Archive for the ‘Human rights’ Category

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Ebola Changes You: Reflections of a Nurse Upon Return from Liberia

November 12, 2014

By Deborah Wilson, RN. The author is currently an IV infusion therapist with the Berkshire Visiting Nurses Association in Pittsfield, Massachusetts, and is completing her BSN at UMass Amherst. In October, she returned from Liberia, where she worked with Doctors Without Borders at a 120-bed Ebola treatment center. Names of patients mentioned in the article have been changed to protect patient privacy.

At the cemetery, newly dug graves

At the cemetery, newly dug graves

I have recently returned from Liberia, where I worked as a nurse for six weeks along with a dedicated team of physicians, nurses, and other professionals, treating 60 to 80 Ebola patients a day. My 21-day transition time is recently over and, although I am back at work and school, my heart is with the West African nurses who I worked with for those weeks in September and October.

I worked in a town called Foya, managing a 120-bed Ebola treatment center (ETC). During the first two weeks, I wondered if I would last. In the grueling heat, dressed up in all that personal protective equipment (PPE), constantly sprayed with chlorine, each day I was haunted by the question of whether I’d somehow gotten infected.

It all took its toll. Twice a shift the nursing team would put on PPE and enter the confirmed Ebola isolation area. People lay on mattresses on the floor, vomit and diarrhea everywhere. In our bulky gear, double-gloved, goggles fogging and sweat running out of every pore, we would insert IVs, push meds, try to help someone eat a little something, tell the hygienists that a body needed to be removed to the morgue.

So how did I go from wondering how I would make it through my six-week assignment to now actually considering going back? It was thinking about the nurses and teams who are still there going in every day, never having a 21-day transition period like mine to look forward to, all with colleagues and family who died during this devastating outbreak.

With staff at the 120-bed Ebola clinic in Foya

With staff at the 120-bed Ebola clinic in Foya

Our lives were in each other’s hands—we helped each other dress in PPE and double-checked each other before going in. Talking with one patient, I said, “we must look really weird,” and he laughed, which made us all laugh.

But there was not much laughter in the area for confirmed cases. We never knew who would live or die; sometimes the healthiest would suddenly be dead. We delivered babies who were so small and premature—I think about the young 19-year-old mother dying only an hour after her little boy had been placed in a white body bag and given a name so he could be identified in the morgue. I find myself wondering what her and her son would be doing now if there had been a way to save her.

I wonder about Joy, whose love and dedication to her husband touched all of us deeply. Daily she would come to the fence with his favorite food and George would come out and sit on the other side. When he got too sick to come outside, we dressed her in PPE and took her in, where she prayed with him. We all rejoiced when a pregnancy test revealed that Joy was pregnant, then saw her nearly immobilized with grief the next day when George died. Joy’s cries and sobs as the psychosocial team sat with her is something I still wake up to. I wonder how she is doing and where she is now. Will she have a boy or girl and what will she tell him/her about George?

The Liberian nurses still call me on the phone. They tell me that there is not one case of Ebola now in the ETC! Many have to go back to the health clinics where they worked before. All of them lost colleagues because, when sick people came to their clinics, they had no gloves, masks, or chlorine to protect them. Will they have basic protective equipment now?

They also haven’t been paid for September or October. The Liberian Ministry of Health keeps saying that they will get paid, but I fear that this outbreak has wreaked such havoc on the economy that they have risked their lives, working in conditions we will never have to endure, perhaps only to also risk earning no income as well for their efforts.

My three-week transition involved learning the news of the two nurses in Texas who were infected caring for Thomas Eric Duncan, of physician Craig Spencer testing positive in New York City and Kaci Hickox being locked up in an unheated New Jersey tent with no shower. At times I thought I would go mad—watching as a collective insanity gripped our nation about a virus unlikely to ever take hold in the U.S., I yearned for the day when we could instead turn our attention to what I believe this terrible epidemic in West Africa could really be teaching us: Read the rest of this entry ?

