Friday, October 24, 2014

Nurses and Ebola

   I am very pleased with the news that both of the nurses who contracted Ebola in Texas have made recoveries. It has become apparent that health care workers, and nurses in particular, are the individuals most at risk during outbreaks of infectious diseases such as Ebola.
   There has been  much discussion in the literature of infectious diseases concerning the course of a hypothetical large scale outbreak of Ebola here in the USA as opposed to what has actually been seen i Africa. The speculation is that the mortality rate would be a great deal lower here for several reasons:
   1. Hygiene. The limitations on the supply of clean water make a western standard of hygiene difficult, if not impossible, most places in Africa. This makes handling of patients far riskier.
   2. Nutrition. A well nourished person has an immune system far more capable of fighting off Ebola.
   3. Co-morbidities. The presence of other disease processes would make Ebola more likely to be fatal. Take for example Malaria. It is estimated that at any given time, 30 to 40% of the population in west Africa is carrying Malaria.
   4. Cultural practices in caring for family members who are ill and in dealing with the dead make the spread of Ebola more likely in west Africa than here.
   5. The supportive care (IV hydration, parenteral nutrition, etc) available to an Ebola victim here is vastly superior to west Africa. Supportive care gives the body a better chance of overcoming the virus.
   The medical people in these discussions are estimating that the mortality rate would be in the range of 20 - 30 %. Still a very scary number, but nowhere near the 40 - 60% that has been seen in Africa.
   Another concern is that many health care workers would simply not show up for work in the event of a major outbreak. The level of risk in west Africa is actually greater than in front line infantry engaged in combat. Nurses are not soldiers, and have not signed on for those sort of odds of survival.
   Food for some serious thought. It does not have to be Ebola. There have been outbreaks of influenza  with similar morbidity and mortality, the Spanish Flu that broke out just after WW1 for example.

While you are here, please scroll down and read a sample of the Book "The End of Shift Report". Thank you!
  

Monday, October 20, 2014

Nurses, Ebola, Hospitals and the CDC

  Texas Health Presbyterian Hospital (THPH) has apologized to it's community for the mishandling of the Ebola patient. Missing, however, is any apology to the nurses who work there for the chaos, incompetent management and lack of leadership that led to two nurses getting infected and more than forty confined to their homes in quarantine. Accountability? I thought that what admins are paid the $$ and why they get the perks.
   The CDC says it is revising its protocols for PPE (Personal Protective Equipment) for nurses caring for Ebola patients to include 100% coverage of skin and hair with impermeable material and the process for removing it. Not to mention how to handle the infectious waste. About time. Do the nurses get an apology from the CDC?
   How about the Lab worker from THPH that was confined to her cabin for the duration of the  vacation cruise she was on?
   The message we get is that health care workers are "little people" who do not count and are expendable, and hey, taking those kind of risk is what they get paid for, right?
While you are here, please scroll down or jump to July 2012 to read a sample of the book "The End of Shift Report". Thank you!

Friday, October 17, 2014

Nurses, Ebola and the CDC

How the CDC handles Ebola in it's lab:
How the CDC handles an infected Nurse's apartment:
How the CDC says nurses should handle Ebola:
This nurse will not care for any Ebola Patient without the same kind of gear the CDC uses for its own people.

While you are here, scroll down or jump to July 2012 and read a sample of the book "The  End of Shift Report" Thank You!

Wednesday, October 15, 2014

Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United | National Nurses United

Ebola, Nurses and Hospitals

 The reports coming out of the Hospital in Texas from nurses are truly alarming. A picture of a failure of leadership, decisions on protocol being made by clueless administrators which changed on a day by day basis. Apparently, the patient was treated using standard "Contact Isolation" procedures which are totally inadequate for a disease like Ebola. Below is a protocol for Ebola sent E-Mail to the nurses of a highly respected hospital with a national reputation for excellence.
 First, contrast these pictures with what you have seen on TV of health workers in Africa in full hazmat suits being sprayed down with disinfectant after coming out of contact with patients before disrobing. Second, the panel on the sequence for removing protective equipment has a serious error: Instructing one to remove gloves first. Right. Then you touch your contaminated gown etc. with bare hands. Any OR nurse will tell you that you remove your gloves LAST.  Note also the lack of Hoods to cover head and neck, backless gowns, lack of rubber boots or clogs that can be autoclaved (high temperature/pressure sterilization), or any information on how to deal with all the contaminated trash, how to deal with floors and bedding contaminated with all manner of body fluids, etc. They handle all of this better in the bush in Africa.
  If this was how they were dealing with Ebola in Texas, it is a miracle that only two nurses contracted the disease. It is also apparent that nurses were assigned to go straight from the Ebola patients room to care for other patients.
  It is also apparent that nurses are reluctant to speak up for fear of retaliation.
  Lastly, read Richard Preston's book "The Hot Zone" to see how NIH (not CDC) deals with Ebola. That will really open your eyes as to the inadequacy of the above protocols. If either of these nurses dies, the authorities of that Texas hospital should be tried for murder or at least manslaughter.

While you are here, scroll down or jump to July 2012 to read a sample of the book "The End of Shift Report" Thank You!

Saturday, January 4, 2014

A new blog:


Orfyn has started a new blog, another book in progress. Please visit www.carrstale.blogspot.com

While you are here, scroll down or jump to July 2012 and read A sample of the book "The End of Shift Report"Thank You!

Wednesday, June 26, 2013

Amanda Trujillo Part 3

   I recently Googled to find out what has been going on with Amanda Trujillo's case. I had been aware that there had  been a postponement of a board hearing, but had not heard anything else. The news is: 1) The case has been settled with a consent decree with Amanda agreeing to a year of probation and the findings of the Board of Nursing. The facts of the case and a copy of the decree can be seen at http://thenerdynurse.com/2013/01/update-on-the-amanda-trujillo-case-doing-the-right-thing-can-be-subjective.html Thanks to the Nerdy Nurse for an excellent post that the rest of the nurse-online world is curiously quiet about.
   It seems that Nurse Trujillo was not truthful in her on line letters and posts. I know I responded strongly when I first heard of the matter, posting here on a blog centered on fiction informed by my experiences. My response and the outrage of it was due to the fact that I and many other nurses have first hand experience of abuse and assault by physicians which has been aided and abetted by hospitals and the powers that be. That caused me to uncritically rush to a judgement.
   It is true that such behavior by physicians is less common and less tolerated now. I think that this is often more a reflection on the difficulty and expense of recruiting experienced nurses  than anything else. A hospital I know of which was notorius for outrageous behavior by its surgeons recently required all their surgeons to take a class on anger management on pain of losing their block time in the OR. While this is encouraging, one must also recognize the  enormous double standard: Nurses are fired  on the spot for behaviors that  are free of consequences for physicians. And Boards of Nursing can be used as weapons against nurses.
   In the end, I feel that justice has been done in this case. While some of the Board's findings have a feel of "piling on", a year of probation is proportional to the actual offense, and the Board could have been much, much more punitive.

While you are here, please scroll down to read a sample of the book "The End of Shift Report" - the first four chapters.