Health Services
Newsletter - May 13, 2020
Florence Nightingale
This month marks the 200th birthday of nurse Florence Nightingale. Florence was a pioneer in healthcare reform and during this current pandemic her achievements resonate with us more than ever. International Nurses Day, is observed annually on her birthday, May 12th; and for this there is good reason.
Florence was named after the Italian city of her birth and was raised by wealthy English parents. During the era in which Florence lived, nursing was looked upon as an unsuitable, lower class profession. Nurses were typically poor and uneducated; the exact opposite of Florence; however; she did not let that stop her. Florence felt she had a divine calling and went against her parent’s wishes. She refused to marry and received nurse training in Germany ("The Life of Florence Nightingale ").
After training, Nightingale recruited 38 women to help her serve the British soldiers of the Crimean war. At first unwelcomed, Florence and her nurses worked hard to turn around the filth and unsanitary conditions. They provided food, comfort, cleanliness, sanitation, and care to the dying soldiers. It is reported that her efforts reduced the mortality rate by 2 percent; earning her fame, respect, and the nick name “Lady with the Lamp” (Selanders, 2020).
Much of what we know of nursing now, we owe to Florence. She was “the foundational philosopher of modern nursing” (Selanders, 2020). After the Crimean war she focused her labors on social reform. She kept meticulous records and statistics regarding efficiency of staff and causes of illness; helping to form basic nursing concepts which still remain today. Nightingale formalized nursing education; establishing the first scientific based nursing school. She also famously started Notes on Nursing: What It Is and What It Is Not, which provided direction on how to manage the sick. These notes have been in continuous publication since 1859 and include helpful hints on hygiene, fresh air, nutrition, quietness, and attentiveness (Selanders, 2020).
The World Health Organization (WHO) designated 2020 the International Year of the Nurse and Midwife “to honor the clinicians who devote their lives to the healthcare of people, and who are often the first point of care in their communities” ("The Year 2020 Honors and Celebrates Nurses for the Florence Nightingale Bicentennial", 2020). As this is amazing and welcomed news, we can’t help but tip our hat to Florence as being instrumental in first bringing recognition and respect to the importance of nursing care.
Amy Forrester BSN, RN (LH Area Support Nurse)
References:
The Life of Florence Nightingale. (n.d.). Retrieved May 11, 2020, from https://library.uab.edu/locations/reynolds/collections/florence-nightingale/life
Selanders, L. (2020, May 8). Florence Nightingale. Retrieved May 11, 2020, from https://www.britannica.com/biography/Florence-Nightingale
The Year 2020 Honors and Celebrates Nurses for the Florence Nightingale Bicentennial. (2020, January 22). Retrieved May 11, 2020, from https://www.amnhealthcare.com/2020-honors-and-celebrates-nurses-florence-nightingale-bicentennial/
Giving Grace During Collective Trauma
“The term collective trauma refers to the psychological reactions to a traumatic event that affect an entire society.” (Hirschberger, 2018). A world pandemic like COVID-19 qualifies. Our discomfort during this time stems from many sources: physical threats to our wellbeing, psychological stress as we navigate our responses, and our grief as we lose--well, lots. Recognizing how these factors affect us is the first step in helping us process trauma and stress as we live through it.
According to Maslow’s hierarchy of human needs, we need our basic bodily needs (breathing, food, etc.) met before we can attend to higher-level needs (learning, relationship-building, or self-esteem). This is one reason why we have school nurses! We know that people don’t learn if they are hungry, ill, or physically unsafe.
COVID-19 is traumatic because it literally threatens our basic need to breathe. Even if we live in an area that is less impacted by the virus itself, we are exposed to the suffering and fear of others (which has its own classification--secondary trauma) through the media. For many of us, the adjustment from attending to our self-actualization needs to wearing masks and sheltering in place for months is jarring enough to be its own stressor. (Geher, 2020). Acknowledging the immensity of the situation allows us to give ourselves (and others) grace when we do not live or behave the way we normally would outside of such a threatening situation.
