Immigrant women receive dubious hysterectomies and staffers openly neglect even basic COVID precautions at Georgia’s Irwin County Detention Center, says LPN Dawn Wooten in a complaint filed by four non-governmental organizations.
According to Wooten, the private immigrant detention facility has refused to test symptomatic inmates, has not been isolating those suspected of having the virus, and is disregarding mandatory CDC social distancing practices. Wooten’s complaint also notes that she and other nurses have been alarmed by the inordinate number of hysterectomy operations performed at the Center. In reference to the frequent and questionable hysterectomies one detainee described the detention center as “an experimental concentration camp.”
COVID-19 safety and treatment are given short shrift at the center, and Wooten says that even before the pandemic the facility was often dilatory in providing medical care for detained immigrants. Since the pandemic, the complaint alleges, the center has made almost no use of its two rapid-response COVID testing machines, and has instead sent swabs to be tested at a local hospital. Wooten was told she should not be “wasting tests” on people she suspected of being infected, and when she inquired about testing one detainee, a co-worker responded, “He ain’t got no damn corona, Wooten.”
In addition to failing to provide PPE for staff working directly with confirmed cases of COVID-19, Wooten’s complaint states that the facility forced symptomatic staff to continue to work in the facility and threatened them with discipline if they refused to work in dangerous conditions. Because she spoke out against such practices, Wooten says that she was transferred from her full-time position to a part-time job in which her shifts consisted of a few hours a month.
On Tuesday, September 15, House Speaker Nancy Pelosi called for an investigation. Regarding the alleged misuse of hysterectomies on immigrant women detainees, Pelosi said “The DHS Inspector General must immediately investigate the allegations detailed in this complaint. Congress and the American people need to know why and under what conditions so many women, reportedly without their informed consent, were pushed to undergo this extremely invasive and life-altering procedure.” She also called attention to the neglect of COVID safety measures and proper treatment, and referred to “ICE’s egregious handling of the coronavirus pandemic, in light of reports of their refusal to test detainees including those who are symptomatic, the destruction of medical requests submitted by immigrants and the fabrication of medical records.”
Project South, one of the organizations filing the complaint, states that “ICDC (Irwin County Detention Center) has a long track record of human rights violations.”
For more details on this story and quotes from Dawn Wooten, see the article in The Intecept.
This is Nephrology Nurses Week, and our latest Nurse of the Week is RN Sandy Nichols, who treats acute dialysis patients in hospitals in Albuquerque. When there was a call for nurses willing to volunteer in COVID hotspots, Sandy stepped forward and flew out to Chicago. The need for nephrology nurses was urgent: AKI is a complication that affects about 15% of all hospitalized coronavirus patients—even those with no previous history of kidney problems—and 20% of the COVID patients in ICU suffer from kidney failure.
After parting from her husband and 20-year old daughter in New Mexico, for nearly a month Sandy devoted 12-18 hours a day to caring for Chicago’s COVID patients—and she says she’s ready to go back if she’s needed. Sandy told DailyNurse about her background as a nephrology nurse and shared her reflections on the pandemic and her frontline experience.
DailyNurse: How long have you been a nephrology nurse, and how did you decide on this field?
Sandy Nichols: “I have been a nephrology nurse for eight and a half years and have worked in every form of renal replacement therapy available except for kidney transplantation. I first learned about nephrology nursing during my third semester of nursing school when I was one of two nursing students chosen to go for a week of clinicals in a chronic hemodialysis clinic. I hadn’t decided on the field of nursing I wanted to go into yet so I went in with an open mind. From that first day, I was fascinated by the mechanics of the dialysis machines, the concepts of renal replacement therapies, the dedication and involvement in the patients’ health, and the knowledge that I could be giving my patients life because of the care I was providing with every treatment.”
DN: What were your first thoughts about COVID—and what are your current views on the pandemic?
SN: “When I first heard about COVID-19, I thought, “Wow! That is going to spread quickly through China because of the sheer number of people living so close together there.” I could’ve never imagined what we’ve now seen here. This pandemic has impacted every human being in some way.
“I needed to do this. I felt like it was my calling because both our patients and my colleagues in those cities needed help.”
When Fresenius Kidney Care asked for nurses to volunteer in hospitals because of the rise in acute kidney injury caused by COVID-19, I just knew I needed to do this. I felt like it was my calling because both our patients and my colleagues in those cities needed help. Having seen the effects of this virus firsthand, and helping patients fighting it, the most important message I share with people is to take this seriously. Help us slow the spread of COVID-19 by social distancing, wearing masks, and washing your hands.”
