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Incredibly Easy blog

The Incredibly Easy blog will expand on selected topics presented in the print journal.

Friday, March 27, 2020

Covid-19.jpg

The COVID-19 pandemic has put much of the US in a standstill in recent weeks as healthcare professionals work to accommodate mounting cases around the country. COVID-19 seems to be everywhere—on social media, in the news, in the community, and in healthcare facilities. According to an online tracker of COVID-19 cases compiled by Johns Hopkins University, there were more than 90,000 confirmed cases and nearly 1,400 deaths in the US as of 2 p.m. on Friday.1

COVID-19 is caused by a specific virus called SARS-CoV-2, which has been colloquially referred to as "the coronavirus" by media outlets.2 Having originated in Wuhan, China, the virus was designated as a pandemic by the World Health Organization on March 11, 2020.3 It has affected many countries around the globe, including the US, where all 50 states are reporting cases.2

As healthcare facilities race to prepare and respond, there have been many headlines regarding public reaction, from retail business closures to supply hoarding.4,5 The practice of "social distancing" has emerged in a nationwide (if not, global) effort to curb the spread of COVID-19, with the White House issuing guidelines for limiting unnecessary exposures.6,7 These include avoiding travel, shopping outings, and social gatherings of more than 10 people, as well as working from home when possible.7

Twenty-three states have issued stay-at-home orders to date, asking residents to leave their homes only to buy food and medicine and for other "essential" reasons that vary by state, such as outdoor exercise while maintaining a safe distance from others.8  Some states had closed "non-essential" businesses but had not issued a statewide stay-at-home order as of noon Friday. However, many cities and counties around the country have issued stay-at-home orders, even if their states do not yet have a similar policy.

CDC efforts to reduce the spread of COVID-19 have focused on travel guidelines, resources for identification and tracking, and the development and production of diagnostic tests.2 Meanwhile, healthcare organizations and professionals continue to prepare, adapt, and provide care in uncertain times. Internationally, South Korea made testing notably accessible and efficient by opening "drive-thru" facilities, in which passengers were swabbed in their cars.9 Similar facilities have popped up in some municipalities and healthcare centers around the country as testing has ramped up in recent weeks after initial delays.10 Several clinical trials are underway to find a potential COVID-19 vaccine, and the WHO announced a major study last week that will compare treatment strategies in a streamlined clinical trial design in which doctors around the world can participate.11

The US is also among scores of countries facing a widespread shortage of personal protective equipment (PPE) for healthcare workers amid the pandemic. The WHO said in a media briefing on Friday that the PPE shortage is "now one of the most urgent threats to our collective ability to save lives."12

The Food and Drug Administration (FDA) released a guidance this week that outlines temporary policies to help curb the PPE shortage while a federal public health emergency declaration related to the COVID-19 outbreak remains in effect.13 The guidance is designed to increase the availability of general use face masks for the public and particulate filtering facepiece respirators (such as N95 respirators) for healthcare professionals. The new guidance can be found here.

The introduction of COVID-19 and subsequent efforts to contain the virus have resulted in societal changes both at home and abroad. The last few months have been chaotic and stressful around the world, especially for nurses and everyone in the healthcare workforce. Sharing knowledge and insights will be vital as the world fights this virus.

On behalf of Nursing made Incredibly Easy!, we would like to wish all our readers and their teams good health, personal safety, and the best of luck in the coming weeks. As such, we have provided the following additional resources:

• www.coronavirus.gov

• www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

• www.who.int/emergencies/diseases/novel-coronavirus-2019

• www.jamanetwork.com/journals/jama/fullarticle/2762692

• https://tools.ovid.com/coronavirus/

• https://www.nursingcenter.com/coronavirus

Stay safe!


This is a developing story. Check back with our blog for updates in which we'll share guidelines and other helpful information for nurses.

 

REFERENCES

1. Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Coronavirus resource center. Johns Hopkins University & Medicine. 2020. www.coronavirus.jhu.edu/map.html.

2. Centers for Disease Control and Prevention. Coronavirus (COVID-19): situation summary. 2020. www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html.

3. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020. www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

4. Duffy C. Nike, Urban Outfitters and other retailers shuttering stores temporarily because of coronavirus. CNN. 2020. https://www.cnn.com/2020/03/15/business/retailers-nike-store-closures-coronavirus/index.html.

5. Frankel TC. The toilet paper shortage is real. But it should be brief. The Washington Post. 2020. www.washingtonpost.com/business/2020/03/13/toilet-paper-shortage.

6. Stevens H. Why outbreaks like the coronavirus spread exponentially, and how to "flatten the curve." The Washington Post. 2020. www.washingtonpost.com/graphics/2020/world/corona-simulator.

7. The president's coronavirus guidelines for America: 15 days to slow the spread. 2020. www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf.

8. Secon H. Almost half of all Americans have been ordered to stay at home. This map shows which cities and states are under lockdown. Business Insider. 2020. www.businessinsider.com/us-map-stay-at-home-orders-lockdowns-2020-3.

9. Bicker L. Coronavirus in South Korea: how 'trace, test and treat' may be saving lives. BBC. 2020. www.bbc.com/news/world-asia-51836898.

10. Affo M. The US decided to make its own coronavirus test, but the process was plagued by errors and delays. Here's a timeline of what went wrong. Business Insider. 2020. www.businessinsider.com/us-coronavirus-testing-problems-timeline-2020-3.

11. Kupferschmidt K, Cohen J. Race to find COVID-19 treatments accelerates. www.science.sciencemag.org/content/367/6485/1412.

12. World Health Organization. "Media briefing on #COVID19 with @DrTedros. #coronavirus" March 27. 12:14 p.m. Tweet.

13. Food and Drug Administration. Enforcement policy for face masks and respirators during the Coronavirus Disease (COVID-19) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff. 2020. www.fda.gov/media/136449/download.

Thursday, June 6, 2019

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Guy Vandenberg, RN, MSW, speaks glowingly of his time practicing on the world's first special care unit dedicated to caring for patients with HIV/AIDS. The ward opened in San Francisco General Hospital's Ward 5B in 1983 and had moved to a larger ward, 5A, by the time Vandenberg arrived in the 1990s as a per diem nurse. At that time, people were still dying fighting a disease that had no cure.

"It was a combination of trying to cure what we could cure and providing palliative care to patients who couldn't be cured," Vandenberg said in a recent interview.

Vandenberg and other nurses and caregivers who played a role in creating and nurturing the ward in the 1980s and 1990s tell their powerful stories in a new documentary, 5B. Made by filmmakers Paul Haggis and Dan Krauss, the film was acquired by Verizon Media and is slated for an exclusive screening during the opening festivities at LA Pride Weekend in West Hollywood on Friday, June 7. It will then hit select theaters nationwide on June 14. The documentary will give a portion of its proceeds to The Global Fund.  

For Vandenberg, working on the ward was a freeing, rewarding experience. Then in 1999, his husband, Steve Williams, was diagnosed with HIV and was soon hospitalized in the ward.

"I had been working in HIV [care] for a number of years at that time, and I had this idea that somehow people close to me should be exempted," Vandenberg said. "Of course, it doesn't work that way."

While his husband was ill, Vandenberg would work on the opposite side of the ward to where Williams was staying.

"It's not a good situation when you work in the same place where they're taking care of your loved ones," Vandenberg said. "The nurses were very supportive and kept me updated and involved, but obviously I couldn't take direct care of him."

Vandenberg's husband was comatose in the ward for 2 months and almost died, but he survived over the course of several months of treatment, which had become more advanced. 

On days when his husband was very sick or anxious, the nurses would prepare a cot for Vandenberg next to his husband's bed. In Ward 5B, family members and loved ones could stay overnight, and the ward recognized same-sex visiting rights, he said.

"We did things differently," he said. "We redefined what was family. People who weren't biologically related or married would be turned away [in other hospitals]. The administration and management left nurses to figure that out and gave us the freedom to create that space where nurses and social workers on staff could make it work."

The documentary shares the stories of those who created and worked on the unit and the patients who lived and died there. Cliff Morrison, a program director at the hospital, had become frustrated at the lack of care and humanity that patients with HIV/AIDS were receiving in the early 1980s. He spearheaded the effort to create Ward 5B. Alison Moed, one of the original 12 nurses who launched the unit, later became the ward's nurse manager. LGBTQ activist Rita Rockett first visited the ward to visit a close friend and soon started the ward's longtime tradition of hosting weekly brunches and entertainment for its patients.

