Nurse Leadership in Epidemic Response : Journal of the Association of Nurses in AIDS Care

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Nurse Leadership in Epidemic Response

Treston, Carole RN, MPH, ACRN, FAAN*

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Journal of the Association of Nurses in AIDS Care: November/December 2022 - Volume 33 - Issue 6 - p 683
doi: 10.1097/JNC.0000000000000369
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This issue went to press in September and features manuscripts that were submitted and edited over the summer, including two important nurse-led articles on the monkeypox virus, based on the best available information at that time. Once again, we were on the brink of a major public health challenge, potentially facing a new epidemic that requires community and individual education and evidence-based, person-centered approaches to prevention, diagnosis, and treatment. The reality of limited public health infrastructure and resources, including inadequate supply of available vaccines and delayed timelines for diagnosis, defined the first months of this emerging infection in the United States. Strategies to address this shortage were initiated by health departments and systems of care. Initially, screening protocols for vaccine eligibility included questions to patients that required them to identify if they had sex with other men, engaged in sex work, or had multiple same-sex partners. Ironically, in some progressive communities with large numbers of gay men, respondents answered yes to all questions, regardless of whether the answers were accurate or not, to get vaccines. But in communities where MSM are stigmatized and fears about community knowledge about one's same-sex relationships or sexuality remain powerful, this approach could be counterproductive and a barrier to those that need protection. Could this be a factor in the racial and geographical disparities in monkeypox vaccine uptake?

Instead, we highlight one nurse-led implementation alternative designed to destigmatize monkeypox vaccination and expand community education. Education sessions were held at community centers and events. At the health centers and off-site vaccine clinics, a list of potential risk factors for monkeypox virus were distributed and participants were informed that if any of the factors applied to them, they were eligible for vaccination. No questions asked. They were not required to identify their specific potential risk.

In a robust and a prepared public health approach, on-demand vaccine would be available to all, but within the current reality of limited resources, this may not be the immediate case. Developing and implementing approaches to service delivery that consider both resource limitations and patient and community concerns are where nurses come in.

Nurses are on the frontlines of implementing community and individual education, prevention and treatment for health conditions, including emerging infectious diseases and public health responses to epidemics. This is enhanced by nursing's perspectives on person-centered engagement and knowledge of the lived experiences of individuals and communities that affect prevention and treatment acceptance and access. Yet this broad range of knowledge and expertise is often not included at large scale or local planning and decision-making settings. Effective nursing practice is at the intersection of science, evidence-based quality service delivery with limited resources, and an awareness and understanding of individual patient and community factors. Important health care design and delivery decisions must include these perspectives and that is achieved by intentional and invited inclusion in local, regional, and national planning and decision-making bodies. ANAC is a resource for identifying nurse subject matter expertise in a wide range of areas that include not just HIV but also the many intersectional issues that affect patient and community acceptance and uptake of prevention and treatment. ANAC nurses have deep experience with a stigmatizing epidemic and addressing a public health crisis with science, compassion, and understanding. It is past time to include this experience in meaningful ways in planning and implementation decisions.


The author reports no financial interests or potential conflicts of interest.

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