DN: What prompted you to start working on the front lines?
SN: “When I started to hear about all of the different places being hit so hard by COVID-19 and the nursing shortages, I knew I wanted to help in some way. I always had the desire to volunteer when natural disasters would happen but I was never in a position to do so, until now. As soon as Fresenius put out the call for volunteers, I signed up. I knew that I was drawn into nursing to help people and I couldn’t think of a better way to do that then to go and give my fellow nurses support when they so desperately needed it.”
DN: What were the most striking aspects of your experience?
SN: “Going into Chicago, which was known as a hot zone at the time, I was anticipating staffing and supply shortages, long grueling hours, and constant chaos. What was most striking in my time there was the camaraderie that I witnessed and felt every day. The staff was exhausted and overwhelmed working 18 to 24-hour shifts to maintain patient care, but they were all so supportive and helpful of each other. It was so obvious that they were all bound together as one big family. They welcomed me in as one of their own and even invited me to one of their rare potlucks.”
“The staff was exhausted and overwhelmed working 18 to 24-hour shifts to maintain patient care, but they were all so supportive and helpful of each other.”
“I got to see success stories of patients with COVID-19 who survived being on a ventilator and walk out of the hospital. They would announce a “Code Joy” over the intercom and everyone would stop and cheer. I also saw devastating outcomes that broke my heart. Going through those experiences, which I will never forget, gave me a whole new perspective and I truly believe it made me a better person and a better nurse.”
DN: What are you doing now?
SN: “I am currently working in an acute setting at Fresenius Kidney Care in Albuquerque, NM. The camaraderie that I experienced in Chicago has followed me back to Albuquerque because my coworkers are closer to me than ever before. We are there together, going through the same thing, every workday. I am so thankful for my career and the knowledge I continue to gain every day. I wouldn’t be the nurse I am today without the support of my work family and my home family as well as my community in New Mexico and my company, Fresenius Kidney Care.”
Unprecedented numbers of patients have been placed on mechanical ventilators during the COVID-19 pandemic. Being connected to a ventilator can take a massive toll on the body and mind, and we know that the ordeal can contribute to Post-ICU Syndrome (PICS). Making a human connection with a patient in this state is challenging, but it is not impossible–in fact, a 2015 study found that over 50% of ICU patients on ventilators are capable of communicating.
DailyNurse asked the co-author of that 2015 study, Mary Beth Happ, PhD, RN, FAAN, FGSA, for advice on how to communicate with patients on ventilators (last week, Dr. Happ, who specializes in patient-provider communication, shared her tips on communicating while wearing PPE). Dr. Happ offered a number of suggestions:
What to Expect When a Patient is on a Ventilator
Patients are unable to vocalize during mechanical ventilation due to the breathing tube. Also, ventilated patients may be sedated or have fluctuating consciousness; their ability to comprehend or attend to communications may also fluctuate. Patients often have other pre-existing communication impairments – many will be hard of hearing and approximately 80% will be glasses wearers, however, most will not have glasses or hearing aids readily available at the bedside. Writing may be impaired due to swollen hands/fingers, muscle weakness, or lack of coordination.
Assessing the Patient’s Communication Abilities
Assume that all mechanically ventilated patients need support for understanding your message to them. I suggest beginning with your assessment of cognitive (following commands, attention/inattention, consistent yes/no signal) and language abilities (reading, writing, limited English proficiency), sensory deficits (such as hearing and vision), and the patient’s upper motor strength and coordination (holding a marker or pen, pointing, activating touchscreen on an electronic tablet).
Tips for Communicating with a Patient on a Ventilator
Get the patient’s attention by touch and maintain eye contact
Have glasses and hearing aids or amplifiers, large print if needed,
Have notebook and marker available to write key words or phrases that emphasize or reinforce your message,
Use picture boards in addition to your words to explain medical procedures,
Use pointing and gestures as you speak
Speak slowly, over enunciate, and in short sentences or phrases
Pause 10 seconds to wait for the patient’s response before going on
Consult with your hospital’s speech-language pathologists. SPLs are skilled in assessment of communication-impaired patients and can recommend low tech and electronic augmentative communication tools.
Helpful Online Resources
Use picture word-phrase boards or tablet applications designed for patient communication that are matched to the patient’s abilities and preferences. The SPEACS-2 training program and website has these assessment and tool selection guides available https://go.osu.edu/speacs2.
Dr. Mary Beth Happ, PhD, RN, FAAN, FGSA is a specialist in patient-provider communication and has conducted extensive research on the issues associated with communicating with patients on ventilators.
