One Question That Can Change the Diagnosis: Why Travel History Matters

A college student presents to the emergency department with fever, nausea, vomiting, and diarrhea after returning from a spring break humanitarian mission trip to Haiti. During the nursing assessment, the patient reports having brushed their teeth with water that might have been untreated and recalls receiving multiple mosquito bites. What might at first appear to be a routine case of gastroenteritis comes in this case with concern for dengue, malaria, typhoid fever, or cholera. The patient’s travel history changes not only the differential diagnosis but also the urgency of testing, treatment, and infection-control decisions.

One simple question can change a patient’s outcome: Have you traveled recently? According to the CDC, nearly half of travelers to low- and middle-income countries become ill during or after travel. Although many illnesses are mild, some require hospitalization, and others may not become apparent until weeks or even months after returning home. Some syndromes can present years after travel.

Why travel matters.

According to the WHO, international travel is on the rise. Millions of people are traveling for professional, personal, and humanitarian reasons. International travel exposes people to infectious diseases that may be uncommon in the United States. Contaminated food and water, insect bites, animal exposures, health care […]

2026-08-28T09:50:45-04:00August 28th, 2026|infectious diseases, Nursing, Public health|0 Comments
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E-Bikes and Kids: Permission Is Not Preparation

When a student returns to my middle school after an e-bike or e-scooter crash, the emergency may be over, but the injury is not. I see the cast and crutches, the concussion plan, the missed classes, the headaches that linger, and parents still trying to understand how an ordinary ride changed so much. That is why “Are you ready to ride?” must mean more than having permission to leave the driveway.

I have been a nurse for more than 30 years, the last 11 of them as a school nurse. I am not usually the nurse at the crash scene. I am the nurse who sees what comes next. I see the student navigating hallways on crutches. I see the child who insists the headache is gone because they are tired of missing gym or practice. I see the parent coordinating appointments, transportation, schoolwork, and recovery while wondering when life will feel normal again.

Outside our schools, the change arrived silently. Dismissal once meant the rumble of buses, parents calling through open car windows, and the rattle of bicycle chains. Now students glide away with a quiet electric hum, heading to practice, work, friends’ homes, and the growing independence every generation of teenagers has […]

2026-08-12T15:41:12-04:00August 12th, 2026|Nursing, Public health, school nurses|0 Comments
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Dengue Cases Are Rising: Why Every Nurse Should Be Paying Attention

A patient presents to the emergency department with fever, headache, nausea, and severe muscle pain after returning from a Caribbean cruise. A few years ago, dengue fever may not have been high on a nurse’s list of possible diagnoses. Today, it should be.

Cryoelectron microscopy renderings of mature dengue virions (DENV-1) and photo of an Aedes mosquito. (NIAID)

Dengue is the leading cause of febrile illness among travelers returning to the United States from endemic regions. According to the World Health Organization, about half of the world’s population is at risk for dengue, with an estimated 100 to 400 million infections occurring annually, although many cases likely go unreported because symptoms are mild or absent.

In a recent MMWR, 3,798 dengue cases were reported in the United States in 2024 representing a 359% increase compared to the annual average reported between 2010 and 2023. Nearly 97% of reported infections occurred in travelers, with many cases linked to destinations in the Caribbean, including Puerto Rico and the U.S. Virgin Islands. However, locally acquired cases were also identified in Florida, California, and Texas.

Cause and Challenges

Dengue, sometimes called “breakbone fever,” is caused by one of four related […]

2026-07-14T11:03:15-04:00July 14th, 2026|infectious diseases, Nursing|0 Comments
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Beyond Environmental Services: Common Cleaning Gaps in Patient Care

During rounds in an outpatient clinic, I noticed staff cleaning vaginal ultrasound probes between patients with a quaternary ammonium disinfectant wipe (a low-level disinfectant appropriate for use on devices that come in contact with intact skin).

When I asked about the process, the staff explained that because the probe was covered with a probe cover, they assumed a disinfectant wipe was sufficient. While probe covers provide an important layer of protection, they can leak or develop microscopic perforations. Because contamination can still occur, these probes should always be treated as if they have contacted mucous membranes and require a high-level disinfectant (appropriate for use on devices that come in contact with mucous membranes or non-intact skin) instead of a low-level disinfectant.

Gaps in knowledge and execution.

This type of misunderstanding is not uncommon in health care and illustrates a broader challenge: cleaning failures are often not caused by lack of effort but by gaps in knowledge and execution. Despite longstanding guidance, inconsistencies in cleaning and disinfection practices continue to be cited during regulatory and accrediting surveys.

The Spaulding classification system.

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2026-06-15T09:46:46-04:00June 9th, 2026|infection control, Nursing, patient safety, Public health|1 Comment
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Nurses Know Safety Can’t Depend on Assumptions

In health care, we are trained not to rely on assumptions. We build systems that anticipate risk, standardize response, and make the next step clear before it is needed. When something goes wrong, we do not improvise. We follow a plan that already exists.

This is why it is so striking to encounter environments where safety depends almost entirely on assumption.

The tragic example of AED accessibility.

I began thinking about this outside of health care. I came to this through someone I know, John Ellsessar, whose life has been shaped by loss. His son, Michael, died at 16 after suffering sudden cardiac arrest on a high school football field where an AED was not immediately accessible.

That experience changed what he did next. It also changed how I think about a question that often goes unasked: What is the plan when something goes wrong?

Consider sudden cardiac arrest. It is one of the few situations in medicine where the response is both straightforward and time-dependent.

When John explained it to me, he put it simply: A heart attack is a plumbing problem, a blocked artery.
Sudden cardiac arrest is an electrical problem. The heart’s rhythm stops. […]

2026-05-15T13:18:43-04:00April 27th, 2026|Nursing, Public health|0 Comments
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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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