About Betsy Todd, MPH, RN

Former clinical editor, American Journal of Nursing (AJN), and nurse epidemiologist

COVID-19 for Nurses: Skip the Rumors and Stick to the Basics

(Published: February 28. Editor’s note: much information in this post is now dated and the post should be read only as a response to a particular moment in time. COVID-19 is now officially a pandemic and has rapidly spread worldwide. While rumors and misinformation were, sadly, already very much in play when this was written, and the overall tone of this post was neutral and descriptive according to our knowledge at that current moment, the post only remains live for archiving purposes. Our most recent posts on the crisis can be found here.)

In the U.S. at the time of this writing, the major risk presented by the current novel coronavirus (COVID-19) is not from the disease itself but from misinformation. Rumors, misinterpretations, and conspiracy theories are being transmitted at a rate far greater than that of the coronavirus itself. While the situation is evolving rapidly and things can change quickly, our understanding of the illness has also grown in a remarkably  short period of time.

So, is this a pandemic?

In an NPR interview this week, WHO director-general Tedros Adhanom Ghebreyesus said the term is used to suggest that the spread of a new infection is out of control and doing significant damage worldwide. We are not quite there yet. COVID-19 transmission in China appears to have plateaued, and, while the virus has been detected in numerous other countries this week, several countries have also been successful in controlling the spread of COVID-19 within […]

2020-03-19T14:34:33-04:00February 28th, 2020|infectious diseases, Public health|13 Comments
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Will your ‘RN’ Name Tag Protect You from Violence?

When I stepped into the entryway, I was met by a group of men, crouched on the floor over a game of craps and shouting excitedly. One of them stood up when he saw me come through the door . . . He dropped the dice, pulled a gun from his waist, and pointed it at my face.

Workplace violence prevention training has become the latest mandatory education module in many hospitals. But what about nurses who work in non-hospital settings? In this month’s Viewpoint, “Workplace Violence Outside the Hospital Setting,” NP and visiting nurse Joanne Schmidt describes the terrifying situation she walked into one day at the start of her morning home visits.

In many community settings, no cameras or security staff.

Schmidt points out that nurses who work in home care, mobile medical vans, school clinics, and other community-based settings may be considerably less safe every single day than those of us who work in relatively protected hospital environments. At least in acute care there are cameras and security staff! […]

2020-02-20T10:55:11-05:00February 20th, 2020|Nursing, nursing stories|1 Comment
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Serious Mental Health Issues: No Room for System Errors

I knew that my patients were once without mental illness, just like my little sister Doris had been before her diagnosis 10 years before, and I always tried to picture them like that, each their own best version of themselves.

A sister’s preventable death.

In this month’s Reflections column, “No Room for Error: Reflections on My Sister,” family nurse practitioner Kelly Vaez shares the story of the unexpected death of her sister, who had been diagnosed with schizophrenia ten years earlier. It’s particularly heart-wrenching to be able to see clearly, in retrospect, the ways in which our rushed, fragmented, and mental-health-unfriendly health care system contributed to what was probably an easily preventable death.

A dentist prescribed an unusually long course of antibiotics after a routine tooth extraction. The primary care team seemed unaware of the antibiotic therapy. No one made the connection between Doris’ diarrhea and this antibiotic, a frequent cause of C.diff infection.

And finally, loperamide—a drug that should never, ever be given for diarrhea that might be caused by C. diff—was prescribed with what seems to have been minimal assessment for the cause of the diarrhea. Was this last because the patient was a young adult with schizophrenia, and […]

2020-02-10T10:13:29-05:00February 10th, 2020|mental illness, Nursing|1 Comment
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Polypharmacy in the Elderly: The Risks Often Outweigh the Benefits

“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of many […]

2020-02-03T08:54:32-05:00February 3rd, 2020|Nursing|0 Comments
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As Another Coronavirus Begins to Spread, Follow Reasonable Precautions and Avoid Fear-Mongering

(Editor’s note: Published January 24. The situation has considerably changed in the intervening weeks, during which the virus has rapidly spread across the globe. We obviously now know a great deal more about the dangers it presents.)

Emerging infections are part of our world—more evident these days because we have the tools and global communication networks to quickly identify them. This month, we’ve begun another crash course in the initial management of a new pathogen.

Short timeline from first cases to screening test availability.

Rumors of a concerning cluster of undiagnosed pneumonia in Wuhan, China, surfaced on social media on December 31. The patients weren’t responding to antibiotic therapy, but tests were negative for the usual viral suspects. World Health Organization staff quickly connected with Chinese health officials and testing and epidemiological investigations kicked into high gear.

Many of the infected patients had worked at a fish and live animal market in Wuhan, suggesting that the illnesses might be zoonotic (passing from animals to human) in origin. On January 7, the pathogen was identified as a new coronavirus, related (though not closely) to the coronaviruses that cause SARS and MERS. The viral genome was quickly sequenced, and on January 12, China shared the genetic sequence with the global scientific community. By […]

2020-03-19T17:12:45-04:00January 24th, 2020|infection control, infectious diseases, Nursing, Public health|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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