The world is watching the developments related to this new
coronavirus, officially designated 2019 Novel Coronavirus or
2019-nCoV, As a nurse, you may be wondering what to tell your
patients about this life-threatening virus.
Coronaviruses are so named due to their particular shape,
which is similar to a crown. They are very common; many are responsible for the
upper respiratory infections from which we often suffer and treat their
symptoms with rest and over the counter medications. But occasionally
coronaviruses become much more serious, as in the cases of Severe Acute Respiratory
Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
To help you educate and prepare your patients, we’ve provided some basic information and tips to help them avoid panic and stay as healthy as possible.
As of this writing, there have been 31,472 confirmed cases of 2019-nCoV, according to the real-time status map from Johns Hopkins University’s Center for Systems Science and Engineering. The majority of cases have been in mainland China and surrounding Asian countries. There have been 638 deaths thus far, all of which were outside the United States. In North America, there are twelve cases confirmed in the US, five in Canada, and none in Mexico at this time. No deaths have occurred in North America.
You should be concerned about
any patient who has recently traveled to China and is symptomatic. You should
also be concerned about any patient who has been exposed to a lab-confirmed
2019-nCoV within fourteen days of the onset of symptoms. For any patients
presenting with a fever and cough, you should obtain a detailed travel history.
As with most viruses and illnesses, the most medically fragile are those who are most at risk. The Journal of the American Medical Association (JAMA) reports the median age of patients is 49 to 56 years, with rare cases in children.
There have been many news reports of
Asian retailers of medical face masks being out of stock, as people rush to
purchase them for protection. Unfortunately, these masks give
a false sense of protection against the disease for healthy persons, as
coronavirus is not airborne, and they do not prevent the wearer from putting
their hands behind the mask to touch their face. The CDC is
not currently recommending the use of facemasks for the prevention of
coronavirus. However, they can be beneficial for infected persons to prevent
them from coughing or sneezing into their hands and thus more readily spreading
the disease.
The best prevention tactics are the very same as the CDC
recommendations for the common cold, says Neha Pathak,
MD:
Wash your hands thoroughly and regularly
throughout the day.
Avoid touching your eyes, nose, and mouth with
unwashed hands.
Symptoms of coronavirus can
appear in as few as two days or as many as fourteen after exposure to the
virus, according to the CDC. Some of the most common symptoms are fever, cough,
and shortness of breath. People who suspect that they may have been exposed
should contact their doctor immediately.
Treatment for coronavirus is the same as for a cold- namely supportive care – rest, fluids, and over the counter medicine for sore throat and fever. But if the symptoms worsen, those individuals should contact their physician.
What About a Vaccine?
There are multiple efforts underway to create a vaccine for
2019-nCoV, however, there are none expected to be ready for deployment until
approximately April of 2020. One of the potential vaccines is the previous
labors to develop a vaccine for the coronavirus
SARS, which was shelved before reaching clinical trials. The
vaccine was shelved when SARS was defeated by improved hygiene efforts.
The second potential
vaccine is under development in Boston, an mRNA vaccine
that is showing promise. The earliest trials with people show a good immune
response, but the vaccine has not yet been tested in an outbreak. There are
reportedly other vaccine candidates being developed as well.
For daily updates on the worldwide developments of
2019-nCoV, in addition to the real-time map from Johns Hopkins, you can follow
WHO’s daily situation
reports or the CDC’s Situation Summary.
At any given moment working nurses are pulled in numerous
directions, as multitasking is the currency of the occupation. In many
instances, nurses are caring for high acuity patients on units with inadequate
nurse staffing. Nurses are trained in principles of documentation, the six to
eight “Rights”
of medication administration, and round regularly on their patients to maintain
safety.
Distraction can still wreak havoc on a shift if a nurse is not focused carefully on the immediate task at hand. A 2013 study revealed that “42% of healthcare-related life-threatening events and 28% of medication adverse reactions are preventable.” So how can nurses bring their full attention to what they are immediately concerned with?
Mindfulness Can Help
By embracing the practice of mindfulness. It’s a term that’s mentioned often in relation to relaxation and meditation these days, but it can be helpful during working hours as well as after hours. To be mindful, according to Merriam-Webster, one is “bearing in mind,” “aware,” or “inclined to be aware.” PsychologyToday.com states that mindfulness “is a state of active, open attention to the present.” Essentially, being mindful is being fully present and attentive to what is happening in the present.
Mindful over Multitasking
Nurses can incorporate mindfulness into their everyday
practice by making the effort to bring their focus to the present whenever they
are interacting with patients, which will improve work performance.
Save any multitasking for times not spent working directly with patients.