People deal with stress in a range of helpful and unhelpful ways. For example, the sense of vulnerability that comes with a threat to life can trigger preparedness, paranoia, or hopelessness. The denial stage of grief (of the loss of people, our previous lives, etc.) may cause us to seek out healthy distractions or alternatively could lead to avoidance of reality.
When we are aware of the spectrum of responses, we can cut ourselves some slack when we don’t meet standards that were developed outside of a marathon crisis. We can also give grace to others by keeping in mind that they are also operating under unprecedented duress. Recognizing patterns that accompany big psychological events like stress, collective trauma and grief can give you a more realistic foundation for goal setting during this time.
Emily Winn BSN, RN (WRE)
References:
Hirschberger G. (2018). Collective Trauma and the Social Construction of Meaning. Frontiers in psychology, 9, 1441. https://doi.org/10.3389/fpsyg.2018.01441
Vitelli, R. (2013, May 29). When the Trauma Doesn't End. Retrieved May 6, 2020, from https://www.psychologytoday.com/us/blog/media-spotlight/201305/when-the-trauma-doesnt-end
Geher, G. (2020, Mar 19). Corona viewed from Maslow’s Hierarchy of Needs. Retrieved May 6, 2020, from https://www.psychologytoday.com/us/blog/darwins-subterranean-world/202003/corona-viewed-maslow-s-hierarchy-needs
COVID-19 Antibody Testing: The Good, The Bad, The Truth
You may have had symptoms of COVID-19 – fever, cough, shortness of breath; but were unable to get tested. You may have been exposed to a family member that had the coronavirus and you don’t know if you had it or not. Maybe you are an essential worker or around someone that is, but you’ve had no symptoms. How do you know if you had COVID-19 or not?
One option is to be tested with a nasal swab. Unfortunately, that test only tells if you have the virus right now. Test are limited and results may take several days, if you qualify to get tested.
In addition to a swab for testing, antigen tests are being developed. An antigen test is a saliva or mucous test that can determine if you have the virus. The test looks for antigens, which are foreign substances in the body that stimulate the body to produce antibodies. Advantages of the antigen test over the swab test, is the time of results and cost. An antigen test can give you results in a matter of minutes instead of days or weeks. They are also less expensive. Unfortunately, none have been approved for use in the United States.
If you have recovered from being sick or you never had symptoms, but you want to know if you have been exposed to the coronavirus, you may want to consider an antibody test.
What is an antibody test? An antibody test, or serological test, is a blood test that can detect the presence of antibodies, or proteins in the blood that help protect against viruses and bacteria. It is not a diagnostic test. Instead, it is a test that indicates if a person was exposed to the virus and has antibodies that could indicate at least some immunity to COVID-19.
Since this is so new and there are many things we do not yet know about the coronavirus and testing, the FDA (Food and Drug Administration), a department of the Health and Human Services that protects public health, is working to approve manufacturer’s tests to be sure they are accurate and safe. Many tests, both diagnostic swabs and antibody tests are unreliable, showing false positive and false negative results. Also, researchers are still trying to determine if having antibodies mean you have an immunity to the virus and for how long.
As news of the new antibody testing spreads, you may have a few questions about the testing process.
-Who should get tested? Anyone who is curious to see if they have been exposed to the virus.
-Is the antibody test effective? The CDC has assessed the current tests available and found that they are accurate up to 90% of the time. The tests can sometimes detect antibodies from other closely related Corona viruses (such as the common cold or Flu) instead of COVID-19 resulting in a false positive. Also, it is important to remember that the test only detects presence of antibodies (positive or negative), not the level. Therefore, it cannot tell you if you are now immune to COVID -19.
