Archive for the ‘International nursing’ Category


Ebola, One Year Later: What We Learned for the Next Big Epidemic

November 6, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

Read the rest of this entry ?


Violence Against Women: Old Stories Repeat, But Some Progress

October 19, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Emergency lights #5, by DrStarbuck via Flickr

Emergency lights #5, by DrStarbuck via Flickr

It seemed ironic that, during this month of domestic violence awareness, a Florida judge showed little awareness of the fear that intimate partner violence can instill. Judge Jerri Collins came under attack from victim advocacy groups after she jailed a young mother who was a victim of domestic violence for failing to show up in court to press charges against her husband. According to various news reports, the distraught woman was afraid to face her husband in court for his sentencing to 16 days for choking and threatening her with a knife. Advocates say the judge’s action sends a message that may result in many women not bringing charges against abusers.

According to the CDC report Intimate Partner Violence Surveillance: Uniform Definitions And Recommended Data Elements (version 2.0; 2015), “over 1 in 5 women (22.3%) and nearly 1 in 7 men (14.0%) have experienced severe physical violence by an intimate partner at some point in their lifetime.” The real numbers are almost certainly higher, as many victims are afraid to report their partners for fear of retaliation once the abuser is released from jail. There are too many cases where that has happened, many ending in a woman’s death. Judge Collins’ actions seem heartless; she appears to be woefully misinformed about the dynamics and psychological effects of abuse.

At the recent Association for Women in Communications meeting in Kansas City, Nanette Braun of UN Women talked about several programs to raise awareness about women’s rights and reducing violence against women. The UNiTE to End Violence Against Women campaign has proclaimed the 25th of every month “Orange Day,” a call to action day to end violence against women and girls; Braun reported that over 60 countries have signed on to promote the campaign.

Another initiative that seems to have taken off, with the help of actress Emma Watson, is the HeForShe campaign, which aims to engage young men to end discrimination and violence against women and promote gender equality.

And here are some resources in AJN that you might find helpful: Read the rest of this entry ?


On Nursing Identity: What We Can Learn from African Nurses’ Oral Histories

August 17, 2015

 By Sylvia Foley, AJN senior editor

Port of Mauritius by Iqbal Osman, via Flickr

Port of Mauritius by Iqbal Osman, via Flickr

“I have chosen this profession and nobody can take it away from me.”—Sophie Makwangwala, study participant

In the summer of 2009, at the International Council of Nurses (ICN) Quadren­nial Congress in Durban, South Africa, a small group met to discuss collaborating on joint history projects. At that meeting, several African leaders of pro­fessional nursing associations reported that their expertise had long gone unrecognized. Seeking to have the stories of African nursing history told, they pro­posed interviews with other retired nurse leaders. Barbara Mann Wall, an American nurse researcher who was in the room that day, found herself intrigued.

The study. In keeping with Braun’s tenet that “indigenous research should be led, de­signed, controlled, and reported by indigenous peo­ple,” Wall first trained three of the African nurse leaders in the oral history method, aided by a grant from the University of Pennsylvania School of Nursing. Then the team embarked on the study reported on in this month’s original research CE, “ ‘I Am A Nurse’: Oral Histories of African Nurses.” Here’s an overview: Read the rest of this entry ?


AJN in August: Oral Histories of African Nurses, Opioid Abuse, Misplaced Enteral Tubes, More

August 3, 2015

AJN0815.Cover.OnlineOn this month’s cover, a community nurse practices health education with residents of a small fishing village in rural Uganda. Former AJN clinical managing editor Karen Roush took the photo in a small community center made of dried mud bricks, wood, and straw.

According to Roush, nurses wrote the lessons out on poster-sized sheets of white paper and tacked them to the mud wall as they addressed topics like personal hygiene, sanitation, food safety, communication, and prevention of infectious diseases. The reality of nursing in Africa is explored this month in “‘I Am a Nurse’: Oral Histories of African Nurses,” original research that shares African nurse leaders’ stories so we may better understand nursing from their perspective.

Some other articles of note in the August issue:

CE feature: A major source of diverted opioid prescription medications is from friends and family members with legitimate prescriptions.  “Nurses’ Role in Preventing Prescription Opioid Diversion” describes three potential interventions in which nurses play a critical role to help prevent opioid diversion.

From our Safety Monitor column: More than 1.2 million enteral feeding tubes are placed annually in the United States. While the practice is usually safe, serious complications can occur. “Misplacements of Enteral Feeding Tubes Increase After Hospitals Switch Brands,” a report from the Pennsylvania Patient Safety Authority, reviews cases of misplaced tubes and offers guidance for how nurses can prevent such errors in their own practice.

Clinical feature: It is no surprise that physical activity comes with numerous physical and mental benefits, nor that a majority of Americans do not get enough exercise. “The Evolution of Physical Activity Promotion” updates nurses on physical activity guidelines and provides tips for encouraging patients to improve their physical activity. This feature also highlights the importance of decreasing one’s amount of sedentary and sitting time, even in physically active people. Read the rest of this entry ?


An Unending Series of Challenges: APIC Highlights the ‘New Normal’ in Infection Control

July 6, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Panelists to the Opening Plenary, Mary Lou Manning, Michael Bell, CDC, Russell Olmsted, Trinity Health, Phillip W. Smith, Nebraska Biocontainment Unit discuss various topics pertaining to infection control.

APIC panelists (APIC president Mary Lou Manning; Michael Bell, CDC; Russell Olmsted, Trinity Health; Phillip W. Smith, Nebraska Biocontainment Unit) discuss various topics pertaining to infection control.

