A Call for a More Balanced Approach to Family Presence During a Public Health Emergency

What would you want for your family?

Nine years ago, AJN published a Viewpoint article asserting the essential role of family caregivers. The article featured an elderly woman recuperating in a hospital, her daughter at her bedside planning for discharge with the care team. The authors argued that family engagement creates the foundation for safer care, better patient outcomes, and greater efficiency for nurses.

The same patient’s experience would likely have been very different during the Covid pandemic, especially during the intermittent surges over the past two years. The patient would be alone in the hospital, her daughter’s assurances communicated through a digital tablet. Overstretched nurses would provide updates to the family over the phone. Discharge education would occur through a car window moments before the patient’s daughter drove her home, feeling unprepared for what came next.

COVID-19’s highly transmissible properties have complicated the family engagement equation. Over the past two years, hospitals and nursing homes have enacted, eased up on, and then reinstated visitation bans, at times leaving questions as to whether restrictions implemented to reduce disease spread may be more detrimental than beneficial.

As we contended in recent months with the extremely contagious Omicron variant, family caregivers who had assumed an essential role as […]

2022-03-02T10:21:04-05:00March 2nd, 2022|Nursing|2 Comments

A Safety Paradox: Stay-at-Home Policies and Domestic Violence Risks

What happens when the very measures put in place to keep us safe and healthy instead place us at risk for harm? For women in abusive relationships, the stay-at-home strategy for controlling the spread of COVID-19 can do just that.

A perfect storm of risk factors for escalating violence.

High stress levels, loss of a sense of control, unemployment, increased time together—all are known to increase the frequency and intensity of intimate partner violence (IPV). A study of IPV rates before and after Hurricane Katrina found a 98% increase in physical IPV and a 35% increase in psychological IPV against women after the hurricane, with stressors as one of the strongest predictors for increased violence. IPV rates are known to rise with unemployment rates; a study of IPV during the economic recession of 2007-2008 found that a rapid rise in unemployment led to increased violence and controlling behaviors. And multiple studies have found that IPV incidents occur at much higher rates on weekends and during the summer—times when couples spend more time together. With Covid-19, people are suddenly unemployed and experiencing stress due to economic hardship, fear of illness, and uncertainty about the future. And couples are now spending all their time […]

2020-05-04T12:27:03-04:00May 4th, 2020|Nursing, Public health, women's health|0 Comments

Multi-Drug-Resistant Organisms and Contact Precautions

When MRSA was new on the scene, strict isolation precautions were the norm.

Photo by Rick Sforza, Redlands Daily Facts / SCNG.

Years ago, when we first started to see patients with methicillin-resistant Staphylococcus aureus (MRSA) infections at the hospital where I worked, we kept them in what was then called “strict isolation.” These patients were kept on one unit and cohorted in two rooms at the end of the hall. Staff wore gowns, gloves, masks, and hair covering. How we hated having to put on all that gear!

The current challenge of MDROs.

Today, we understand more about transmission, and isolation precautions are better tailored to the epidemiology of each drug-resistant organism. Unfortunately, though, since that time antibiotic resistance has rapidly increased, and we now find ourselves not only with a lot more MRSA to contend with, but with patients whose infections are susceptible to only one or two antibiotics (and occasionally, to none).

Some of these multi-drug-resistant organisms (MDROs) seem to be persistent colonizers—that is, the organism “takes up residence” on or in the body without causing infection, and can still be transmitted to others. In some cases these patients will need to be on isolation precautions every time they are admitted […]

Measles 101: The Basics for Nurses

While debates about measles vaccination swirl around the current U.S. measles outbreak, most U.S. nurses have never actually seen the disease itself, and right now we are a lot more likely to encounter a case of measles than of Ebola virus disease. Here, then, is a measles primer.

Symptoms.

Measles is an upper-respiratory infection with initial symptoms of fever, cough, runny nose, red and teary eyes, and (just before the rash appears) “Koplik spots” (tiny blue/white spots) on a reddened buccal mucosa. The maculopapular rash emerges a few days after these first symptoms appear (about 14 days after exposure), beginning at the hairline and slowly working its way down the rest of the body.

Infected people who are severely immunosuppressed may not have any rash at all. “Modified” measles, with a longer incubation period and sparse rash, can occur in infants who are partially protected by maternal antibodies and in people who receive immune globulin after exposure to measles.

Transmission.

The virus spreads via respiratory droplets and aerosols, from the time symptoms begin until three to four days after the rash appears. (People who are immunosuppressed can shed virus and remain contagious for several weeks.) Measles is highly contagious, and more than 90% of exposed, nonimmune people will contract the disease. There is no known asymptomatic carrier state, and […]

Fear of Infection, Getting Job Done: Not New to Nurses

Quarantine, isolation: medical terms heavy with accreted meanings (psychological, metaphorical). Terms we’ve been hearing a lot lately, as in the case of nurse Kaci Hickox, quarantined in a tent in New Jersey after her return from treating Ebola patients in Sierra Leone, released today after days of public controversy.

These words have vivid histories. Epidemics of polio, influenza, and other illnesses took many lives in the U.S. during the 20th century. And nurses were always there, taking risks, applying the latest knowledge to control or cure. In the April 1940 edition of the American Journal of Nursing, a nurse wrote a short but evocative essay about her own fears of entering an isolation room to treat a child with an unnamed condition, perhaps measles or scarlet fever. Here’s a snippet.

Germs

(One wonders if she had been given the recommended personal protective equipment of the time for such infections . . .)

To read the article, free until December 1, click this link and then click through to the PDF version in the upper-right corner of the landing page.—Jacob Molyneux, senior editor

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2016-11-21T13:03:38-05:00October 27th, 2014|Nursing|3 Comments
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