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The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

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The Ethics of a Nurse’s Refusal to Force-Feed Guantanamo Hunger-Strikers

July 18, 2014

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

The Miami Herald reported this week that a U.S. Navy nurse and officer refused to take part in force-feeding hunger-striking detainees at Guantanamo Bay.

There’s much we still don’t know about this story, but the force-feeding of prisoners at Guantanamo has been a contentious issue for some time. The practice has been compared by some to torture, and ethicists in the medical literature have urged the physicians involved to refuse to participate, while the U.S. government and President Barack Obama defend the practice on humanitarian grounds of preventing the deaths of the detainees.

Whether or not one feels that nurse participation in the force-feeding is justified, this officer, whose identity has not been released, appears to deserve the profession’s praise for taking a moral stand in an extraordinarily difficult circumstance. All nurses have the right of conscientious objection, of refusing to participate in practices that they find morally objectionable—assisting in abortions is another practice that some nurses have opted out of on moral grounds—and officers in the U.S. armed services are bound to consider the legality and morality of orders they carry out.

Much is at stake for this nurse. Not only do officers risk their careers when refusing an order on moral grounds, but they must breach a sacred principle of effective military operation: obedience to the chain of command except by an officer in extraordinary circumstances.

Further, the officer deciding to refuse an order must make this determination alone and accept severe consequences if the further consideration of the higher chain of command, the courts, or history does not support her or his assessment. Read the rest of this entry ?

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Addressing Health Care Disparities: Best Practices for LGBT Patients

June 9, 2014

By Sylvia Foley, AJN senior editor

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume, at a nursing care facility. Rheume suffered from Parkinson's dementia. The couple struggled to find a facility welcoming of them as a couple. Photo © Gen Silent documentary film / http://gensilent.com.

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume. Rheume suffered from Parkinson’s dementia. Photo © Gen Silent documentary film / http://gensilent.com.

It’s arguably easier these days to identify as “queer”—lesbian, gay, bisexual, or transgender (LGBT). Our society has come a long way since 1969, when the infamous Stonewall riots and other events heralded the gay rights movement. Many LGBT people can live more openly and fully as who they are. Yet this population—which constitutes an estimated 5% to 10% of the U.S. population—continues to receive often substandard health care. In this month’s CE feature, “Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review of Best Practices,” Fidelindo Lim and colleagues explore these disparities and explain why it’s important for nurses in all practice settings to know how to address them. Here’s a quick overview.

The health care needs of people who are lesbian, gay, bisexual, or transgender (LGBT) have received significant attention from policymakers in the last several years. Recent reports from the Institute of Medicine, Healthy People 2020, and the Agency for Healthcare Research and Quality have all highlighted the need for such long-overdue attention. The health care disparities that affect this population are closely tied to sexual and social stigma. Furthermore, LGBT people aren’t all alike; an understanding of the various subgroups and demographic factors is vital to providing patient-centered care. This article explores LGBT health issues and health care disparities, and offers recommendations for best practices based on current evidence and standards of care.

Lim and colleagues also consider issues specific to LGBT youth and older adults, and discuss the Joint Commission’s recommendations for health care leaders. And they provide

  • a practice guide to improving cultural competence.
  • a detailed list of Web-based resources, including videos.
  • evidence-based strategies for promoting inclusive patient- and family-centered care.

For more, read the article and listen to our podcast with the lead author; both are free. We invite you to share your experiences and insights with us below.

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Nurses Join Fight Against Counterfeit Medicines

May 30, 2014
Hidden-in-Fake-Meds-2-1024x1809

Click infographic to enlarge

“Fight the Fakes” is a scary article in the June issue of AJN about counterfeit medicines and the role the International Council of Nurses (ICN) has taken in the Fight the Fakes campaign to inform the public about just how common the problem is and how dangerous it can be. Here’s the opening paragraph:

In February 2012, a cocktail of salt, starch, acetone, and a variety of other chemicals was delivered to 19 U.S. cancer clinics, instead of a vital chemotherapy medication they were expecting. Earlier this year, the Daily Mirror reported on black market abortion tablets that are being sold online to young teenage girls too scared to tell their parents they’re pregnant. The pills can kill if the wrong dose is taken.

