On November 16, the NCBSN and six other top US nursing organizations issued an urgent policy brief to remind members of the most trusted profession to honor that trust and fight misinformation related to Covid-19. “When identifying themselves by their profession, nurses are professionally accountable for the information they provide to the public,” the brief states, and warns nurses that “dissemination of misinformation not only jeopardizes the health and the well-being of the public but may place their license and career in jeopardy as well.”
The full text of the brief, issued by the National Council of State Boards of Nursing (NCSBN), the ANA, NSNA, and other major nursing organizations follows.
To address the misinformation being disseminated about COVID-19 by nurses.
For the purposes of this statement, misinformation is defined as distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature, and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).
Nurses are expected to be “prepared to practice from an evidence base; promote safe, quality patient care; use clinical/critical reasoning to address simple to complex situations; assume accountability for one’s own and delegated nursing care” (AACN, 2021).
SARS-CoV-2 is a potentially deadly virus. Providing misinformation to the public regarding masking, vaccines, medications and/or COVID-19 threatens public health. Misinformation, which is not grounded in science and is not supported by the CDC and FDA, can lead to illness, possibly death, and may prolong the pandemic. It is an expectation of the U.S. boards of nursing, the profession, and the public that nurses uphold the truth, the principles of the Code of Ethics for Nurses (ANA, 2015), and highest scientific standards when disseminating information about
COVID-19 or any other health-related condition or situation.
When identifying themselves by their profession, nurses are professionally accountable for the information they provide to the public. Any nurse who violates their state nurse practice act or threatens the health and safety of the public through the dissemination of misleading or incorrect information pertaining to COVID-19, vaccines, and associated treatment through verbal or written methods including social media may be disciplined by their board of nursing. Nurses are urged to recognize that dissemination of misinformation not only jeopardizes the health and
well-being of the public but may place their license and career in jeopardy as well.
DailyNurse is inviting nurses in every branch of the profession to share their pandemic experiences and reflections with their peers. Was there a particular experience that you will carry with you for life? Have you been inspired by specific colleagues or a group of nurses? Has Covid significantly changed the way you work, teach, or learn? Did it affect your goals, your role, life? Are you rethinking your ideas about what it means to be a nurse, or has Covid reinforced them? To share your story, submit a 400-800 word post to firstname.lastname@example.org.
It is well known that the COVID-19 pandemic has significantly impacted the profession of nursing. Thankfully, there are still nurses who want to be nurses, but many are leaving the profession due to the stress of the pandemic. What’s concerning to me as a nurse scientist is the decrease in nurses who are learning more about, and engaging in, research and evidence-based practice.
When taking care of patients became the one and only priority,I definitely began to question the importance of my role and wondered how, as a nurse scientist, I would be able to contribute during the pandemic.
Understandably, nurse participation in research and evidence-based practice projects declined with the COVID-19 pandemic. As a nurse scientist, it is my goal to assist nurses in conducting research and implementing best evidence to improve practice and patient outcomes. Nurse scientists provide education and opportunities to foster a spirit of clinical inquiry in nurses. But as of early 2020, the level of interest and engagement among nurses in research and evidence-based practice declined significantly. Especially when taking care of patients became the one and only priority, I definitely began to question the importance of my role and wondered how, as a nurse scientist, I would be able to contribute during the pandemic.
Contributing as a nurse scientist in the wake of Covid-19
None of these amazing contributions to the profession of nursing would have been possible without the leadership and colleague support I received in my department. Our work truly made a difference. We proactively identified best practices for working in nursing during a pandemic, rapidly implemented evidence-based education to assist nurses who were caring for COVID-19 patients, contributed to nursing science, and stayed on-call to join in caring for patients if needed. I do miss my team, though. While working remotely is not new to me, the amount of being at home versus being in the office these past two years has been eye-opening. But that’s a different conversation! Especially since this isn’t an option for many nurses.
I am so grateful for the nurses who have been working the front lines during this pandemic. I know you are burnt out. I know you want to leave. Hang in there because this will pass! We need the knowledge and experience you gained from this.
