Far from Home, a Flight Nurse Cares for One of COVID-19’s ‘Peripheral Victims’

‘Deemed stable to fly home.’

Our fixed-wing air ambulance was recently dispatched to Spain to bring 87-year-old John and his wife of 62 years, Rose, home to the US. They’d traveled to Spain for their annual vacation before “COVID-19” or “coronavirus” were household terms, but John had fallen early on in the trip and broken a hip. He’d spent four weeks in a local hospital and had his injured hip surgically repaired, and then was deemed “stable to fly home” by a doctor. And so he’d been transported back to his hotel two days prior to our arrival. The crew deposited him in the bed, bid farewell to his wife, and left.

Spain’s deserted beaches seen from author’s hotel room, March 2020

And now John was dying. He lay on the twin bed in his hotel room. His eyes were closed. His breathing was rapid and shallow. My partner and I stood, stunned into momentary silence. We had come straight to his hotel from the airport, and his condition was far worse than we had anticipated.

We’d left our equipment in the aircraft, as John’s transport was planned for the following morning to allow time for our pilots to rest. John’s respiratory rate was 60 with frequent pauses, his pulse weak, heart rate about 95 and irregular. He wouldn’t open his eyes or respond to us verbally, but he fought us when we tried to move him. He was covered in feces.

No room at […]

2020-04-09T10:25:10-04:00April 9th, 2020|infectious diseases, Nursing, nursing stories|3 Comments
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Preserving Integrity and Staying Power as a Nurse in a Pandemic

We are in unprecedented times—uncertainty and fear are ever present and nurses are being called to serve others in ways that challenge our appraisal of benefit to our patients and risk to our families’ health and well-being. Many of us are experiencing varying degrees of moral distress and moral outrage arising from the gaps between what we ought to be doing and what we are actually doing under these adverse conditions. It can feel as if it is impossible to do ‘the right thing.’

What can we do to remain whole in the midst of the COVID-19 crisis? How can we accept what seems unacceptable?

Instead of using precious energy in unproductive ways, we can focus on the things that are within our control for meeting the demands of the situation with integrity.

Recognize your moral distress.

It’s easy to get swept away with fear. When fear takes over, we can become paralyzed—unable to think clearly or to act in accordance with our values. One way to confront our fear is to recognize and name the source of the angst.

What is causing your distress? Notice tension anywhere in your body. Accept whatever it is you find. What are the conflicting obligations you are confronting? Try to name the conflict.

You may realize that your core value in the current situation is to not cause harm to your patients. You may say to yourself, […]

2020-04-07T11:14:22-04:00April 7th, 2020|infectious diseases, Nursing, nursing perspective|3 Comments
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As Conflicting Recommendations Sow Public Confusion, Nurses Still Lack Adequate PPE and Equipment

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. April 3.

One problem central to the experience of nurses during this pandemic is the disastrous lack of essential supplies and equipment. How different would your work days be right now if you had plenty of PPE and ventilators? In the parts of the country with the most COVID-19 cases, this problem is far from being resolved. In many other cities and states, unbelievably (after three months), you are likely to be faced with it soon.

Where is our PPE?

For weeks, nurses and physicians in states that were initially hardest hit by the pandemic (New York, California, Washington) have reported severe shortages of personal protective equipment. (See, for example, this ICU nurse’s anonymously published note to AJN.) Respiratory protection has been in particularly short supply. In many hospitals, staff are reusing one droplet mask or N95 respirator for an entire shift or longer. These dire circumstances were predictable. A  2015 article from researchers at the National Institutes of Health predicted that in a pandemic in which only 20 to 30 percent of the population is infected, up to 7.3 billion N95 respirators would be needed. COVID-19 is likely to infect a considerably higher percentage of the population. Where are our masks? […]

2021-01-21T11:08:39-05:00April 3rd, 2020|infectious diseases, Nursing, Public health|3 Comments
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COVID-19: On and On

A note from AJN’s editor-in-chief Shawn Kennedy.

Published: March 30. As I write this, the United States has over 140,000 COVID-19 cases and over 2,400 deaths, and we’re told those numbers have yet to peak. The US Navy hospital ship Comfort is on it’s way to New York City, bringing its 1,000 beds to be used as a supplemental hospital. Its sister ship Mercy is on its way to Los Angeles. Bedside nurses and CNOs alike talk about the “war zone” that their hospitals have become. And they’re exhausted: many ICU nurses are working five days of 12-hour shifts as they await help from nurses who are getting crash courses in ventilator management.

Perspectives for and by nurses, from many angles.

Our goals during this pandemic are to serve as a reliable and up-to-date source of information and advocacy for those on the front line, to bear witness and give nurses and other health workers a voice during these uncertain times.

We’ve been using this blog to bring you evidence-based information about the COVID-19 pandemic, mostly via posts by our clinical editor Betsy Todd, whose expertise is in public health and infectious disease. She has done a yeoman’s job, researching the latest information and ensuring what we publish on PPE and COVID-19 is in in accord with the most current state of knowledge at the time—even contacting study researchers to verify facts […]

2020-03-30T15:03:14-04:00March 30th, 2020|healthcare social media, infectious diseases, Nursing, nursing perspective, Public health|0 Comments
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Moral Courage in a Pandemic: a 14th Century Physician and Health Care Workers Today

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

A physician during the Black Death.

Guy de Chauliac

As a hospice social worker who loves the humanities, I find that historical figures often come to mind when there’s a parallel with things that are happening with patients and their families. Amidst the COVID-19 pandemic, I’ve been thinking a lot about a 14th century French physician named Guy de Chauliac.

Although little known today, in his time he was one of Europe’s most respected medical practitioners. In fact, his text Chirurgia Magna was a standard part of medical education for 200 years.

I came across de Chauliac’s story years ago while researching the ‘Black Death,’ the plague that decimated Europe in the 1340s, killing up to a third of its population.

Those who have read Giovanni Boccaccio’s contemporary account of this plague in his work Decameron are often left with a cynical impression that, as Boccaccio puts […]

2020-03-27T12:15:38-04:00March 27th, 2020|Ethics, infection control, Nursing, nursing perspective, 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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