School may be closed, but nursing students have continued to learn while working on the COVID-19 frontlines. Most find that they are more dedicated than ever in the wake of the pandemic. Now in her third year at University of Virginia, Martha Peterson says, “It’s definitely made me want to become a nurse even more. All this has also given me a greater appreciation of nursing, too. If it’s for the greater good, and helps people survive, the risks are really worth it.” “I do think that I feel more needed than ever, more necessary,” says fourth-year UVA student, Tyler Gaedecke, who begins work on a pediatric ICU this month.
A major challenge for many has been learning to cope with fear. Gaedecke says, “There are some who’re asking, ‘Did we sign up for this?’ which will be a big debate for years in the particular generation of nurses I’m a part of, and that’s a complicated question, but I’m definitely ready to get out there.” Northeastern University grad Hannah Terry made herself available to work wherever she was needed at Massachusetts General Hospital, but she admits to having been deeply afraid: “Seeing that some of these patients were so young and there was nothing [else] wrong with them—this was at the time where everyone was saying that it was only the elderly and the immuno-compromised that were getting sick. A lot of people were—including myself—very fearful of what we couldn’t see.”
Third year Northeastern student Susan Dawson, reflecting on her 36 hours a week on the COVID-19 ICU at Massachusetts General, said, “I’m glad I had hospital experience before this all broke out. I think I would have been a lot more scared and tentative if I had not.” However, she cannot help feeling emotional when she thinks about the death toll. At the height of the outbreak, Dawson recalls, “The patients are not just in-and-out in a few days. We see these patients each day, we get attached to these patients, even though they can’t talk—we still are attached to them, we care for them. Seeing a patient not come out of this, knowing that the doctors and nurses are doing everything they can, it just isn’t good.”
Overall, though, students have focused on giving patients the best nursing care possible under such extreme conditions, helping facilitate Zoom meet-ups with family members and providing human contact amid the PPE. Columbia student Ashlynn Lawrence held patients’ hands and did her best to lift their spirits: “I always try to tell them that underneath all the personal protective equipment, I’m smiling, and I encourage them to do the same. The comfort of a friendly face goes a long way.”
Nurses are generating a host of innovations to resolve healthcare pain points during the age of COVID. At the Nurse Hack 4 Health virtual hackathon, a project to make telehealth more accessible to rural Americans and a “GPS” that helps hospital nurses quickly locate available equipment were just two of the five winning ideas that emerged from the May meeting of minds.
Some 30 teams of nursing innovators competed in the hackathon, and five winning proposals were chosen by a team of judges from Johnson & Johnson, SONSIEL (Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders), Microsoft, dev up, and prominent independent nurse-entrepreneurs and leaders. Over the summer, SONSIEL and Microsoft will have business and technical mentoring meetings with the winning teams. The teams presented the following stand-out projects:
Well Nurse (Resiliency and Self-Care category), a peer-to-peer app to help nurses cope with stress, connect with one another, and identify best practices to foster mental well-being. “The end goal is that the application will be not only functional, but a helpful resource for nurses facing mental health challenges,” says team member Charlene Platon. Team members: Chris Caulfield, Charlene Platon, Ahnyel Burkes, Jillian Littlefield, Kathy Shaffer, Kristy Peterson, Natale Burton, Xiaoyun Cong, Anil Punjabi, Laura Deschere.
HearNow (Acute Care Patient Monitoring category) is designed to connect patients and their loved ones at times of social distancing and also accommodates the usual communication issues in acute care. With this system, loved ones can transmit video and audio messages from home that nurses can share when patients are alert and in need of comfort. Team members: Molly Higgins, Kelly Ayala, Sabine Clasen, Rosemary Yetman.
Activate School Nurses (Data and Reporting category) connects short-staffed school system nurses with nursing students to manage school re-openings and maintain and monitor student health data to reduce the danger of further outbreaks. Team members: Joanna Seltzer Uribe, LeAnthony Mathewshttps, Blanca Badgett, Ramona Ramadas, Chris Young, Lacey Sprague, Brian Goldenberg, Pao-Chu Tseng, Pramila Thapa.
Nurse GPS (Patient Care Coordination category) is a technology that provides nurses with the floor and room location of urgently needed equipment. The aim of the project is to reduce delays in obtaining equipment and lessen the danger of infection by making it unnecessary for a nurse to leave and reenter a room multiple times. Team members: Subbu Venkat, Mary Kavalam, Ian Kerman, Julie Gerlinger.
Project Flourish (Remote Patient Monitoring category) seeks to broaden the reach of telemedicine in rural areas and among senior citizens by working around obstacles such as a lack of broadband access and smartphones. Primarily making use of Unstructured Supplementary Service Data (USSD) 1990s-era technology such as Nokia flip-phones, care providers can make contact and receive health data from patients who lack technical literacy and/or present-day devices. Team members: Joshua Littlejohn, Kim Bistrong, Lisa Rickers, Biemba Maliti.