Supplies of N95 face masks, surgical face masks, and face shields at US hospitals are under the microscope in the latest research project led by nurse scientist Kelly Aldrich, DNP, MS, RN-BC, FHIMSS, associate professor of nursing informatics at Vanderbilt University Nursing School.
The DNP and her team are receiving CDC funding to the tune of $80,000 to support their analysis of daily hospital personal protective equipment (PPE) on-hand inventories to measure trends, patterns, or statistically significant changes in PPE supply in the nation’s nearly 7,000 U.S. hospitals. The project is designed to support the CDC’s National Personal Protective Technology Laboratory, which was established under the aegis of the National Institute for Occupational Safety and Health (NIOSH) in 2001 and invested with the mission of preventing disease, injury, and death for the millions of American workers who rely on personal protective technology (PPT).
“In analyzing the data with advanced analytics, we will be able to find patterns that were not seen before. I think because of that, it will have a true impact on supply chain management for the country.”
Aldrich is being supported by a Vanderbilt team that includes four second-year data science students under the supervision of Jesse Spencer-Smith, chief data scientist of the Data Science Institute, and Dana Zhang, professor of computer science and electrical engineering, to leverage artificial intelligence and data modeling for this large-scale analysis and reporting effort.
Nurse scientist Kelly Aldrich, DNP, MS, RN-BC, FHIMSS.
“We’re conducting data analysis on a medical organization’s average consumption rates to figure out if they have enough PPE and other essential items to provide for their teams,” Aldrich said. “In analyzing the data with advanced analytics, we will be able to find patterns that were not seen before. I think because of that, it will have a true impact on supply chain management for the country.”
“By [enlisting the aid of] the Data Science Institute to support this important work, Dr. Aldrich has deepened and extended the research while providing a meaningful opportunity for our team to put their expertise to use,” said Jesse Spencer-Smith, chief data scientist for the Data Science Institute. “Our faculty and graduate students formed a team that is enabling this analysis to go from simple data points to insights that can shape the country’s future responses to health care events.”
Study aims to increase transparency and efficiency of PPE supply distribution
The necessity of this effort was brought to light by pandemic-related lack of access to PPE due to supply shortages or prohibitive costs. In the early stages of the pandemic, the World Health Organization called on industry and governments to boost PPE manufacturing with a warning of “severe and mounting disruption to the global supply of personal protective equipment—caused by rising demand, panic buying, hoarding and misuse.”
The WHO was right. Months into the pandemic, PPE shortages among hospitals, nursing homes and medical practices across the U.S. put health care providers and patients at heightened risk of exposure to COVID-19. Two goals of Aldrich’s project are to bring transparency to PPE supply across the country and to eliminate the common problem of one hospital having a PPE surplus while neighboring hospitals scramble.
The project is a follow-up to a 2020 project Aldrich led with the Center for Medical Interoperability, a national nonprofit working to integrate health care technologies for information exchange, and the National Personal Protective Technology Laboratory, part of the National Institute for Occupational Safety and Health. The TOGETHER for PPE project phase connected 78 hospitals in nine federal Health and Human Services’ regions. Thousands of real-time data points allowed for predictive modeling and other data analysis which helped hospitals and the CDC examine exactly what PPE they had on hand, which enabled hospitals to plan and develop solutions that kept caregivers and hospital patients safe. A paper on the project phase entitled Lessons Learned from the Development and Demonstration of a PPE Inventory Monitoring System for US Hospitals was published in the journal Health Security on Nov. 9.
Aldrich’s trans-institutional project will restart and amplify the TOGETHER for PPE effort. The data collected by Aldrich’s team in 2021 will focus on N95 face masks, surgical face masks, and face shields.
“Collaboration with the Data Science Institute in data modeling and data analysis with predictive and artificial intelligence models are of high priority,” said Aldrich, also the director of Vanderbilt’s new Nursing Informatics Innovation Lab within the Vanderbilt School of Nursing and the chief clinical transformation officer for the Center for Medical Interoperability. “This collaboration is a terrific example of bringing researchers together with diverse areas of expertise and distinct backgrounds to discover new information. We are excited about the progress to date.”
