This post is follow-up to our widely shared post (“Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective”) by AJN clinical editor Betsy Todd. The author, Amanda Anderson, is a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. Her last post for this blog is here.
By CDC microbiologist Cynthia Goldsmith, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. CDC image library.
I don’t know a single nurse who likes caring for multiple isolation patients. The process of donning a new gown, pair of gloves, and mask each time you enter an isolated patient’s room is arduous and time-consuming. Personal protective equipment (PPE) clogs the garbage cans and can be hot and confining.
PPE has been in the news quite a bit lately because of Ebola. An interview with Liberian nurses by Hunter College’s Diana Mason on her WBAI radio show Healthstyles revealed that the Liberian Ministry of Health estimates 75% of virus victims are women—mostly nurses and caregivers. Nurses in West Africa might really love some of those pesky yellow isolation gowns.
Ebola can be a messy virus. Infected people have copious diarrhea and vomiting, often containing blood. The basics of care for Ebola patients should not be new to us; HIV and hepatitis can be spread in many of the same ways. We’ve got little to fear if we follow CDC guidelines for PPE and infection control. But in parts of Africa, where supplies we take for granted are scant, nurses and caregivers can’t even hold the hand of a dying patient or family member, much less clean them, without fearing for their lives.
As Mason’s interview reveals, many nurses are assigned 25 or more patients each shift in hospitals that lack electricity, running water, and gloves. (In an article for Buzzfeed, Jina Moore describes a nurse working in an Ebola ward who wears the isolation kit sent to her by the Liberian Ministry of Health. The kit includes a shower cap, gloves, and rubber bands for her wrists. Her ankles and neck are exposed, peeking out from her own short scrubs.)
Many sources have noted other complicating practical and cultural factors in the countries most affected by Ebola. Care of infected family members is often in the privacy of the home, with an emphasis on touching. Postmortem care may be undertaken without appropriate precautions. Other problems result from health beliefs at odds with infection control practices and from suspicion of governments and health care workers.
In America, where the nurses of Emory University Hospital have administered Ebola care in a cutting-edge isolation unit, the work is a lot less risky. As described in a forthright article by the head nurse at Emory University Hospital (“I’m the Head Nurse at Emory. This is Why We Wanted to Bring the Ebola Patients to the U.S.”), nurses on this unit treated the American Ebola patients with tact and skill. Their success shows that there is no reason any American nurse should be afraid to care for any Ebola patient that might land in their own unit.
Ebola action. Knowing the facts, how can we, the American nursing community, help our international colleagues? We can educate ourselves, our colleagues, and our patients on the reality of the disease, with a focus on countering misinformation and calming fears (for example, it appears unlikely that the Ebola virus will mutate in such a way that airborne transmission becomes possible). We can do this on social media and in local newspapers. And for those who are able to donate money or volunteer, Vox.com has provided a helpful article listing organizations needing your help.
One important thing nurses could do is educating not only ourselves but also common folks about this disease as much as you can. Learn the prevention and proper action to take if infected.