be it Harvey, Haiti or something at home, may be personal involvement-finding successful ways to get boots on the ground, serving and connecting one-on-one with the victims. But another way to really make a difference is to carefully examine organizations that are already there and support them financially. There will be lots of unemployed in that area, needing jobs. Making meaningful work possible by sending support can be a win-win for all. Boots on the ground there? Maybe. But only after careful planning and consideration. Boots on the ground where you are? For sure. Commit. Give. Connect. Remember.
  10. Yesterday, I was listening to an interview Matt Lauer of the Today Show conducted with Briana Aguirre, a Registered Nurse from Texas Health Presbyterian Hospital in Dallas. Briana in the interview states, "I can no longer defend my hospital at all" and was one of the nurses who treated Nurse Nina Pham, her friend and colleague, after she tested positive for the Ebola virus. While listening to Briana's story, I felt her pain and frustration, and during the interview I had a sinking feeling in the pit in my stomach as she was describing the events. I was horrified to learn about how the Ebola case was managed and how ill equipped the nurses and medical staff was when they were faced with the daunting task of managing the care of patients diagnosed with or suspected of having the Ebola virus. What struck me personally, as a fellow nurse, was the fact that Briana was scared to tell her story. Briana was brought to tears, for fear that she might face retribution from the hospital and lose her job. I can only imagine the amount of strength and courage it must have taken Briana to come forward with her story. As nurses we can all think of the potential ramifications and mistakes that could possibly be repeated if her story was not heard and she remained quiet. By speaking out, Briana Aguirre is not only potentially saving the lives and further spread of the Ebola virus to her coworkers and to the patients of the hospital, but also impacting the lives of all medical professionals and their patients around the world. As nurses we must rally behind, support and make certain that the courageous actions of Nurse Briana Aguirre is not taken in vain. As health care professionals, we must ensure that: we listen to the lessons learned, create awareness about Briana's story and share this information with fellow nurses. This will aid nurses in this country and around the world to continue the fight against Ebola. All of these actions will lead to improvements that, as nurses, we are able to offer all of our patients. Our voices as nurses must be heard, and those voices should never be intimidated or threatened when we dare to share the truth. The voice of Briana comes from grave concern and warning. I believe that if this knowledge and warning is not taken seriously, it could have a catastrophic impact on the overall health of our nation. I personally would like to thank Registered Nurse, Briana Aguirre, for coming forward to share her story about her personal experiences. Fear of retribution should never be the fear of any nurse when it comes to the health of our nation. As nurses we must have a voice and we must be listened to. I encourage all nurses to do their homework, become passionate about this issue and ensure that all measures are being followed appropriately. As we all know, the educational process for nurses is never over and it is now up to us to ensure proper safety for ourselves and for the patients we take care of. Actively seek out your hospitals policies regarding Ebola, compare those policies to the standards set by the CDC. Also, research what other originzations, such as Doctors Without Borders, Nebraska Medical Center and Emory University Hospital, and find out how they handle Ebola. If you find gaps in policy in your local hospital, help fill them; make your voice heard, share you concerns with hospital administrators and ensure that those are followed through and new policies implemented. Do not let the gaps in the healthcare system lead to you becoming exposed, potentially exposing your family members and others patients to this deadly disease. Start the courageous conversation today, continue to educate yourself and ensure that your voice is listened to and immediate action is taken. Michael M. Heuninckx RN-BSN ***For anyone who is interested in listening to Briana Aguirre's full interview with Matt Lauer, copy and paste the link below into your browser: Full interview: Matt Lauer and Dallas nurse Briana Aguirre - Video on TODAY.com
  11. Cynthiahowardrnphd

    The Contagion of Fear in the Ebola Crisis

    Headlines like this have been the center of our attention, not only in the US, but in the world as well. Ebola in NYC What You Need to Know 2nd Ebola Case in U.S. Stokes Fears of Health Care Workers Ebola's Other Contagious Threat: Hysteria CDC says it should have responded faster to the Dallas Ebola Crisis For Infected Nurse's Neighbors, Ebola Brings Worry to Doorstep In addition to the thousands in Africa, a doctor in New York City and 2 nurses in Dallas have been infected with Ebola. The physician who worked with Doctors Without Borders returned to the US was diagnosed with Ebola. Upon arrival to the US, he took his temperature twice a day and reported to the hospital when it was 100.3 and not 103. In his opinion, the doctor erred on the side of caution. Many people have a problem when one physician makes a decision about this disease that can affect so many others. In an article in the Daily News on October 24, the reporter writes, "As a doctor, he knows he is not contagious without