New data from the Texas health department released on November 7 proves what health officials have been trying to tell vaccine-hesitant Texans for months: The COVID-19 vaccine dramatically prevents death and is the best tool to prevent transmission of the deadly virus.
“We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
—Dr. Jennifer A. Shuford, state epidemiologist
Out of nearly 29,000 Texans who have died from COVID-related illnesses since mid-January, only 8% of them were fully vaccinated against the virus, according to a report detailing the Texas Department of State Health Services’ findings.
And more than half of those deaths among vaccinated people were among Texans older than 75, the age group that is most vulnerable to the virus, the study shows.
“We’ve known for a while that vaccines were going to have a protective effect on a large segment of our population,” said Dr. Jennifer A. Shuford, state epidemiologist. “By looking at our own population and seeing what the impact of the vaccines have been on that population, we’re hoping just to be able to reach people here in Texas and show them the difference that being fully vaccinated can make in their lives and for their communities.”
The state health department study covers most of the positive cases and COVID-19 deaths reported in Texas among residents from Jan. 15 to Oct. 1. It’s the first time state officials have been able to statistically measure the true impact of the vaccine on the pandemic in Texas — which has one of the highest death tolls in the nation. The majority of Texans ages 16 and up didn’t become eligible for the vaccine until late March.
State health officials also found the vaccine greatly reduced the risk of virus transmission, including the highly contagious delta variant that ravaged the state over the summer.
Only 3% of 1.5 million positive COVID-19 tests examined since mid-January occurred in people who were already vaccinated.
State researchers matched electronic lab reports and death certificates with state immunization records and measured cases and deaths since mid-January, a month after the first shots were administered in Texas.
The study was done using data similar to those used by other states that conducted similar studies and methods recommended by the U.S. Centers for Disease Control and Prevention, Shuford said.
And while the outcome was not particularly surprising, Shuford said, officials hope that the new data will increase trust in the benefits of the shot.
“Texas is a unique place; it’s got a lot of diversity, geographic and population-wise,” Shuford said. “We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
In Texas, it literally requires a disaster — like a pandemic — before the state records precise information about vaccinations. As a result, there is a record for every single COVID-19 vaccine dose of the name and age of the person who received it plus the date it was administered. Normally, vaccination records are shown to schools by parents, but details of all vaccinations are not regularly kept by a state registry in Texas, unlike nearly every other state, because it’s a voluntary system.
However, state officials still don’t have official numbers on how many vaccinated people were hospitalized with COVID-19 because hospitals are not required to report that level of data under state law.
But the state’s largest hospital districts and counties have reported that at least 90% of the hospitalized Texans with the virus were unvaccinated.
The state’s new health data comes as Republican state leaders grapple with local cities and school districts about masking, which has been proven to reduce transmission of the virus, and with federal officials over vaccine mandates.
About 53% of the Texas population is fully vaccinated. More than 70,000 Texans have died from COVID-19 since the pandemic began.
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Mandi Cai contributed to this report.
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Throughout the COVID-19 pandemic, health care practitioners have relied on COVID-19 testing to tell them what safety precautions to follow with each patient. Carl Johnson, Cornelius Vanderbilt Professor of Biological Sciences, wondered how the virus might act differently depending on the time of day and the body’s circadian rhythms.
Johnson collaborated with Candace McNaughton, former adjunct assistant professor of emergency medicine, and Thomas Lasko, associate professor of biomedical informatics at Vanderbilt University Medical Center, to determine if the percentage of people testing positive for COVID-19 varies based on time of day. They found that people were up to two times as likely to have an accurate positive test result if they tested in the middle of the day compared to at night.
The data support the hypothesis that COVID-19 acts differently in the body based on our natural circadian rhythm, which has also been implied by studies of other viral and bacterial infections. COVID-19 virus shedding—when infected cells release infectious virus particles into the blood and mucus—appears to be more active in the middle of the day due to modulation of the immune system by our biological clock.
