Archive for the ‘H1N1 virus (swine flu)’ Category


AJN’s December Issue: Working During a Pandemic, HIV Foot Care, Healing Pet Visits, a Focus on Narrative

November 27, 2013

AJN1213.Cover.OnlineAJN’s December issue is now available on our Web site, just in time for some holiday reading. Here’s a selection of what not to miss.

Working during a pandemic. Flu season is in swing, but how do nurses feel about working during a flu pandemic? Researchers investigating terrorism and catastrophic events found that up to 96% of health care workers reported being unable or unwilling to work during some emergencies, with some infectious diseases associated with the highest rates of unwillingness. “Predictors of Nurses’ Intentions to Work During the 2009 Influenza A (H1N1) Pandemic,” December’s original research CE, suggests that providing adequate resources during an emergency (such as personal protective equipment) will not only ensure the safety of patients, nurses, and nurses’ families, but may also increase nurses’ willingness to work in times of crisis. Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

HIV foot care. Peripheral neuropathy, which causes debilitating symptoms such as burning pain and sensation loss in the foot, continues to be prevalent in people with HIV, but is often overlooked. “HIV Peripheral Neuropathy and Foot Care Management” reviews what is known about distal sensory peripheral neuropathy in HIV patients, and provides nurses with information on its assessment and management. You can earn 2.5 CE credits by reading this article and taking the test that follows.

Hospital noise reduction strategies. The importance of maintaining a quiet, restful environment for patients has long been recognized by nurses. Our Cultivating Quality article, “Quiet at Night: Implementing a Nightingale Principle,” describes how nurses implemented a noise-reducing strategy in their hospital to provide patients with an optimal environment for care. Listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article or downloading the podcast from our Web site.

Family pets in hospitals. Animal therapy for hospital patients can reduce stress and depression, and may aid in the healing process. “Family Pet Visitation” describes how nurses at one hospital instituted a pet visitation program to help patients feel more comforted and supported. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

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‘Spread the Word, Not the Germs’ – Infection Control During Religious Gatherings

November 6, 2013

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Last week there was a disconcerting report from the Associated Press about a Catholic clergyman in North Dakota who may have inadvertently exposed many members of his church to hepatitis A. According to the report, the ill bishop had probably contracted the illness from contaminated food while attending a conference in Italy and, because he didn’t immediately feel ill (incubation period usually ranges from two to four weeks, though can be as long as eight weeks), continued to dispense communion at several area churches.

According to the Centers for Disease Control and Prevention (CDC) Web page for hepatitis A, infection “is primarily transmitted by the fecal–oral route, by either person-to-person contact or consumption of contaminated food or water.” A person is infectious from two weeks before to one week after the onset of symptoms. The FAQ page on the site does say, in regards to infected food handlers (which would seem to fit this case, in that the bishop handled communion hosts), that “transmission to patrons is unlikely”—and also offers some guidance for postexposure prophylaxis (PEP). In this case, too much time had elapsed: PEP needs to be given within two weeks of exposure.

SpreadTheWordNottheGermsOpeningSpreadScreenshotThis situation made me wonder, though, as we’re about to enter peak flu season, if there are any infection control guidelines appropriate for religious services. Some faiths include taking communion or drinking from a communal cup, and many include shaking or clasping the hands of other congregants. Certainly these practices are ripe for transmission of bacteria and viruses. And if your church is anything like mine, there are many frail elderly people and families with infants and young children who would be at high risk.

I asked a colleague, Kathy Schoonover-Shoffner, PhD, RN, the editor of the Journal of Christian Nursing, if she was aware of any guidelines. Well, it happens that her journal addressed this topic two years ago in an article in preparation for the H1N1 influenza pandemic: “Spread the Word, Not the Germs” (abstract only). The article discusses, among other related topics, the process of creating a free toolkit, Infection Control and Emergency Preparedness Toolkit for the Faith Community. (You can download the 200-page PDF document for free.) Read the rest of this entry ?


Behind Our Ambivalence About Flu Vaccines

November 9, 2012

By Amy M. Collins, editor

Influenza virus particle/CDC

Tis the season to start thinking about getting the flu vaccination. Every year I consider doing so, but due to my own personal vaccine angst I usually decide to just take my chances (while simultaneously lecturing elderly family members to make sure they get theirs, of course).  Working in Manhattan, with the vaccine available at most pharmacies and even vaccine access through work, gives me very little reason to forgo vaccination. And my theory that I am young and strong and can brave illness gets weaker as I pass the point of being able to comfortably claim youth. Riding the subway every day amid a festival of germs reminds me that I should know better.