symptoms," explaining why the doctor took the subway, went bowling and took a cab. Where did he get his information about Ebola? The fact that he was diagnosed with the disease implies that this virus is not as predictable as we would like it to be. Fear escalates in NYC as people wonder about taking the subway. Governor Cuomo is all over the morning shows allaying anxiety stating, "Ebola is not like the flu, it is not airborne... it is not contagious by sneezing." This is part of the problem and not the solution. Mixed messages are only going to drive fear to hysterical levels when the information presented conflicts with other information. The problem with Ebola is that there have been reports that the virus mutates and it can be carried on droplets. Misinformation is making it difficult to build trust with the CDC and other agencies spreading information. It is confusing when healthcare professionals that have potential exposure are moving about the country. It invokes fear and anger as it looks like there is no one centrally in charge or knows what they are talking about. As information comes out in bits and pieces, fears escalate. Initial comments by public leaders that there is "no risk" associated with Ebola to implications it was the nurse's "breach in protocol," to a Fox News physician actually saying it was fear that caused the breach only serves to escalate fear. As long as the information presented is incomplete, the whirlwind of "what if" scenarios will run rampant. It is human nature to want to make sense of all threats and we are hardwired to respond to threats through the primitive survival instinct of fear and the stress reaction. Once the stress reaction is triggered, perspective shifts and the behaviors become defensive rather than proactive. Fear short circuits effective outcomes and promotes more reactionary fear. Fear more than likely pushed the individual to omit information about exposure in order to come into the US. Was it fear and overwhelm (fear of not being able to handle the problem) within the bureaucracy of CDC causing a slow and inadequate response for accurate information and safe, effective protocols? It is probably fear that now prevents the Texas hospital from sharing information with other experts and facilities that would be helpful moving forward. Ebola caught this country off guard with most hospitals unprepared to handle the type of isolation required with this disease. More specialized respiratory masks are required along with a very detailed process to put on and take off the protective gear that includes a buddy system to further lessen any risk of exposure. The handling of infectious waste is in itself another challenge along with what it takes to decontaminate exposed areas. Never before has this type of preparation been required or implemented in the majority of hospitals. The fear of being caught unprepared only gets in the way of effective operation. An article in MedPage Today shares the experience of a nurse in Florida who was suspended from her job because she called the CDC to get the precautions and protocols for handling patients with Ebola. How does this reaction by the facility promote readiness, confidence in the staff and in the ability to be prepared in order to do one's job? Fear and the defensive behaviors and actions that are born out of fear cannot be the driver for healthcare readiness. This current dilemma highlights a need for a shift in how healthcare leadership handles challenges. Fear is as much of the problem as the actual disease of Ebola. Fear sets up the flight or fight response when what is needed is to embrace the challenges presented in this global issue. What can be done to be better prepared; hospitals, nurses, healthcare workers, along with the rest of the world? Fear is driving the spread of this disease in Africa as people there believe it is caused by a curse and have actually stoned and killed missionaries and educators who have tried to help the communities stop the spread. On September 22, 2014, CBN.com news story, "Ebola Aid Team Killed in Attack in Guinea." Fear is as much the disease as its' infectious nature. Facts about Ebola from WHO: World Health Organization From a fact sheet by the WHO, World Health Organization, the Ebola virus and disease had it first outbreak in 1976, simultaneously in 2 different areas; Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The outbreak in March of 2014 in West Africa has since been the most serious. According to the WHO, fruit bats are natural Ebola virus hosts with the virus introduced into the human population through contact with infected animals (chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines) either by ingesting raw meat and or contact with sick or dead animals. Ebola then spreads person to person via contact with bodily fluids of infected people or with contact of surfaces, clothing, blankets, bedding, etc contaminated with these fluids. The WHO reports that people can remain infectious as long as the virus lives in their body fluids which include semen and breast milk. WHO report states that "men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness." (WHO | Ebola virus disease) The presence of fear is not the problem. It is a natural reaction to uncertainty. The problem comes when fears are denied, avoided and rationalized rather than faced head-on. The healthcare system (and the country) has to face the fears that are the result of the potential dangers of this disease and then leverage those fears to prepare with facts, the right equipment, training and support within the local healthcare team along with an organized effort globally at containment and treatment.