WHY IT MATTERS
“Taking a COVID-19 test at the optimal time of day improves test sensitivity and will help us to be accurate in diagnosing people who may be infected but asymptomatic,” Johnson said. Their results indicate that viral load is lower after 8 p.m. If people choose to get tested at that time, there could be a higher chance of a false-negative result. False negatives can be harmful to the community and for the patient, who might not seek additional care due to their negative test result.
A difference in COVID-19 viral shedding throughout the day is important information that may inform how we test for and treat the virus. As Johnson and his co-authors report, the peak shedding in the afternoon, when patients are more likely to interact with others or seek medical care, could play a role in increasing the spread of the virus in hospitals and the wider community.
Further research is needed to confirm the diurnal—meaning active during the day—nature of SARS-CoV-2, the virus that causes COVID-19. Experimentally testing patients who are infected with COVID-19 to see if individuals shed the virus differently throughout the day would have important public health implications, Johnson said.
Johnson and his co-authors hope this early research can be used to optimize COVID-19 testing and improve test accuracy. The researchers believe temporal considerations may be leveraged to maximize the effectiveness of intervention strategies and even vaccine strategies.
This research was supported by the Research Education Clinic Center, Tennessee Valley Healthcare System, VA Office of Rural Health grant ORH-10808, as well as the National Institutes of Health grant R21HL1140381, Veterans Affairs grant IIR-19-134, and Pfizer.
New research addresses the misconception that children are less susceptible to infection with the new coronavirus. According to a recent report in JAMA Pediatrics, children and adults have similar risks of becoming infected with SARS-CoV-2, but a much larger proportion of infected children do not show symptoms of COVID-19. When one household member is infected, there is a 52% chance they will transmit it to at least one other person with whom they live.
The findings are based on the Coronavirus Household Evaluation and Respiratory Testing (C-HEaRT) study led by the Centers for Disease Control and Prevention (CDC) in collaboration with investigators at University of Utah Health, Columbia University, Marshfield Virology Laboratory, and Abt Associates.
“Often, it seemed like children weren’t sick because they didn’t have any symptoms,” says Christina Porucznik, Ph.D., professor of public health at U of U Health, who led investigation of 189 families in Utah. “But some were actually infected, and they could still spread COVID-19.”
Early in the pandemic, reports indicated that children accounted for the minority of COVID-19 cases. However, the observation was not able to distinguish between two scenarios. One was that children were less susceptible to infection. Another was that reported case rates in children were artificially low because they did not show symptoms, and therefore were not tested.
To better understand infection dynamics, the C-HEaRT study followed 310 households with one or more children aged 0 to 17 years in Utah and New York City. More than 1,236 study participants submitted samples for weekly molecular testing (PCR) for SARS-CoV-2 infections and completed weekly questionnaires about symptoms. On average, each person was observed for 17 weeks, and the report included a total of 21,465 person-weeks of surveillance time. The results were from September 2020 through April 2021, before the Delta variant emerged in the U.S.
The study showed that:
Children and adults 18 years and older had similar rates of infection.
Children in different age groups (birth to 4 years; 5 to 11 years; 12 to 17 years) also had similar rates of infection. Infection rates in each group were between 4.4 to 6.3/1,000 person-weeks.
About half of the cases in children were symptomatic, compared with 88% of adult cases.
In households with one or more infected individuals, the overall average household infection risk was 52%.
The mean household infection risk was 40% in Utah and 80% in New York City.
More research will need to be done to investigate whether differences in housing density, the timing of emergence of the Delta variant, or other factors contributed to differences in household transmission rates in Utah and New York. Additionally, infection rates and household infection risk may be higher in the general population since study participants could be more likely to carry out COVID-19 prevention behaviors.
This study’s results highlight that many infections in children go undetected, underscoring the need for surveillance testing and for children to continue public health safety measures to protect the people around them, Porucznik says. “We know that until kids can be vaccinated, it’s still important for them to wear masks when they’re in groups and to keep them apart,” she says. “And most of all, when they are sick, keep them home.”