-How do I get tested? In doing research on this topic, I (Shannon) chose to go through the process of getting tested myself. I went to the Quest Lab website https://questdirect.questdiagnostics.com/ and clicked on the “COVID-19 Immune Response” option. I then followed the steps to set up an account, order the test, and pay online. The total cost of the test with fees was $130. It does not go through health insurance. The final step was to schedule an appointment time at a Quest Lab to get my blood drawn. The following day, I showed up at the chosen Quest Lab at my appointment time, had my blood drawn, and that was it! I received my results the next day via email. It was an easy and quick process.
Remember that the antibody test is an informational test only. It is not meant to diagnose current COVID-19 or tell you if you are immune. It can only tell you if you have been previously exposed. Whether your results are positive or negative, you should still continue to follow state and CDC guidelines for social distancing.
Jennifer Nixon, BSN, RN (SKY) and Shannon Webb, BSN, RN (Stults)
References:
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-test-validation-and-education-efforts
https://abcnews.go.com/Health/antigen-versus-antibody-testing-covid-19/story?id=70409446
https://www.cdc.gov/coronavirus/2019-ncov/lab/serology-testing.html
What is Herd Immunity?
When most of a population is immune to an infectious disease, this provides indirect protection to those who are not immune to the disease. This is called herd immunity. But what does that really mean?
When a person has already contracted a certain illness, it is unlikely they will catch the same virus again. If a large percentage of the population develops immunity through prior illness and an equally significant portion is immune through vaccination, the viral spread from person to person greatly diminishes. When societies collectively fight off new transmissions to decrease the spread of disease, herd immunity develops. This phenomenon was seen in the cases of measles, mumps, and polio, which were all once very common but are now quite rare due to vaccine-induced herd immunity.
Jaquelin Dudley, associate director of the John Ring LaMontagne Center for Infectious Disease and professor at the University of Texas at Austin, explains herd immunity through this logical measles example. “If 90 out of 100 people in a room are immune to measles, the other 10 people are not likely to get the disease even if they aren’t immune. The antibodies of the majority of individuals, built up either via exposure or vaccination, protects the remaining vulnerable people. But if the number of immune people drops to 80, the remaining 20 will have a higher chance of contracting measles.” With the novel coronavirus, experts predict at least 70% of the population will need to be immune to the virus in order to achieve herd immunity.
Despite this logical and promising statistic, scientists are still unsure whether individuals who have recovered from the novel coronavirus are truly immune to further infection, much less if herd immunity can develop before the disease reaches society’s most vulnerable members
Jared Baeten, professor of medicine and global health at the University of Washington, states in the case of COVID-19 “Individual immunity is not yet proven, much less herd immunity.” If prior COVID-19 infection offers partial protection and we are able to develop a vaccine that is also partly protective — as is the case with the flu — we could still achieve a form of herd immunity. Despite the lingering uncertainties, both Baeten and Dudley emphasize that a vaccine will be crucial to achieving widespread protection from SARS-CoV-2 in the future.
As the number of vaccines entering human trials continue to increase, we are getting closer and closer to cracking the code on an effective and life-changing vaccination. Experts agree that a COVID-19 vaccine, while at least several months away, is our best chance to safely achieve herd immunity and minimize infections. Without a vaccine — and proper social distancing measures to break the chains of transmission in the meantime — some experts fear hospital systems could be overwhelmed and many more people could die. Therefore, it is important to continue to reduce the spread in other ways as we continue to await the COVID-19 vaccine. Wash your hands, wear a mask, and continue to practice social distancing. We are on our way.
Evelyn Berndt, BSN, RN (MHE)
Angela Watkins, BSN, RN (LH Area Resource Nurse)
References:
D’Souza, G., & Dowdy, D. (2020, April 10). What is Herd Immunity and How Can We Achieve It With COVID-19? Retrieved May 6, 2020, from John Hopkins Bloomberg School of Public Health
Science for the Curious, Is Herd Immunity Our Best Weapon Against COVID-19? Discover Magazine, 1–9. Retrieved from https://www.discovermagazine.com/health/is-herd-immunity-our-best-weapon-against-covid-19
Detecting and Reporting Child Abuse in the Online Learning Environment
Training on child abuse detection and reporting is an unfortunate reality for all teachers and school staff on a yearly basis. Fortunately, over the past 20 years, rates of childhood sexual and physical abuse have declined. But we know that 1 in 10 children will be sexually abused before their 18th birthday and that currently the most common form of child abuse remains neglect. When statistics about child abuse tell us that 73% of abused children won’t tell anyone and 92% of children know their abuser, it falls on educators to advocate and speak up for their students.