  12. On January 12, 2010 at 4:53pm EST a 7.0 magnitude earthquake struck the nation of Haiti destroying over 300,000 homes and buildings and taking the lives of over 200,000 people. As a nurse who has responded to many disasters within the United States, my heart cried out to assist the survivors. 48 hours later my OH5 DMAT was placed on alert for deployment to Haiti. When our orders came, I was faced with the reality we were going to a country few of us knew anything about; I knew we were facing challenges way beyond the experiences of past deployments. In the early morning hours before we were to board our flight, doubt and fear set in and I questioned my decision to go. It was in those dark hours I received a message from a friend who shared with me these words: "Then I heard the voice of the Lord saying, "Whom shall I send? And who will go for us?" And I said, "Here am I. Send me!" Isaiah 6:8. My doubts and fears subsided. The daunting task ahead seemed lighter. Darkness and fear was replaced with calmness and serenity. I knew I was where I needed to be. I boarded the plane to Haiti where I spent two weeks caring for the people of Haiti. And here are the things I remember... Haiti- "the Event" Shambles, noise, dust... Despair... Hope... Haunting eyes of the children... Tragedy... Life and Death... An International Coalition of Care pouring their hearts and efforts into a country many had never paid attention to until "the Event"... Long hours with the greatest of friends old and new... MRE's... Tears... Smiles... Cultural differences... Life and death choices... Failure to thrive... Wondering if your efforts really make a difference... I returned home and four days later I was again called again to serve. This time I did not question my decision- remembering instead "Here I am. Send me!" Haiti- "my Return" Shambles, more noise, dust replaced by mud and sewage, little progress ... Despair... Hope... Still the haunting eyes of the children... A tent city on the other side of an iron fence and razor wire... Tragedy as result of gunshot wounds, stabbings, rapes... Again, Life and Death... The generosity of a new portable x-ray machine donated by J/P HRO... Longer hours with new friends... MRE's now picked over; will I ever be able to eat meatloaf again... More tears... More smiles... Awakened late at night by a tremor... Then again by casualties at the gate... And finally, a cold night sweat rapidly followed by nausea and then vomiting... Unable to keep anything down... Exhaustion, muscle ache, cramping, and of course diarrhea... Zofran, an IV, 7 pound weight loss... And an early ticket home... And would I do it again? Not soon, but yes I would go back....and only because of the wonderful loving and generous support of my wife and family who believe in me, the most amazing friends and neighbors who cared for my family, home and of course dog, co-workers covering my absence, a most remarkable boss who supports me, and because it's the least we can do for the people of Haiti....
  13. 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.