Dr. Happ is the Nursing Distinguished Professor of Critical Care Research and Associate Dean for Research and Innovation at The Ohio State University College of Nursing. She and her team developed the SPEACS-2 online training program to reduce misinterpretation of patient messages and facilitate ICU liberation for mechanically ventilated patients.
As Xinyi Christine Zhang watched the COVID-19 death toll among healthcare workers rise this spring, she wanted to find a way to give solace — and thanks — to their families.
The 15-year-old teen, of South Brunswick Township, New Jersey, joined her church in commemorating members who had died of COVID-19. But she was driven to try to do more, something personal. “I thought there could be something more meaningful I could do for the families of the doctors who lost their lives fighting the pandemic,” said Christine.
A gifted artist, Zhang resolved to draw the fallen U.S. healthcare workers in colorful memorial portraits, distribute them to their families and post them on her website. She wanted the relatives to know that people appreciated those who were trying to help Americans heal while putting their own lives in jeopardy.
Zhang frequently draws portraits for her friends and knew memorial portraits are usually rather expensive. She realized that drawing front-line workers could actually help families and was a better use of her time than drawing her friends — whom she said she’d drawn “like 10 times already.”
According to KHN and The Guardian’s “Lost on the Frontline” project, more than 900 healthcare workers in the United States have died after helping patients battle the coronavirus. The pandemic overburdened many hospitals and led to shortages in protective equipment such as masks and gowns that endangered many of those assisting patients.
Zhang found her subjects through that project. She set up a website to upload her portraits and to let families request drawings of their loved ones. Her portraits are free and easily accessible online, she said.
She has finished and posted 17 portraits since she started in late April. Each one takes six to eight hours, and Zhang spreads that work out over a few days so as not to interfere with her school assignments. Using a close-up image as a reference, she first digitally sketches the proportions of the person’s face with a pencil and then adds unique colors to “really bring life to the portrait.”
Her largest obstacle is getting in touch with the families. She hopes more families will request portraits through her website so she can work with them from the beginning.
One person Zhang featured is Sheena Miles, a semiretired nurse from Mississippi who died of COVID-19 on May 1. Christine tracked down her son, Tom Miles, who expressed his gratitude on Facebook.
“When you’re going through a loss like that, like the loss of a mom, to get the email from out of the blue just kind of gives you a profound feeling that there are some good people in this world,” Tom Miles said in an interview. “For her to have such talent at such a young age, and that she really cares about people she doesn’t even know — she is what makes America what it is today.”
This kind of response is exactly what Zhang aims for — she wants the families to know that she is thankful for the work of their loved ones.
“Someone they don’t know personally, even a stranger, appreciates what their loved one has done,” she said.
The portraits may be a source of brightness for grieving families, said Zhang’s mother, Helen Liu.
“I hope that families who receive these portraits will have a feeling of hope that better times will come,” Liu said. “A memorial is something meaningful and permanent, and I feel her portraits capture the happiness that will forever be with them.”
She hopes to get additional requests for the memorials from families.
In addition to drawing, Christine is a member of the South Brunswick High School’s Science Olympiad team and helps build projects for competitions. She’s interested in exploring engineering or product design as a career. Anything related to building or creating, she said.
She plans to either major or minor in art in college. For now, she wants to continue this project throughout high school — hopefully with help from others who know how to create digital art. She has a form on her website where others with art experience can sign up to help out. She said they can also add “other heroes in our society, such as war veterans or firefighters.”
“There are so many people that need to be honored, but I can’t do it by myself,” Zhang said.
Published courtesy ofKHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Among older former cigarette smokers, a strong correlation was shown between smoking duration and health, with longer smoking history associated with greater risk for poor overall health, chronic obstructive pulmonary disease (COPD), and chronic disease, according to CDC research.
In national data, for people ages 65 and older who had once smoked but quit, a linear association was seen between years of active smoking and risk for fair or poor health, reported Ellen A. Kramarow, PhD, of the CDC in Atlanta, in National Health Statistics Reports.
Based on data from the 2018 National Health Interview Survey (NHIS) and adjusted for age, sex, race, and Hispanic origin and education, the analysis linked several negative health outcomes with increasing smoking duration:
Poor or fair health: 17.8% (smoking duration ≤10 years), 20.3% (>10 and <25 years) , 23.4% (25 to <40 years), and 28.5% (≥40 years)
COPD: 9.1%, 12.2%, 20.3%, and 32.7%
At least four chronic conditions: 18.1%, 17.2%, 23.3%, and 26.1%
Limitations on social life: 8.6%, 9.1%, 10.7%, and 14.2%
Kramarow told MedPage Today that while the health benefits of quitting smoking are numerous and well characterized, less is known about the health risks associated with smoking in the past among older former smokers.
