Cast Into the Shadows: COVID-19’s Power Over Non-COVID Cases

As a pediatric ICU nurse in a hospital that has not experienced an overwhelming surge of COVID-19 patients, it has taken me some time to register the ways this pandemic has affected my perspective and practice.

Non-COVID diagnoses left in the shadows.

Photo by Unjay Markiewicz/ Unsplash

I recently took care of two young patients, each with acute and unexpected conditions. One was under post-operative care after a brain tumor had been removed the day before. The other had been newly diagnosed with acute lymphoblastic leukemia. What stood out to me as I interacted with their families was that these were some of the only people I would interact with in this period who did not have COVID foregrounded in their mental and emotional space. This feeling was followed by the sobering realization that this was only because they found themselves dealing with something just as insidious, if not more so.

In both cases, the families observed confusing symptoms in their children and had to wrestle with whether or not to go to the ED in the midst of a pandemic. Only when the symptoms became so severe and concerning did these families decide they could no longer avoid the ED. Now facing an inpatient hospital stay […]

2020-06-02T09:32:44-04:00June 2nd, 2020|family experience, infectious diseases, Nursing, nursing stories, patient engagement, Public health|1 Comment
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How Can We Improve the Hospital Experience of Visually Impaired Patients?

VIP Care Toolbox used in QI project

“Hello, I’m your nurse, Jane. Are you able to see me clearly?”

I have trouble functioning without a pair of eyeglasses within reach. If I were in the hospital without my glasses, I’d be at a loss—unable to read for pleasure, let alone read menus or instructions or consent forms. How much harder is it for people with moderate vision loss, or those who are totally blind?

Christine Carlson and her colleagues at St. David’s North Austin Medical Center in Austin, Texas, set out to answer this question. They met with visually impaired people in the community, reviewed the literature, and surveyed their own staff in order to learn the best ways to accommodate the unique needs of visually impaired patients, or ‘VIPs.’

In “Caring for Visually Impaired Patients in the Hospital: A Multidisciplinary Quality Improvement Project” in the May issue of AJN, the authors highlight how frightening and frustrating a hospitalization can be for those with limited or no sight, and share simple, practical interventions that can make an enormous difference in the safety and quality of a VIP’s hospital experience.

“I’m always afraid to go to the hospital. They don’t know what […]

2020-05-21T09:52:23-04:00May 21st, 2020|patient experience, Patients|0 Comments
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Two Poems by an ED Nurse

Mask

         -from Latin, masca (specter, nightmare)

My borrowed face,

incorporeal,                blue—

I give you        only

my eyes.

First Sunday on the Ward, Pandemic

Deft swallows nest inside the thorny crown of a stone Christ.

I whisper Our Father . . .                   

twice

over the scrub sink.

 

-Editor’s note: These two spare poems were sent to us recently by Stacy Nigliazzo, an ED nurse and poet whose work has been featured in JAMA and the Bellevue Literary Review, as well as in AJN’s Art of Nursing column. We don’t usually publish poems on this blog, but make an exception here because they seemed to us urgent and yet timeless. Publishing them implies no affiliation of AJN with any particular religion. At the same time, it’s only natural that faiths and practices of every sort are likely to be a source of strength and meaning during this time for nurses around the world. 

2020-04-10T13:39:42-04:00April 10th, 2020|Nursing, nursing perspective|2 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, I […]

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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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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