Before entering a patient’s room, pause briefly and take a breath. Bring the
focus to the specific details of the patient’s case and keep it there as long
as the interaction lasts. Actively listen when they speak.
Before entering a patient’s room, scan your body
for tension – look for tension in common places such as the jaw or shoulders
and relax those areas.
Be aware of feeling rushed or anxious, and
acknowledge these feelings without trying to eliminate them.
Take a couple of mindful breaths, dissolving
your tension and busyness on the exhale.
As you prepare to meet your patient, adjust your
mindset to be fully present.
Knock on the door and make eye contact as you
enter the room.
Introduce yourself and make a personal
connection.
Chat with your patient for a few moments before
moving on to your assessment or reaching for your computer.
Whenever you notice your focus has wandered,
gently redirect back to your patient and the task at hand.
Reduce Stress
Incorporating mindfulness into everyday practice can reduce reactivity to stress. By being more mindfully deliberate, nurses can implement their daily plans with less distraction. Adopting the mindful approach is considered much healthier than multitasking. And paying full attention to patients can only improve assessment skills.
Adopting the practice of being mindful and returning the
mind to the present whenever the focus strays can help keep nurses on task with
less stress and more efficiency. A mindful nurse is far less likely to make
mistakes. And that’s something from which everyone benefits.
Nurses caring for patients in a facility have the advantage of a controlled environment, predictable routines, and a team of clinicians working with them. Home health nurses working solo encounter far less predictable circumstances, including varied environments, situations, or schedules. Here are some tips to ensure success as a home health nurse in your community.
Top off the Fuel and Kick the Tires
Whether you drive your personal or company vehicle, keep the
car well-maintained and fueled. Treat the half-full mark on the gas gauge as
“empty”; don’t wait to look for gas when you’re on fumes in unfamiliar
territory. Make sure all the tires are properly inflated, including the spare.
Keep a flashlight in your car – you may need it one day. You’ll also want to
keep handy some vehicle chargers for your phone and your point of care device.
Nothing will throw your day into chaos like a DOA device that your daily
documentation and communication depend on.
Take Stock of Supplies
Clinical supplies should be stored in containers that
protect them from heat or moisture and kept in the trunk or hatch. It’s helpful
to organize the supplies by purpose so that you can retrieve exactly what you
need quickly. Keep track of your inventory and make note of what you use (and for
whom) to alert you when it’s time to restock specific items, as well as ensure
that the charge items can be applied to the proper patient’s account.
Safety First
It’s hard to fathom home health nursing before the advent of cellular phones. Home health requires a great deal of phone work such as calls to the home health office, physicians’ offices, pharmacies, colleagues, and of course, patients. And most of the call work occurs while you’re traveling between stops. Accepted wisdom recommends that we pull over to safely conduct phone calls in our vehicles, but that would make it impossible to get through the day in home health.
That’s why it’s smart to have a car phone cradle so that you can safely conduct hands-free calls. Nearly all smartphones have a voice assistant that makes calling without ever touching the phone a breeze. In addition, most late model cars are Bluetooth enabled, making hands-free calling even easier.
Lunch on the Run
Even in home health, a lunch break can be a rarity, so many nurses carry a cooler in their car. They stock them with water or other beverages to stay hydrated throughout the day, along with their lunch and snacks as desired. Packing your own lunch prevents spending on drive-through fast foods and can provide healthier choices as well.
Planning Makes Perfect
Respect the time of your patients’ and their families – schedule visits no later than the evening prior to the date you’d like to see them. It can often be ineffective to call much sooner than that, as patients’ schedules and circumstances can change with little notice. Generally, scheduling visits on the afternoon or evening before works well.
Map out the next days’ visit route in an orderly fashion to prevent zig-zagging across town, wasting time and fuel. Whether you choose to start with the patient closest to you or the one furthest away, scheduling your visits in a logical sequence is the most time-efficient plan.
Patients usually want to see their home care nurse first thing in the morning, which is physically impossible – no one can be everywhere at once. Do your best to accommodate the patients’ scheduling requests, but keep in mind you’ll have several patients to see in a workday. Try as you might, you won’t be able to satisfy everyone.
HIPAA Still Rules
Today, most home care agencies provide portable point of care devices on which clinicians submit their daily documentation. Maintain the privacy of all patients when using these devices in patient homes and in public spaces. Any paper documentation that you must carry with you should be kept in secure storage containers and not left loose in your vehicle.
Home health nursing can be very rewarding and can provide nurses with more variety and a flexible schedule. Keeping these pointers in mind can ensure safety and efficiency in daily practice.
Nursing is consistently voted the most trusted of all professions. One that involves providing medical and personal care for individuals at their most vulnerable. So, why should nurses consider carrying nursing liability insurance to protect themselves from litigation? Because we live in an increasingly litigious society. Nurses are human, and, unfortunately, they can make mistakes.