Older adults in the U.S. are more likely than younger adults to have a history of smoking, with former smokers making up 21% of the 2018 NHIS population overall, and 40% of survey participants who were ages 65 and older. This 40% represented nearly half of men in the 65-plus age group and a third of women.
Quitting smoking is associated with immediate and long-term health benefits, such as improved lung function and reduced risk of heart attack and stroke.
Among the former smokers, ages 65 and older, who participated in the 2018 NHIS, more than half reported smoking for 25 years or more, with 23.5% smoking for 40 or more years, and 31% smoking for 25 to 40 years.
Some 18% reported smoking for less than a decade, and 27.6% reported smoking for more than 10 years and less than 25 years.
Roughly three-fourths of the older former smokers had started smoking by age 20, and 93% of those who smoked for less than a decade reported quitting 40 years earlier or more.
Conversely, among older former smokers who smoked for 40-plus years, 37.4% reported quitting within the last 5 years, and 57.3% reported quitting more than 5 years and less than 25 years before participating in the 2018 survey.
The analysis divided the older former smokers into four smoking duration categories: 10 years or less, more than 10 years and less than 25 years, 25 to less than 40 years, and 40 years or more.
Kramarow noted that the study had significant limitations, including the inability to control for how long ago a former smoker quit. Smoking length was established based on answers to the questions; “How old were you when you first started to smoke fairly regularly?” and “How long has it been since you quit smoking cigarettes?”
“There may be independent effects of time since quitting on health among older adult former smokers,” she wrote. “Measured at one point in time, it is difficult to separate the impact of number of years smoked from time since quitting because they are so highly correlated.”
Information was also lacking on the intensity of smoking — whether the former smokers had been light or heavy smokers. The survey also did not ask about use of other tobacco products.
Despite the limitations, Kramarow told MedPage Today that the findings bolster evidence of a dose-response relationship between smoking and poor health, and she said clinicians caring for older patients should ask about smoking history.
“When considering the health of older people, it is worth keeping in mind that a significant proportion are former smokers,” she said. “Smoking history is probably still relevant, even if someone stopped smoking decades ago.”
Kramarow disclosed no relevant relationships with industry.
Enterprise High School students refused to allow anti-mask protesters to disrupt the start of the new school year. Senior Dalee Cobb, a cheerleader and javelin thrower, declared, “I feel like the opinion of parents and adults in general right now are just a big part of that problem.” Prior to a football game in late August, Cobb and other student athletes at the Utah school urged their community to take a stand against a growing anti-mask movement that threatened to postpone local school reopenings: “We, of all people, know that wearing a mask is not fun, “Cobb said. “Neither is wearing a seat belt or a life jacket or pads for football, but we do all these things so we have a future.” (As of September 1, there have been over 52,000 COVID-19 cases in the state).
As the public becomes accustomed to the ebb and flow of COVID outbreaks, a resurgence of protests against the state mask-wearing mandate came into conflict with the reopening of Utah’s public schools. Students became alarmed when hundreds of parents demonstrated outside the school district administration office and circulated threats to engage in a #NoMaskMonday. Enterprise students decided to use the football game as a platform to take action to protect their own health—and persude parents to send their kids to school in masks so they would be able to resume classes. “We ask that you put your mask on so we can get our game on,” Cobb said, as she urged local football fans to look out for the best interests of their community.
That weekend, Enterprise students also made use of social media to counter parents attempting to organize a #NoMaskMonday protest. Cobb told the Deseret News, “It’s sad to say, but the parents that are doing this, they aren’t us.” School Principal Calvin Holt supported students’ efforts and remarked, “[Students] were concerned about what a rebellion against masks was going to do to their opportunities for school and other activities.”
When schools did open, according to Deseret News, “Most students complied with the mask order, though the school district received some phone calls from concerned parents who got calls or messages from their children that not all students were wearing their masks all the time inside school buildings.” By the end of the first day, the local school district reported that no more than six students had been sent home for refusing to wear masks.
Anti-mask protesters cite a variety of reasons for their refusal to wear a mask. Some refer to the mixed messages that prevailed in the early stages of the pandemic; some are vehemently opposed to statewide mask mandates (at present 34 states require that masks be worn in many public settings); others say that they are still dubious about the severity of COVID-19 and have adopted various conspiracy theories promulgated on social media; a large contingent of anti-mask protesters, of course, use all of these arguments.