  14. SarahLeeRN

    Two Epidemics and Nursing

    In the year 1952, the United States had the worst outbreak of polio in its history. Polio is defined by the CDC as "A crippling and potentially deadly disease. The virus spreads from person to person and can invade an infected person's brain and spinal cord, causing paralysis." There were around 58,000 reported cases of polio in 1952, with 3,300 people killed. No-one knew how this disease was transmitted, or how to cure it. Entire communities were panicked because of polio. Because no one knew how this disease was transmitted, children (and parents) were often told to stay home. Bodies of water were avoided, as this was thought to contribute to polio. Many children were getting sick, and their parents did not know if they would survive. In a June 2014 article by the Omaha Magazine, Dr, Byron Oberst, who is a retired pediatrician is quoted as saying "1952 was one nightmare after another. We were working 26 out of 24 hours a day. We got maybe a few hours of sleep. There were so many sick children, it made your heart sick." (This has similarities to what we have seen of Ebola caregivers in West Africa). Often paralyzed patients had to be placed in iron lungs, which were machines that breathed for them. Doctors and nurses had to care for patients during these times, in spite of the fear of the disease. One town, Hickory, North Carolina, became known as "Polio City" when it had an earlier but just as serious polio epidemic in 1944. An emergency hospital was formed in Hickory, with doctors and nurses coming in from across the country to aide and fight polio. The dedication that the doctors and nurses demonstrated against this polio epidemic in Hickory is something to be admired by medical professionals today. They were truly on the front lines of this epidemic, and research by the reader will provide how they rose to the occasion. In fact, it was a nurse, a Sister Kenny, who was the originator of one of the treatments for polio; she developed warm moist compresses to ease muscle spasms instead of the use of braces. Her methods were controversial, but seem to have demonstrated success for recovery from polio. We are all aware of the eventual positive outcome of poliomyelitis-the discovery and widespread use of the polio vaccine. Thankfully today polio is hardly a concern, at least in developed nations were the vaccine is readily available for children. Fast forward to today, the year 2014. I do not think that it is a stretch to draw some comparisons with past polio epidemics and the Ebola outbreaks. The widespread concern among communities about Ebola is not dissimilar to the panic that was found in communities during outbreaks of polio. The difference up to this date, however, is the difference in actual cases seen, at least in the US. We are not at this time like the families of the polio generation, whose neighbors,fellow church-goers and coworkers had family members afflicted by this disease. Ebola, like polio, is a scary disease. It is scary because it is still a mystery. Like polio, how the virus is transmitted is really not well understood. The West African outbreak of Ebola has been terrible, with the CDC reporting 2705 deaths out of 4665 reported cases in Liberia. But what we must remember is, at the time of this writing, according to the CDC, there have been 3 reported cases in the US, with 1 death. Also, as we are hopefully well aware, protocols are almost daily being developed here in the US to fight against Ebola. And we, as health care professionals and as nurses are on the front lines of this epidemic. We need to be sure that we are not giving into the Ebola panic. Our patient population is already panicked enough. We need to be sure to exercise professionalism and good assessment skills during our patient interactions. We need to be careful with our patient's health care histories. We need to not immediately assume that everyone coming to our hospitals has Ebola just because some of the symptoms are the same. At the same time, we do not want to automatically discount Ebola. If we do have a patient with symptoms such as diarrhea, nausea, vomiting or any other symptoms, we need to be sure that we are asking about their travel history. We need to respect and fear the potential of Ebola in our communities but we also need to not let that fear cloud our judgment when obtaining a patient's medical history. This is an exciting and also a scary time to be a health care professional in the United States. We as nurses should have the utmost respect for Nina Pham and Amber Vinson for caring for Thomas Duncan. We should be grateful that they are at this time doing well, and that because of them, how to handle this disease is being addressed. We should take heed of the death of Thomas Duncan, and realize just how dangerous this disease is and how much we have to learn. Historically, how to deal with a disease in epidemic proportions is often a case of trial and error. There has been much blame cast on many different areas about Ebola being in the U.S. I believe that if anything is to be blamed it is the disease itself, and the time it takes to develop a solution. It took time for the polio vaccine to be developed. It will take time to learn how to deal with Ebola. Meanwhile, we should all do our part, becoming educated, and using every precaution during these times. I hope that we can balance caution with good judgment. I hope that we don't have to deal with Ebola on a massive scale. And if we do, I hope that we and our families are kept safe. We need to rise to the occasion, like the medical professionals did about polio in Hickory in 1944 and 1952. We need to maintain a swift and efficient response to this disease. It comes down to caring one patient at a time to the best of our professional ability. And if I know nurses, we are up to the task. I wish us all the best in our daily practice going forward. Resources: Sister Kenny: Confronting the Conventional in Polio Treatment Polio Panic of 1952 Global Health - Polio
