1918 Redux: Supportive Nursing Care for the Coronavirus Pandemic Is Courageous Care

Litter carriers at Red Cross Emergency Ambulance Station in Washington, D.C., during influenza pandemic of 1918.

The lessons of the past.

As we struggle to make sense of unfolding data, announcements, and public health directives about the current coronavirus pandemic, appreciating the lessons from past pandemics can help us understand the effectiveness and challenges related to quarantines and social isolation, as well as the need for reliable and timely communications.

In times of public health uncertainty, nurses and nursing care have played a critical role in saving lives and relieving suffering. We now know a great deal about the role of nursing during the 1918 influenza pandemic. Some lessons need heeding now.

Historian Nancy Bristow’s American Pandemic (New York: Oxford University Press, 2012) presents the historical facts clearly. For example, public health officials’ 1918 prohibitions on public gatherings, the sharing of such (then) new personal items as toothbrushes, and school attendance and religious services met acceptance as well as resistance. […]

2021-01-21T11:05:06-05:00March 18th, 2020|infectious diseases, Nursing, nursing history, Public health|1 Comment
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Is Your Facility’s Computer System a Patient Safety Risk?

Discussed in this post: “How Often Do EHRs Result in Patient Harm?” (AJN, News, March).

When we first had computers in the hospital—that is, while we still charted on paper but had quick online access to lab, radiology, and pathology results and could easily look up a patient’s prior admission history—it was wonderful. No more little lab slips floating all over the nurses’ station. No more unit-to-unit searches trying to figure out who last had custody of the patient’s X-ray films. (How could objects so large be so easily lost?)

A rocky transition to EHRs.

electronic health recordsThe transition to almost fully digital charting, on the other hand, has been pretty much a nightmare from the beginning. Nursing was rarely included in initial needs assessments. Many rollouts were chaotic, without additional staffing for the inevitable glitches that are bound to occur. Training of frontline clinical staff has been routinely minimal; we seem to be expected to pick up the many fine points of new software by some kind of digital osmosis.

That elusive clinician friendly EHR.

It’s very clear at this point that electronic health records (EHRs) were designed primarily for data collection and billing purposes. I have yet to see a system that could in any way be called […]

2020-03-12T08:02:22-04:00March 12th, 2020|digital health, Nursing, Technology|2 Comments
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If I Want to Wear a Face Mask to Prevent COVID-19, Why Shouldn’t I?

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published. March 6; updated March 12.

Times are uncertain. We don’t know how the spread of the new coronavirus will play out, or what parts of the country will be affected next. Many people continue to insist that wearing a mask in public places is “added insurance” against infection. But the reasons for NOT wearing a face mask far outweigh the purported benefit of keeping your nose and mouth covered when you’re out and about.

First, some background.

Health care workers use two main kinds of mouth and nose protection: either a regular surgical face mask, or an N95 respirator.

The purpose of a surgical mask is to prevent the wearer’s respiratory secretions from contaminating other people or surfaces. This is an example of “source control” in preventing infections. It is the reason the surgical team wears masks during operations and other invasive procedures.

N95 respirators look very much like face masks. They are designed to protect the wearer from inhaling hazardous particles (infectious agents, dust, etc.). Health care workers wear these when caring for people with COVID-19 or other serious respiratory infections.

But at least a face mask provides a physical barrier. Why shouldn’t I wear […]

2020-03-11T12:10:37-04:00March 6th, 2020|infection control, Nursing, Public health|0 Comments
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Defining Death

My first encounter with brain death was back in the early 1970s. I was a new RN in a shock-trauma unit. We admitted a 17-year-old young woman who had attempted suicide by jumping out of a fifth-floor window. If it wasn’t awful enough, I remember it was Thanksgiving weekend and she had been home from college.

Angiograms of normal blood flow in an active brain (at left) and lack of blood flow indicating
brain death. Photos © Fusionspark Media Inc.

As one might imagine, she sustained massive injuries, including severe head trauma. She had been intubated at the scene and was on a mechanical ventilator. Her pupils were fixed and dilated, and she had no spontaneous respirations and virtually no brain activity, according to electroencephalography (EEG) studies.

A gradual refinement of criteria.

I recall that there had to be three consecutive EEGs done before we could remove the ventilator. There was no ethics committee or formal meetings with hospital attorneys or administrators—just the physician, the family, and the pastor. And then the patient’s siblings and grandparents came to say goodbye. It was heart-wrenching.

Things have gotten more defined and […]

2020-03-05T08:21:37-05:00March 5th, 2020|Nursing|0 Comments
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The Sound of Silence: Racism in Nursing

“In the end, we will remember not the words of our enemies, but the silence of our friends.”   -Dr. Martin Luther King

One of the conundrums I face when writing stories from my nursing career is the question “whose story is it?” For instance, does observing an act of racism give the observer the right to tell the story of what happened to another person? Does telling the story with the intent of exposing the ugliness of racism make it okay?

by julianna paradisi

It’s February, Black History Month. How can a white woman, a registered nurse, discuss race issues in a profession in which only 7.8% of the workforce is black without sounding ignorant, or worse, racist herself? Once or twice in the past I’ve made well-intended comments that revealed my own blind spots when talking about race. Fortunately, these were brought to my attention by friends who understood my good intentions, however misguided. I’m grateful for their support, and compassion. Like learning a new language, using the right words when talking about race requires commitment, practice, and a little bit of courage.

‘Here’s the chart. Answer the man’s questions.’

Years ago, I encountered a surgeon I’d never met before who repeatedly asked me for updates […]

2020-02-26T09:39:39-05:00February 26th, 2020|Nursing|3 Comments
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