At the 42nd annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC), held in late June in Nashville, experts from around the world shared information and insights aimed at infection preventionists but of interest to nurses in many practice settings.

APIC president Mary Lou Manning, PhD, CRNP, CIC, FAAN, opened the first plenary with the observation that to be presented with an unending series of challenges is the “new normal” in infection control and prevention. Collaboration is more important than ever in health care, she said, and “there is strength in our combined efforts.”

Cathryn Murphy, PhD, RN, CIC, in accepting APIC’s highest infection prevention award, added that trust, friendship, and passion are essential if these efforts are to succeed.

‘I’m not at Ground Zero. I’m in Dallas.’ The highlight of the opening session was a fascinating conversation with key U.S. players in the Ebola crisis. Seema Yasmin, MD, a former CDC Epidemic Intelligence Service officer and now a staff writer at the Dallas Morning News, described how hard it had been to convey accurate information in the midst of rising public hysteria in the U.S.

As an epidemiologist, Yasmin became an interview subject as well as reporter. She recalled that, after months of worrying about colleagues at risk in West Africa, a reporter asked her, “How does it feel to be at Ebola Ground Zero?” Her reply: “I’m not at Ground Zero. I’m in Dallas.”

Later in the conference, Dr. Yasmin reminded the audience that every disaster drill should include a “public information” component and warned that “misinformation spreads much quicker than a virus” in today’s media environment, adding that we “can’t repeat the same [accurate, informative] message often enough.”

Practice drills vs. the real thing. Philip W. Smith, MD, medical director of the Biocontainment Unit at the University of Nebraska Medical Center, described the unit staff’s experiences in treating Ebola. UNMC’s special unit was built more than 10 years ago after the devastating SARS outbreak in Canada that left 33 dead, including several health care workers. Until Ebola cases arrived in the U.S., the unit had been used for training and occasional patient overflow. Dr. Smith emphasized that, even while the unit was not being used, their mantra was “drill, drill, drill” to ensure that staff would function expertly when this specialty care was needed.

Then, in August of 2014, “Suddenly, nine years of drills had to be translated into reality, and there was not much room for error.” He spoke of how inserting a central line while wearing three pairs of gloves, a face shield, and maximal personal protective equipment (PPE) topped by a sterile gown was a very different challenge from repeated practice runs of the same procedure.

Dr. Smith also noted that the transport of patients with Ebola—airlifting from West Africa, ambulance transport, and movement through the hospital to the unit—was “enormously complex and time-consuming.” A special incident command structure was set up just for transport, in addition to the main hospital incident command center.

A horizontal culture was also vital to their work. “There was no hierarchy,” he said. Cultivating a “classless society,” staff developed a strong sense of team under stressful conditions where they were responsible for each other’s safety.

Nonhierarchical work habits stayed with staff after the unit was closed and they returned to their regular assignments. However, when they continued to make “best practice” suggestions to coworkers, they were met with anger and pushback instead of the thanks and cooperation that had been the norm in the Biocontainment Unit. Read the rest of this entry ?


Remembering Nurses Who Served the Wounded and Dying and Those Who Died Themselves

May 22, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Normandy American Cemetery, France. Photo by Karen Roush

Normandy American Cemetery, France. Photo by Karen Roush

So many of us look forward to Memorial Day weekend as a welcome long weekend and official start of summer. But there are many for whom Memorial Day (the last Monday in May) is a reminder of loved ones who died in military service—and that includes a significant number of military nurses who cared for the wounded in various wars.

We’d like to take this occasion to remind us all of the real meaning of this day and to honor the sacrifices of our colleagues. While it’s hard to find specific numbers of nurses who died in wars, one can extrapolate from what’s known about women who died, since most women who served in combat areas from the start of the 20th century through the Vietnam War were nurses.* Read the rest of this entry ?


Florence Nightingale: The Crucial Skill We Forget to Mention

May 13, 2015

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is that Florence Nightingale was a writer.

In fact, Florence was a prolific writer. She published hundreds of articles and books, along with letters and editorials, pamphlets and briefs. If she lived today, I’m sure we’d be reading her regularly on the op-ed pages of the New York Times.

Suppose Florence hadn’t been a writer? Think about it . . . what would we know of her theories without Notes on Nursing? What would have been lost if she hadn’t written about her work in epidemiology, her research on hospital design, her efforts to improve sanitation and lower rates of infection? It’s incalculable.

But all this wasn’t lost—because, along with all her other wisdom, she was wise enough to understand the importance of communicating through writing what nurses do.

Today nurses continue to do work that has a major impact on health care and patient outcomes. But how much of that is getting lost because nurses don’t think of themselves as writers, because they don’t see writing as a part of what nurses do?

I worked with a group of nurses at a medical center here in New York to help them write and publish articles about the quality improvement projects they had completed. I was amazed by the work they’d done—work that had changed patient outcomes, lowered readmission rates, and improved their own working conditions. Patients discharged from the transplant unit were now going home with more confidence and less fear. Patients with congestive heart failure were able to better self-manage their care, and thus stay home with their families instead of being readmitted to the hospital again and again. Fewer mothers were having C-sections because the OB staff were working as a more cohesive interprofessional team.

The issues they were addressing aren’t unusual. Transplant staff everywhere are struggling with how to prepare their patients for discharge when the hospital stay has grown so much shorter and their needs continue to be so great. I’m sure each of you have stories of poor teamwork that has negatively affected patient care. And there isn’t a hospital in the country that isn’t trying to get their readmission rates down—with efforts to do so placed on the already overburdened shoulders of its nurses. Read the rest of this entry ?


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