  15. Bridgid Joseph

    The Tribulations of an Ebola...Trainer

    My hospital has been preparing for Ebola for months; a multidisciplinary workgroup, all experts in their areas, created policies and procedures to put into place in case they were needed. Procedures from the door of the Emergency Department to inpatient care were created and tested, and a small group of critical care staff that volunteered to care for the patient were drilled. The first trainings went well and staff reported feeling comfortable with the policy/procedures and ready to care for a possible patient. Shortly thereafter, we had a patient admitted for a possible infection. In line with Murphy's Law, it happened on a weekend when most of the training Safety Officers (who are the experts and leaders) were not in hospital, but they went in on their days off (and stayed in hospital for 48 hours until the Ebola tests returned negative) to assure that policies and procedures were followed, and that staff felt comfortable. We had 24/7 coverage of Safety Officers in place, to ensure staff felt supported, despite the added stress and new policies. Everything went right along with policy and procedure....and the patient, thankfully, ruled out for Ebola. Staff reported a positive experience and would repeat the experience (which is all you can hope for!) When the workgroup debriefed the event, some areas for improvement were highlighted: the specialty groups that may respond for an emergency and all of the off-shift covering MD groups weren't fully trained, and extra support for training was needed. I was not a part of the workgroup, and not originally trained, but when it became apparent we had around 100 staff that needed immediate training, and the two Clinical Nurse Specialists that stayed in the hospital for 48 hours, until our patient ruled out, needed help, a colleague and I were asked to assist. I'm a team player, truly both of us are, and when I saw that my colleagues were physically and mentally exhausted, and I know that feeling well, I said I would assist. We were told that we would be fully trained before having to run any training sessions. My concerns started during my training: reading a powerpoint (it was not even a week from last edit and already outdated due to daily CDC changes) and going through a training session myself with the true experts....then I was considered an "expert". I didn't feel like an expert and I started to feel stressed out about the high stakes of training staff without the confidence that I normally have. Honestly, I have been in nursing for 14 years, and working with Trauma/Critical Care patients, I have seen a lot, and I was always known as a bit of a "cowboy"; I did what needed to be done for patients and was always willing to take on a challenge. This is the first time that I have been worried about my own safety and wanted to stay far away from a challenge. Not only that, I am very well versed in training staff to respond to emergencies, and I take the fear factor out of "coding" a patient for staff, which is really easy for me, because when I get an adrenaline rush, I see clearly and it's when I work best. This was different, I felt like a fraud relieving their fears and reservations, when I had my own. I worried about training them according to the policy, which far outweighed the original CDC recommendations (are in line with the current recommendations), that have a high likelihood of changing. I would have loved to answer everyone's questions with assurance: "What exact type of Decon showering are we going to use?" "Why do the CDC healthcare workers wear better suits than ours?" And the simple answer was "I don't know," which doesn't offer a vote of confidence. And in the back of my head, I was thinking: What if they weren't able to follow the procedures? What if they didn't buy into it? My hospital spared no cost at training; everyone was trained using the actual PPE, in hour long sessions, and what I learned was not what I expected to learn through those training sessions. Once I got over my hesitations, and in true form I was able to use some humor to break the tension (mostly by doffing akin to a flight attendant doing their safety talk on an airplane), I finally was able to see beyond my stress during these sessions. I started really watching the interactions of the randomly paired staff members and I was surprised. I found that in our two-person process, while one person supervises the other to don and doff PPE, the person supervising felt so much responsibility for the safety of their colleagues that the process was taking longer than we had expected, in a good way; staff were showing true caring for each other, validating each others fears, and reassuring one another. No matter what disciplines I saw, they were all scared, saw the importance in the training and really invested in it, and took the welfare of their co-workers seriously as well. They all took accountability for the safety of one another, and the community as a whole, and understood the complexity of caring for these acutely ill patients that really need us. I saw rooms full of light and caring during a dark time in healthcare, and I felt proud to work with these staff; instead of letting our fears pull us apart, it brought us together. While I don't wish for an Ebola patient to test our training and the system we put in place, I am very confident that we have the best possible structure in place to care for the patients, and I know that our staff will follow policy (even if there are changes) with the support of our true Ebola experts, if not for their own safety, but for the safety of the whole of us. I am hopeful this can be the norm for all healthcare workers, and all hospitals worldwide as we learn from one another. Have you seen the same in your hospital setting?