The ward's caregivers did what they could to make their patients feel comfortable. They threw parties for patients and allowed pets to visit. They carried out a caring model that would later be studied and modeled in hospitals around the globe.

Then there were patients like George Kelly and Williams, whose health rapidly deteriorated before improved medical treatments would save their lives. The film also shares the perspective of Harry Breaux, who watched as his dying friends and loved ones were treated with acceptance, compassion, and love in 5B.

At the same time, the ward's caregivers had to put their prejudices aside, Vandenberg said.

"It wasn't just about gay men," Vandenberg said. "We had a lot of injection drug users, homeless folks, people coming out of prison. Once you do confront own hang-ups, it is so freeing. It's incredibly rewarding to help somebody in a difficult time, to help somebody restore their dignity.

"Ideally, you want to restore their health. But if that's not possible, be there," he added. "Touch people. Alleviate what you can."

The ward eventually closed as continued advancements in HIV treatment lessened the need for an inpatient HIV/AIDs ward. The hospital, now named Zuckerberg San Francisco General Hospital and Trauma Center, now runs an outpatient HIV clinic, where Vandenberg works as an HIV clinical specialist. There, he coordinates care, provides triage and urgent care, conducts a monthly Reproductive Health Clinic for those affected by HIV, and facilitates the clinic's Opiate Prescribing and Pain Management Committee.

Although the documentary tells the story of a ward that opened four decades ago, Vandenberg stresses that 5B gives its viewers a lesson on the present day.

"This isn't a story about the past," Vandenberg said. "This is about now. Many patients either don't know that they're living with HIV or aren't accessing care. We need to reach them so they know that lifesaving care is there. We have a lot of work to do."

You can watch the official trailer for the film here, and check local theaters to see if it's playing in your area.

Tuesday, June 13, 2017

​I read a great article today that will be in a future issue of NMIE. As a member of the editorial board, I get this pleasurable benefit. The topic is moral distress in nursing and it made me think about the reality that I see every day. From working on ICU, ED, and inpatient floors, I’m acutely aware of how hard it is to be a caregiver and remain untouched emotionally by all that you see. We all have those patients and experiences that create heartbreak, confusion, anger, and sometimes a sense of disconnection in our professional lives. These are the moments that make us take a deep breath and self-evaluate. Remember that you’re doing what you do for a reason and not everyone can do this. Share your stories with us.

Lisa Lockhart, MHA, MSN, RN, NE-BC

Emergency Services Director
KentuckyOne Health, Saint Joseph Health System
Lexington, Ky
.



Thursday, June 8, 2017

​In the face of our increasing opioid crisis in the United States, I watched an interesting report on a group of librarians in a large metropolitan city who’ve taken a class on naloxone administration. The report indicated that within the last few months, one particular librarian had revived seven overdosed individuals in the park where the library is located. I applaud the efforts of these individuals to make a difference, but I worry about the safety of the Good Samaritan. What are your thoughts on this? Are there similar programs where you live?

Lisa Lockhart, MHA, MSN, RN, NE-BC

Emergency Services Director
KentuckyOne Health, Saint Joseph Health System
Lexington, Ky.


Tuesday, May 9, 2017

​Mobility in our inpatient population is my search this week. Are you struggling with getting your patients up and ambulating? Physical therapy (PT) is staffing challenged and often unable to meet the needs of our patients that must be up and out of bed. Patients in critical care areas, on ventilators, and bedridden still need mobility and activity. Before PT was available, nurses did the bulk of this work: getting patients up, out of bed, in the chair, walking, and performing range-of-motion exercises. Now nurses, as well as PT, face growing demands with fewer resources; patients don’t always get what they need in terms of mobility. How’s your organization managing this issue? Are there ambulation teams, unlicensed assistive personnel assistance, or an increase in complications due to little or poor mobility? We want to hear from you.

Lisa Lockhart, MHA, MSN, RN, NE-BC

Emergency Services Director
KentuckyOne Health, Saint Joseph Health System
Lexington, Ky.