The article is by David Benton, chief executive officer of the ICN, and Lindsey Williamson, the organization’s publications director and communications officer. Below is a brief blog post they sent us to give readers an idea of what’s at stake—but we hope you’ll also go ahead and read their article, which raises issues that should concern us all as patients or health care professionals.—JM, senior editor

Fake medicines are a global problem: they are reported in virtually every region of the world. Fake medicines may include products with the wrong ingredients, without active ingredients, with insufficient quantities of active ingredients, or with fake packaging. How common are fake medicines? The problem of counterfeit drugs is known to exist in both developed and developing countries. However, the true extent of the problem is not really known, since no global study has been carried out. Counterfeiting of medicines can apply to both branded and generic drugs, prescription and over-the-counter medicines, as well as to traditional remedies. Read the rest of this entry ?

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Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the U.S.: An IOM Report

December 2, 2013


By Natalie McClain, PhD, RN, CPNP, clinical associate professor, William F. Connell School of Nursing, Boston College, and Barbara Guthrie, PhD, RN, FAAN, Independence Foundation Professor of Nursing, Yale University School of Nursing. The above educational video was created by the Institute of Medicine and is available on YouTube.

Each day in the United States, minors experience abuse and violence that is overlooked and unidentified. In some cases, recognition of the abuse makes these minors subject to arrest rather than assistance and care. These children and adolescents are the victims and survivors of commercial sexual exploitation and sex trafficking. A recent report from the Institute of Medicine (IOM) and the National Research Council sheds light on this serious domestic problem and underscores the critical role that nurses must play in preventing, identifying, and responding to these crimes.

Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States is the culmination of a two-year study conducted by an independent panel of experts appointed by the National Academies of Science and funded by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. The report states that commercial sexual exploitation and sex trafficking of minors are acts of abuse and violence against children and adolescents. However, the response to these victims is often starkly different from that experienced by other victims of child abuse and neglect. In most states, for example, underage victims of commercial sexual exploitation and sex trafficking can be arrested and prosecuted.

Long-term consequences; inadequate services. The report also notes that the consequences of commercial sexual exploitation and sex trafficking are far-reaching and long lasting and include a range of mental and physical health problems. The committee found that there are too few services available to meet current needs of victims of commercial sexual exploitation and sex trafficking of minors. In addition, “services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of these crimes” (IOM and NRC, 2013, p. 260).

This form of abuse and violence against children and adolescents is largely underreported. This is because identification of victims can be challenging. Once victims are identified, there are few service providers who are adequately prepared to assist and care for them. The report describes this and numerous other challenges faced by professionals in law enforcement, education, victim and support services, and health care who seek to prevent and identify these crimes and to assist their victims. It also provides clear guidance on and examples of strategies to increase awareness, strengthen laws, and advance knowledge and understanding.

Nurses are essential partners in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. Two of the report chapters—Health and Health Care and The Education Sector—underscore the critical role of nurses as first responders in prevention, detection, and care of victims. Victims may seek out health care, thereby providing an opportunity for nurses in a range of settings to identify victims and survivors of this abuse. Read the rest of this entry ?

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Kudos to Indy for Tightening Human Trafficking Laws Before the Super Bowl

February 3, 2012

Market St., Indianapolis/ via Wikimedia Commons

According to Stateline.org (a news site of the nonprofit Pew Center on the States), with the Super Bowl taking place this Sunday in Indianapolis, the state of Indiana has decided to toughen up its human trafficking laws.

“Though it is an honor for Indiana to host the Super Bowl, many sincere voices have brought to light the fact that human trafficking is a shameful practice we can’t ignore,” Indiana attorney general Greg Zoeller said in a statement.

The article notes that sex trafficking during highly publicized events has become an issue for many states with hosting duties. While the Global Alliance Against Traffic in Women, an international advocacy group, claims that the estimates of trafficking cases at previous Super Bowls may have been too high, whether there are 60,000 or six in a given year, any number over zero is too many.

For more info, see our award-winning article on the nurse’s role in combating human trafficking, by Donna Sabella. She also talks about her work in a podcast.—by Demaris Bailey
 
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