  16. The recent plethora of news regarding the two nurses who contracted Ebola through contact while giving patient care raises numerous questions as well as a few conclusions. As front line caregivers, nurse expect exposure to illness as a result of their job choice. Nurses who engage in patient care, whether it occurs in hospitals, nursing homes or doctor's offices have been exposed to and infected with any number of pathogenic organisms. From MRSA to hepatitis and TB, strep and simple cold virus' there is not much chance of being a nurse and not catching something from someone at some time. But how can we as nurses know how much protection we need if our very own infectious control specialists do not give us guidelines to follow? In the Ebola exposures, nurses were placed in harms way through what can only seem to be ignorance or negligence on the part of infection control in the hospital which employed them. Knowing hindsight is twenty twenty is not much help when you are suffering from a viral illness with an exceptionally high mortality rate. How could such mistakes occur and how can we prevent them from ever happening again? Nurses know that they cannot always count on higher authority to make correct choices for them, yet are often reluctant to speak out in fear of retaliation. In Texas, we were fortunate that one nurse chose to do the right thing and tell the public what was happening behind the scenes in this hospital dealing with a deadly disease. What if we had not known that for two days, Thomas Duncan was undiagnosed with Ebola yet was raging with the virus and nurses taking care of him were, quite literally risking their own lives without knowing what they were dealing with. This is not a tidy disease, but a messy, contagious fluid filled vomit and diarrhea spewing sickness which required at the very least, constant cleaning, emptying and disposing pathogenic virus loaded contaminants. Knowing what we as nurses know, we presume that the Texas nurses were gowned, and gloved. Period. No masks. No face shields. No respirators. No shoe covers. Later we also found out the trash from the patient was piled to the ceiling. For how long? Who got rid of it? Where did it go? How many others might have been inadvertently exposed just by the detritus? Did it pile up and get thrown out before the patient was known to have Ebola? Or was that after? Who was in charge? Anyone? As nurses, we must take control of this type of situation. In any patient suspected of having any type of communicable disease, we must protect ourselves and ultimately the public from illness as much as we are able. We must not let our managers and supervisors continue to ask us to put ourselves in harms way without our knowledge. When Duncan was admitted to the ER for the second time and was Ebola suspect, the highest level of biocontainment should have been instituted and if it isn't done by the hospital, then we must do it ourselves. We have a duty to protect our health so that we can protect and assist others with theirs. We have to question everything. We have to report things we feel aren't in our or our patient's best interests. We have to above all, feel that we have been informed of any risk we might be taking and have to opportunity to protect ourselves. If we don't do it, no one will. If our employers retaliate, let's make sure we retaliate back. This is after all, our very lives which are at stake. There really isn't anything more important. Lastly, if you are a hospital infection control nurse, or specialist, realize our lives depend on you to get it right. Err on the side of caution, ALWAYS. You don't always get a second chance to save a life.
  17. Chelsea, can you tell us a little about yourself? I am mom to a 5-year-old ASD kiddo in Houston. I have been a nurse for 4 years and love helping people become a family in Labor & Delivery You have been so helpful on the Facebook nursing group, Show Me Your Stethoscope (SMYS). What is inspiring you to help as much as you have been? I have been in awe of the courage of so many people the last several days! An amazing crew of my co-workers were able to make it in before the storm. They are still smiling and giving excellent care to the traumatized community of Houston. I can imagine the full term women of Houston may have been feeling like a ticking time bomb, versus how they would normally be feeling- a little nervous and some major anticipation for labor to begin. I read a story last night about a well-known nurse midwife at Bay Area Birth Center delivering a 9 lb baby alone at the birth center with ferocious wind and flood waters rising towards the building. That's true Texas grit right there. I have also been blown away by the heroism of the LEOs, first responders and everyday citizens who are throwing themselves into flood waters to pull families and pets to safety. I have friends and family who have been out in boats for days helping. They have seen some horrific scenes and everyone is going to need some major decompression very soon. Can you tell us what is your lived experience (feelings) when you are faced with a disaster of these proportions? I evacuated my home in League City with my son before the worst of the storm. We were still driving up to North Houston in blinding rain and tornado warnings. I am so glad we left because I am told by neighbors that I had a river of water flowing through my our houses at 1 am on Saturday. The roads have been blocked and I