Upping the Odds?
Having your own policy does not increase your chances of being brought into litigation. Whether or not you—as a named defendant—have your own malpractice insurance policy wouldn’t be discovered until the lawsuit was actually filed. A plaintiff’s attorney “names multiple defendants in a lawsuit in an attempt to access additional sets of insurance limits and increase the chance for a higher settlement,” according to nurse attorney Katherine J. Pohlman, MS, RN, JD.
Look Out for Number One
The employers’ coverage protects the hospital’s liability first and foremost. Nurse employees may have protection in the case of a lawsuit, but they’d be relying on the attorney retained to protect the hospital and not a privately retained attorney hired to protect the nurse and their own interests. Under an employers’ insurance, nurses share the liability limitations (how much money is available to cover the lawsuit) with every other employee named in the litigation. And it’s possible that the award settlement may not be fully covered by that policy, resulting in potential out of pocket legal expenses for employees, including nurses. Further, the employers’ policy protection for nurses ends when that employment ends, meaning you can still be held liable even if you are working elsewhere at the time of the lawsuit.
Is There Enough to Go Around?
There are some positions which may not be covered by an
employer’s liability insurance, such as contract workers or travelers. Nurses
should not assume that they are covered and should inquire with their employer.
And how do nurses know what the limitations of liability are for that
coverage?
An individual policy belongs to the nurse and would clearly
identify what is covered and what the monetary limitations for litigation
awards would be. Most importantly, individual policies held by nurses will
follow them wherever they may work, even if they are a travel nurse or
self-employed.
Unanticipated Liabilities
Nurse liability insurance can protect nurses in ways that many nurses overlook. A nurse may not even make an error or cause harm to be named in a lawsuit. A patient who perceives wrongdoing can initiate litigation that can cause financial harm to individuals who have done nothing wrong. A nurse can be utterly meticulous in their practice and documentation and still find themselves embroiled in litigation, which can cost them dearly.
Many nurses are often casually asked for health-related advice by colleagues, friends, and family members. Well-intended advice that leads to someone pursuing a course of action (or not pursuing, as the case may be) could potentially lead to perceived or actual harm. An individual policy would protect a nurse in these circumstances as well.
Board Action
Lastly, individual policies protect nurses from actions taken against them by their Board of Nursing. Legal representation in this instance would be covered by the policy as well. Many advanced practice specialty nurses would be unwise to practice without it, such as nurse midwives, nurse anesthetists, and nurse practitioners.
Insurance provides protection. It’s why we carry homeowners
and automobile insurance. Surely the annual cost of nurse liability insurance
is a worthwhile expenditure in the face of the risk that nurses take when
caring for their patients.
Most people in the medical profession agree that a nursing career can often be stressful; it comes with the territory of caring for those who are ill and injured. And on an average day, well-trained nurses are more than capable of managing the day to day stressors that their profession brings. But there are also those occasional shifts that bring nurses to their knees, putting them in need of restorative tactics. Here are some solutions for bringing a nurse back from the brink after a rough shift.
After a rough shift, it helps to debrief with colleagues who have also had a tough day. Reviewing what didn’t go well and determining how events could have been better managed can be educational or reinforce that the decisions made were the best possible options. And the opportunity to share the days’ struggles can be a great bonding experience for the team.
Break up the routine. Take a different or longer route home.
Taking the long way home can provide valuable time to clear the mind and break
up the “autopilot” to which we tend to default on our commutes.
Play soothing or instrumental music on the radio,
or leave it off altogether. Patient care can be extremely noisy, especially in
acute and long-term care facilities. After a long shift of constant noise, a
little oasis of quiet can be very soothing. After you get home, continue to
limit external stimuli for a while. Keep that Zen mode going a little longer if
you’re able.
Are you a pet owner or lover? It’s a wonderful thing after a long day to be greeted at the door by a faithful companion, but take it a bit further. A long walk with your dog or some snuggle time with your cat, ferret, or another small animal can help you detach from the day. Your focus is shifted from your own worries to the needs and appreciation of your furry friend. If you don’t have a pet yourself, perhaps you can visit a friend or neighbors’ dog. Petting an animal lowers blood pressure and facilitates the release of relaxation hormones.
Taking a nap or reading something simple and calming can help bring you back to balance by focusing your mind on something other than the friction of the day you’ve had.
Even if your work isn’t necessarily as grimy as some careers, most nurses make it a point to bathe after a shift. A shower or a soak in the tub cleanses off the residue of the day and leaves you fresh and ready for bed.
However you choose to spend your time after a rough shift, it’s important to make sure that you know how to take care of yourself.