For details about the hackathon, visit the Nurse Hack 4 Health Home page.
Nurse of the Week Ben Busey is no stranger to crises. In addition to working as an Urgent Care Nurse Manager at the Roseburg VA Medical Center in Oregon, Busey is also a part of the VA’s Disaster Emergency Medical Personnel System (DEMPS), which deployed him in Puerto Rico after Hurricane Maria struck. So, he was ready to serve when COVID-19 started to spread in beleaguered New Orleans.
The 34-year-old Busey spent two weeks at the VA in New Orleans at the height of the pandemic, and says, “The first day I walked in there, two people died within the first two hours of me arriving. They had just run out of body bags, the ICU.” In addition to coping with the strained hospital resources, like most frontline nurses he did all he could to maintain connections between isolated patients and their loved ones: “I would end up calling them in the middle of the night to give them updates on a small improvement on my patient, just because I knew that they couldn’t see their family member and they weren’t allowed to be on the unit with them, and they were probably just worrying all the time about how their family member was doing.”
Warned of the PPE shortage in advance, he packed N95 masks for his trip, and used his small supply sparingly, often wearing the same mask for as many as five shifts in a row. Upon his arrival, he quickly learned that it is unwise to make assumptions merely because your age and health place you in a fairly low-risk group. As Busey recalls, “The person who oriented me for a couple of hours that first day when I arrived, he had just come back from being ill with COVID and he was 31. The way he described it, he said every day he sat in his room and he wondered am I dying, because he felt so sick and short of breath…” Fortunately, Busey himself returned unscathed; his test results after his return to Oregon proved negative.
Busey worked night shifts, and provided strong, capable support during his two weeks in New Orleans. When he came back to the Roseburg VA Medical Center, the Center presented him with official recognition for his work during the crisis.
For more on Dan Busey’s experience in New Orleans, visit here.
“You have been one of the pillars of the whole country. To you here and to your colleagues throughout Italy go my esteem and my sincere thanks, and I know well that I interpret the feelings of everyone,” Pope Francis said in a June 20 address to healthcare workers from Lombardy, the hardest hit among the Italian hotspots during the COVID-19 outbreak. In his first large public audience at the Vatican since lockdown was imposed, the Pope lauded health workers’ efforts to comfort families as well as patients, remarking that the former “found in you almost other family members, capable of combining professional competence with those attentions that are concrete expressions of love..”
The pontiff expressed his gratitude for the service of the frontline workers, and observed, “Even if exhausted, you have continued to commit yourselves with professionalism and self-denial. And this generates hope. You have been one of the pillars of the whole country.”
Pope Francis has repeatedly praised the work of nurses and credits his recovery from a life-threatening illness during his twenties to the intervention of a nurse who treated him. The Pope referred to this experience in a 2018 speech to members of the Federation of Professional Nursing Colleges, Health Assistants, and Child Wardens, and added, “The role of nurses in assisting the patient is truly irreplaceable. Like no other, the nurse has a direct and continuous relationship with patients, takes care of them every day, listens to their needs and comes into contact with their very body…”
Although Italy has been emerging from lockdown, social distancing laws are still in effect. Those attending wore protective masks and Pope Francis told the healthcare workers that he would approach them himself at the end of the audience rather than have them follow the customary practice of lining up to greet him. For more details on the Pope’s speech, visit here.
Over the past month, a growing number of nursing associations have been calling upon members of the profession to take action against racism.
The first official remarks appeared the day after George Floyd’s death. On May 31, the Minnesota Nurses Association issued a press release stating that “nurses continue to see the devastating effects of systematic racism and oppression targeting people of color in our communities. We demand justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them.”
The Board of Directors of the New York State Nurses Association declared, “As nurses, we mourn for the hundreds of Black men and women killed by the police every year, like Breonna Taylor, an EMT studying to be a nurse in Louisville, Kentucky.” The NYSNA called upon nurses to “fight against the bigotry, intolerance, and hate fueling current politics and feeding an armed white supremacist movement that threatens our democracy.”
This is “a pivotal moment,” according to ANA President Ernest J. Grant. In a June 1 statement, he urged US nurses “to use our voices to call for change. To remain silent is to be complicit.”
Calling racism “a public health crisis,” the Washington State Nurses Association said, “Racism has a 400 year history in America – and the hand of racism rests heavily on the health care system and public health. We know that people of color face systemic barriers to accessing health care and being listened to or heard. It is the reason African American women face higher rates of maternal death and why the burden of the coronavirus pandemic is falling more heavily on people of color. It is why African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. It is why African Americans are almost twice as likely to die from a firearm than their white counterparts. And, it is why we as nurses must look racism in the face and call it what it is.”