haven't been able to make it back to survey the damage myself yet. I'm sure I'll have a good cry again when I get there. Honestly, after some momentary grieving for things like my son's baby book and my new rug, I just feel really grateful to be alive. Looking now at the devastation of South Texas, I know we are going to be recovering for a very long time. It's overwhelming and hopeless but I know we will rally together and rebuild our city and lives How have you been directly affected? (mail, power, wifi, perishables, getting to stores)? I had some packages in my mailbox which I am sure have been lost to the water. Fortunately, I was able to stock up on water and food before the storm but so many have lost their supplies. We have been fortunate to have only momentarily lost power and WIFI a few times at the friends home I evacuated to. The hardest part is being basically surrounded by flood waters on all of my exit routes and being unable to report to work. I can't stand not being able to do my part. Have you talked with any nurses inside a facility? I have but out of respect for my co-workers and employer, I won't get into specific details. I will say that I have an incredible set of co-workers and work for a wonderful facility. They have done a phenomenal job through this disaster. How can we help? We are really going to need travel medical staff, especially nurses, to help South Texas. Try to come with an agency and check out the Texas BON website for details on how to get emergent licensing here- they have made it very easy. (read How to Help in Texas for key links). We will welcome you with open arms! It never occurred to me before that nurses in these natural disasters probably have to return to work before they can deal with the loss of their homes, cars, etc It's crazy. As far as needs for physical items, I am told the shelters are needing blankets, towels, formula, and diapers of all sizes. The first responders/ LEOs need clean underwear and socks. Monetary donations to places like the Salvation Army, Texas Humane Society, and the Houston Food Bank will do a lot good for us as well. Chelsea, thank you so much for sharing with us. We're in awe of your loving spirit in the midst of crisis. Blessings to you and your loved ones. Nurses across our country support you. Nurse Beth Read Help! In Texas for a list of charitable agencies.
  18. Over the past months, the people of West Africa have been dealing with the Ebola crisis. In spite of the efforts of doctors and nurses from around the world who have traveled to Africa to assist in treating of Ebola patients, the number of newly diagnosed and fatalities keeps growing. The deadly virus has now worked its way across western Africa and the rest of the world. The virus moved into the United States in late September with the first confirmed United States Ebola diagnosis in Texas, Thomas Duncan. Despite medical care, Mr. Duncan became the first Ebola fatality in the US, just a week after diagnosis. Many nurses in Dallas were deeply involved in caring for Mr. Duncan. Unfortunately, two of those nurses became infected with the Ebola virus and are now hospitalized. Dallas Nurse Nina Pham, the first person to contract the virus in the United States, is now a patient at the National Institutes of Health in Bethesda, Maryland. Amber Vinson, the second Dallas nurse to contract Ebola, is a patient at Emory University Hospital in Atlanta, Georgia. We must also remember the nurses in Africa who have cared for many Ebola patients. Since the Ebola issues in Dallas, many nurses have spoken out about breaches in protocol. Some have done so anonymously, while one nurse had the courage to speak out in an interview on national television. These nurse are motivated by a sense of nursing professionalism and a desire to provide safe, quality care to all patients. Take This Opportunity to Say "Thank You" To All The Nurses Who Have Been Involved In The Ebola Crisis Nurses who have cared for Ebola patients, either in the United States or across the globe. These nurses have willingly and knowingly placed themselves in harm's way dealing with a deadly virus, because this is what nurses do. Every day nurses are among the first responders, the first line of defense, advocates for their patients. The Ebola crisis has just magnified the importance of nurses. Nurses who cared for Ebola patients and are now patients. These are nurses who worked diligently to provide compassionate and quality care for Ebola patients. Of course Nina and Amber are "close to home", but let's also remember the number of nurses around the world who have also contracted the virus. Nurses who are speaking out about policy and protocol breaches. By speaking out against unsafe practices when caring for Ebola patients, these nurses are willing to put their jobs on the line in order to potentially prevent coworkers and others from contracting the virus. Thank you for your courage. Nurses....we salute all of you who have been personally touched by the Ebola crisis. We support you and applaud your efforts. Nina, Amber, and other nurses who contracted the virus "in the line of duty", our prayers, well wishes, and healing thoughts are with each of you. Please help us thank these wonderful nurses by posting your words of support, gratitude, and appreciation. This thread is for positive and supportive comments only. Negative or judgmental comments will be removed.
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