The vaccine has caused a stir over the past few years: during the 2009 H1N1 pandemic, people worried about whether or not to get the new combined vaccine, and the question of mandatory vaccination for health care workers remains a hot topic even now.

But a new report, The Compelling Need For Game-Changing Influenza Vaccines, released by scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota, suggests that the flu vaccine may not be as effective as it is touted to be. According to the report, influenza vaccinations provide only modest protection for healthy young and middle-aged adults, and little if any protection for those 65 and older—those who are most likely to contract the illness and suffer its complications. In addition, the report’s authors concluded that federal vaccination recommendations are based on inadequate evidence and poorly executed studies.

With as many as 49,000 Americans dying from influenza each year, approximately 90% of them elderly, should the report matter to those on the fence about getting vaccinated? Not according to Dr. Joseph Bresee, chief of epidemiology and prevention in the CDC’s influenza division, who was quoted in the New York Times as saying, “Does it work as well as the measles vaccine? No, and it’s not likely to. But the vaccine works.” And the risk of being on the safe side and getting the vaccination appears to be quite low—the report acknowledges that currently licensed influenza vaccines in the United States are among the safest of all available vaccines.

The report ends by issuing an urgent call for improved vaccines: “novel-antigen game-changing seasonal and pandemic influenza vaccines that have superior efficacy and effectiveness compared with current vaccines are urgently needed.” These game-changing vaccines, says the report, must demonstrate increased efficacy and effectiveness for populations at increased risk for severe influenza morbidity and mortality.

So, will the report make a difference to nurses’ recommendations to patients this season, or affect their own decision about whether or not to get vaccinated? Will it influence the ongoing debate about mandatory vaccination for health care workers? For the record, it didn’t for me. At my yearly check-up, the flu vaccine was strongly recommended. The American Nurses Association continues to urge people to get vaccinated as part of their Unite to Fight the Flu initiative.

The report is not saying not to get vaccinated, just that it may not work as well as we’d hoped, and knowing this isn’t a deal breaker for me. So now I just have to get over my vaccine angst and take the plunge!

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Questions of Priority, Written in Vernix and Blood: Two Poems in ‘Art of Nursing’

October 1, 2010

By Sylvia Foley, AJN senior editor

Handleaf by The Welsh Poppy / Rachel Davies, via Flickr

Jenna Kay Rindo’s poem “An Ode to My Certified Nurse Midwife” (Art of Nursing, August) brims with the narrator’s gratitude for the clinician who has seen her through a “gloomy complicated gestation” with great skill and compassion. (Art of Nursing poems are always free online—just click through to the PDF files.)

This is no sentimental paean, though. This ode is a gritty read, full of vernix and “unrehearsed pain,” euphoria and shame. The child, we learn, was “conceived completely out of wedlock, / in a rush of holy illicit love.” The narrator at first only wants to know how long she can hide the pregnancy. It’s the nurse midwife whose “jubilant congratulations” never seem to waver, whose “size seven hands covered in  / sterile latex” draw the infant’s wide shoulders into the world, and give the young mother courage. It’s an ode, perhaps, to something we strive for but rarely attain: a nonjudgmental attitude.

“It is lucky to live outside the target groups,” begins the narrator of Erika Dreifus’s poem “The Autumn of H1N1” (Art of Nursing, October). She is referring to those considered most at risk for the flu and thus at the top of the list for immunization.

But when she finds herself hemorrhaging and frightened, waiting to be seen by a gynecologist who minimizes her distress, she reveals far more complicated feelings about “the prioritized.” It’s an unusually frank poem about what it’s like to find out that, for the moment anyway, one’s blood “counts less.”

We invite you to have a look at these poems, sit with them, and if you’re so inclined, leave a comment and tell us what they evoke for you.

And if you’re in the Portland, Oregon, area this month, stop by the Anka Gallery for a look at nurse blogger and artist Julianna Paradisi‘s new show, From Cradle to Grave: The Color White. Paradisi’s Love You to Death appeared on  our cover (October 2009) and new work is forthcoming in Art of Nursing.

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Wrapping Up the Health Care Journalists’ Meeting with Sebelius, Frieden, Pronovost, and Others

April 27, 2010

by holia - taking a break/via flickr

By Shawn Kennedy, interim editor-in-chief

So I got back from the Association of Health Care Journalists conference in Chicago and a colleague asked, “How was the meeting?” I automatically said it was “good.” But then, I started to think about why I said that and what I’d found valuable—in brief, it’s networking and gaining new information.