If you have been an educator for very long, you most likely have encountered a child that you suspect has been abused or neglected. Disheveled, dirty, presenting with odd injuries that don’t match the child’s story, multiple injuries in different stages of healing, changes in behavior or school performance...any of these can be a red flag for child abuse, and noticeable enough to the trained eye when we are with students every day on campus. But what do we look for in this age of online learning? Here are a few things that the Dallas Children’s Advocacy Center recommends when it comes to developing this new skill of detecting child abuse online:
● Ask open ended questions and allow students private ways to respond.
● Has the child’s virtual attendance or work performance declined?
● Pay special attention to any student who has ever expressed a concern for his or her personal safety.
● Watch for a significant change in a student’s mood or behavior in online group sessions.
● Watch during online sessions for what students with a history of suicidal ideation are wearing in case they are attempting to hide injuries.
● Maintain close contact with caregivers of physically or mentally disabled students and provide support as so many have lost any respite during this time.
As a trained professional, you only need a gut feeling about suspected child abuse or neglect to report to CPS. You get the privilege of being your student’s voice. If you suspect child abuse or neglect, get clear answers to the following questions:
1) WHO is doing the abuse?
2) WHAT are they doing?
3) WHEN could it happen next?
THEN STOP! Your role is not as an investigator, but as an advocate for the child!
If you suspect, then report. If the child is in imminent danger (i.e. the abuser lives in the home or will see the child today) then call 911 right away. You can’t get in trouble for making too many reports, but you can be held liable for not reporting when you know something!
An ounce of prevention is worth a pound of cure, and supporting caregivers during this uncertain and isolating time can be an effective strategy in protecting children! Here are a few tips for engaging with families:
● Take the time to reach out to parents regularly via open chat or zoom times.
● Ask parents if they need support and follow through with their requests for resources (i.e. food pantry, clothes, helping children with school work).
● Be mindful of what you see in the background when talking to a caregiver.
● Provide tips for parents regarding internet safety:
○ Set boundaries for daily internet time.
○ Offer education about how to check and use online school apps.
○ Encourage parents to listen to this internet safety article (in Spanish and English).
○ Challenge parents to check out the “Parent Corner” on our district website that includes excellent information about cyber security.
● Encourage parents to “start the conversation” about abuse with their children. Hot Chocolate Talks offers tips for parents on how to start this discussion with children at every age.
In this new world of online education, thank you for remembering to always be on the lookout for your students and their safety. Your bond with your students is what makes educators a key player in detecting and reporting suspected child abuse.
Jessica Haas, MSN, RN (Wallace) and Stephanie Lewis-Ndwadike, BSN, RN (TME)
References:
Arreguin, N., Rodgers, M. (2020, April 29). Strategies & struggles of teaching remotely: Taking care of yourself and students during a pandemic [Webinar]. In Dallas Children’s Advocacy Center Community Lecture Series.
Dallas Children's Advocacy Center. (2020). DCAC improves the lives of abused children. Retrieved from https://dcac.org/
Finkelhor, D., Saito, K., & Jones, L. M. (2016). Updated trends in child treatment. Durham, NH: University of New Hampshire, Crimes Against Children Research Center. Retrieved from http://www.unh.edu/ccrc/pdf/Updated%20trends%202014.pdf
Prepared by the Nurses of RISD
Kimberly Clark, BSN, RN
Nurse Coordinator, Health Services
RISD
Email: kimberly.clark@risd.org
Website: www.risd.org
Phone: 469-593-7445