The Oregon Nurses Association commented, “As nurses, it is our duty and our calling to protect and serve the health and well-being of the entire community. That duty extends particularly to people of color who are especially vulnerable in this healthcare system.” In an interview with Austin station KXAN, Dr. Cindy Zolnierek, CEO of the Texas Nurses Association, echoed Grant’s statement, saying, “This is core to our ethics. It’s human rights so we cannot stand on the sidelines. To be silent is to be complicit. So, we have a role in this. We have a role to play in advancing human rights – in advancing health care.”
The Kentucky Nurses Association released a seven-point action plan to combat racism both in the profession and in the culture at large. The plan includes goals such as “training for nurses regarding racial disparities,” promoting the “recruitment of African American nurses and other nurses of color to serve on boards and commissions and leadership positions within our organization as well as others that focus on health,” and the addition of “cultural competency training, bias training and disparity education in every Kentucky nursing school curriculum.”
The Massachusetts Nurses Association also spoke out: “As nurses and healing professionals… we recognize institutional racism and the systematic oppression of communities of color as both a crisis in public health and a pervasive obstacle to achieving the goals of our work in both nursing practice and in the labor movement.”
Other nursing organizations issued anti-racism action statements as well, including the American Academy of Nursing, the International Family Nursing Association, the Rheumatology Nurses Society, and the Association of Rehabilitation Nurses.
As nationwide protests sparked by the death of George Floyd enter their fourth week, the American Thoracic Society is calling for a moratorium on the use of tear gas and other chemical agents to control demonstrators.
On Thursday, ATS officials issued a statement asking law enforcement groups to stop using tear gas agents such as 2-chlorobenzalmalononitrile (CS) and highly concentrated oleoresin capsicum (OC) pepper oil due to concerns about long-term lung injury.
Concerns about the use of tear gas and other agents on the spread and severity of COVID-19 were a factor in the move, said ATS President Juan Celedon, MD, in the statement.
“The use of chemical crowd control agents is outlawed in the time of war. They cause significant short-term and long-term respiratory health injury and likely propagate the spread of viral illnesses, including COVID-19,” Celedon said.
“Based on the lack of crucial research, the escalation of tear gas use by law enforcement, and the likelihood of compromising lung health and promoting the spread of COVID-19, the American Thoracic Society calls for a moratorium of CS tear gas and OC pepper weapons use,” he added.
The statement was issued on the same day President Trump — speaking at a roundtable discussion on policing and race — praised the use of tear gas and other aggressive tactics against demonstrators in Minneapolis early in the protests, calling it a “beautiful scene.”
Sven-Eric Jordt, PhD, of Duke University School of Medicine, Durham, North Carolina, has spent years researching the impact of chemical exposures — including tear gas — on the lungs.
He told MedPage Today that a study in military recruits linked tear gas exposure to chronic bronchitis, viral respiratory illness, compromised lung function and other acute and possibly chronic lung injuries.
The study, published in the journal Military Medicine in 2014, showed that recruits intentionally exposed to CS during basic training had more than twice the risk for an acute respiratory disease diagnosis after exposure compared to before exposure.
Jordt said recent technical advances in tear gas deployment allow the gas to be dispersed over much greater areas, and the clinical impact of this wider exposure has not been studied.
Likewise, in the U.S. protests and in other parts of the world where tear gas has been widely used to disperse crowds, police tactics have changed in ways that can make exposure more problematic, he added.
“What we are seeing and what we have seen is that police are using massive amounts of these agents,” he said. “In the recent protests in Hong Kong there were days when several thousands of cartridges were used.”
He added that in many recent protests within and outside the United States, tear gas and pepper spray were deployed as a first line measure, rather than a measure of last resort.
“In U.S. cities we have seen episodes where police are boxing in protesters and then using tear gas or pepper spray when the protesters have no way out,” Jordt said.
While there are, as yet, no studies directly examining the impact of tear gas exposure on COVID-19, Jordt and Celedon both said there is cause for concern that exposure may promote SARS-CoV-2 transmission.
Someone exposed to tear gas would be likely to quickly take off protective masks due to contamination, and maintaining a safe distance from other people would probably not be their main concern, Jordt told MedPage Today.
COVID-19 patients also often report loss of sense of smell, which could increase their risk of unknowingly inhaling dangerous levels of tear gas. And tear gas makes people cough, enhancing the virus’s spread if those individuals are currently infected.
“We have seen a dramatic escalation of (tear gas) use that I fear may become normalized,” Jordt said. “We have to reassess the safety of these agents with state-of-the-art toxicological techniques.”