I was looking for new information about the latest health issues—mostly about how the experts see health reform shaping up—and about any new issues or initiatives in health reporting. I attended sessions on how the new health reform legislation will affect hospitals (see my recent post on this) as well as state and local health agencies—but there were also presentations on monitoring food safety, lessons learned from H1N1, guidelines for writing about health guidelines, and patient safety advocacy; the new CDC director launched a report on state tobacco use (another post); and I watched a challenging but fascinating primer on health insurance financing from an actuary.

Some things I found worth noting:

Health and Human Services Secretary Kathleen Sebelius saying she will not stand by while some health insurance companies attempt to deny claims and push breast cancer patients off their plans. She commented, “It will be hand-to-hand combat if they try.” (See Reuters report for full story.)

Tom Frieden (CDC director) saying that increasing tobacco taxes is the single most effective tool to reduce tobacco use. (Yet taxes in South Carolina have been seven cents since 1977!)

Aida Giachello from the Midwest Latino Health Research Training and Policy Center noting that the United States could learn from Brazil, which, she said, “changed its constitution to make health a constitutional right” and integrates health matters into all social policy.

Peter Pronovost’s luncheon presentation about his work to reduce catheter-related bloodstream infections (CRBIs), at which he observed that “arrogance is a primary reason for error.” He likens the number of CRBSIs to “a 747 airplane crashing every three days.”

Of course, networking is a big plus of attending any meeting and I enjoyed seeing people like Melinda Hemmelgarn (a dietitian by background, she writes a blog and is committed to helping people “think beyond their plates” and understand the relationship between what they eat and their health). I also saw Scott Hensley from NPR’s health blog, Shots, who wrote a post about a session he attended on infusion pumps that’s a worthwhile read for every nurse who uses them.

Also interesting was a discussion raised at the annual meeting by Gary Schwitzer about how some TV stations are presenting “news” about hospitals when the segment has been paid for by the hospital (Schwitzer’s Web site and his related blog make you acutely aware of how much health coverage is biased or hyped or just incorrect). The discussion reminded me of why I appreciate the Association of Health Care Journalists—they are committed to transparent, balanced, and unbiased reporting of health news.

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To Isolate or Not To Isolate (and Other Hot Topics at the Epidemiology Conference)

April 13, 2010

By Rachel Zastrow, RN, BSN, patient safety liaison at Central DuPage Hospital, Winfield, Illinois

Back in March, thousands of infection preventionists and hospital epidemiologists (myself included) descended on Atlanta for the Society of Healthcare Epidemiology of America (SHEA) Decennial Conference. Over 3,500 professionals from 74 countries attended the conference. Despite the wide array of subjects, there were recurring themes that inspired intense emotion.

The topic that elicited the most audience participation involved the recommendation by the Centers for Disease Control and Prevention (CDC) to use N95 masks for worker protection from H1N1 patients. As many readers will know, the recommendation sparked a spike in demand that led to product shortages. The frustration of professionals in the room when the topic arose was palpable. Unfortunately, no consensus came from the conference, and the debate does not seem likely to disappear any time soon. A representative of the CDC defended the controversial recommendation.

AJN readers will remember the furor over mandatory influenza vaccination programs for health care facility employees. Although debate and even lawsuits hit both health care and mainstream news last fall, there was broad consensus among attendees regarding the need to improve vaccination rates in health care workers. Many participants expressed concern over the potential legal and organized labor ramifications of instituting mandatory programs.

Finally, the most interesting and unexpected debate came from a symposium Read the rest of this entry ?


H1N1 Influenza Hasn’t Left Yet — And May Be Back

January 8, 2010

By Shawn Kennedy, MA, RN, AJN editor-in-chief emeritus

At the Centers for Disease Control and Prevention (CDC) press briefing yesterday on pandemic H1N1 influenza, spokesperson Dr. Anne Schuchat noted that while H1N1 activity was down, the virus was still more prevalent than what is normally seen for influenza. Warning that people should still get immunized against it, she also noted, “We also saw an uptick in pneumonia or influenza deaths in this past week.  And that isn’t something that we necessarily see around the Christmas holiday.”

The CDC is worrying about a growing complacency among the public. To illustrate the need for continued vigilance and immunizations, she showed this graph (also reproduced below) mapping the deaths from the 1957 influenza activity. You’ll note there was an initial wave in fall 1957, followed by a lull in which deaths decreased, and then a resurgence in which the number of deaths peaked in March 1958, close to the level in the first wave.

Hit it while it’s down. According to Schuchat, the lull (where we currently are) “essentially gave the all-clear whistle in that [1957] December/January time period.” “They had vaccine,” she noted, “but they didn’t encourage its use.” For now, she said, the message is this: “The illness is down.  There’s plenty of vaccine.  It’s a key window of opportunity. We don’t want to repeat the story from 1957.”

Nuff said.


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