Sally Speak is the effort of Sally Ann Sellers, RN, BSN, MA Ed, an old battle-ax who is just delusional enough to think her pen is mightier than a sword. Good night & good luck!
“There is no greater evil than men’s failure to consult and to consider.” ― Sophocles, Antigone
Hospitals in the US cause about 400,000 premature patient deaths each year due to preventable harm (iatrogenic causes). This equates to three jumbo jets falling out of the sky each day (James, 2013). Our dysfunctional healthcare system tolerates the carnage of preventable patient injury and death, and potential occupationally-acquired infectious diseases by healthcare workers (HCW). But with the introduction of Ebola Virus Disease (EVD), we may be creating unsafe conditions that threaten communities outside of the hospital walls if our isolation protocols and personal protective equipment (PPE) do not work properly. This deadly problem may add to the list of poor outcomes of our healthcare system, spreading the disease, since caregivers are vulnerable to being infected and carrying it into communities. In West Africa, as of mid-October, WHO reports 420 HCW cases of EVD, and 239 deaths, and 2 HCW cases in the US and 1 in Spain.
The deadly outbreak of EVD has created the need for change within the U.S. healthcare system, but the leadership at the CDC and other healthcare in-groups are reacting slowly, with groupthink, creating a situation where those who set policies actively suppress dissenting viewpoints, isolating themselves from outside influences and even taking irrational stances that dehumanize other outside groups, such as “sloppy nurses” and a “panicky public.” When groups make faulty decisions that lead to a deterioration of mental efficiency, reality-testing or moral judgment, they are displaying symptoms of “Groupthink”, a term coined by social psychologist Irving Janis in 1972. What are the signs of groupthink, and how do those signs present during a crisis when we need to change healthcare standards and policies? Continue reading The Emperor’s New PPE
As I write, I am sitting in what might be my last airplane seat, stacked cheek to jowl with a couple with a cute but runny-nosed baby. My trip was with girlfriends on a bike tour in California, and I made the most of it, living very much in the moment. As I traveled, I wore my infection control hat, scanning the settings with new eyes for potentially dangerous situations. I was careful in public places such as airports, trolleys, and the BART, washing my hands frequently and keeping them folded in front of me. I was much more aware of impulses to touch my face. I watched a couple in the San Francisco airport who were headed to Nairobi touch their faces, many times, as they waited. Airport bathrooms were mostly hands-free, but the automatic toilets sprayed their contents powerfully in all directions when flushed. There was a new sign in the TSA line warning us to wash our hands because of Middle East Respiratory Syndrome (MERS), but no mention of Ebola (EVD). TSA used gloves to pat me down, but they were not washing their hands after contact with people. Boarding passes, drivers licenses, and credit cards were swiped and exchanged, along with bills and coins. I saw a large homeless population on the waterfront in San Francisco with no access to bathrooms or handwashing, who were using the streets as open latrines. I saw prostitutes. Hotels had carpets and mattresses that would defy cleaning in an outbreak. I saw people hugging, and shaking hands, and doing all kinds of human, caring, or even loving things that would be extinguished in a pandemic.
Today the first nurse within the US healthcare system has acquired EVD. My nursing friends are worried. Are we ready for this? How do we communicate risk, or should we settle for optimistic reassurance that our system can handle this? What are our biggest needs in preparation? Continue reading Clutching our world views with a death grip
Welcome to the arcane and short-sighted world of public health strategic planning. This post introduces the term surge capacity, a term we will hear often in the coming months of this growing Ebola (EVD) epidemic. Surge capacity is the ability to manage sudden or prolonged increases in overall healthcare demand, and the key components are the 4 S’s of staff, stuff, structure and systems, for hospital and community preparedness (Adams, 2009). During a pandemic, lack of surge capacity in all four of these areas become key limiting factors: hospital isolation beds (structure), healthcare providers (HCP-staff), isolation gear (stuff), and an efficient, just-in-time, high-transformity system, which is an obstacle to resilience. Continue reading The 4S’s of surge capacity
In crises, anxiety focuses attention. I continue to focus on the growing Ebola epidemic, which has no real restraints to keep it from becoming a global pandemic. Overpopulation, inequity, peak oil, and disturbed natural environment have converged with the problem of Ebola, to set up the conditions for a pandemic. If we add a slow response from complacent, frozen bureaucracies to this toxic mix, then we can expect a global pandemic to occur. We have met the enemy, and he is us.
Healthcare professionals need to speak up about healthcare inequity and US readiness for pandemics. And I have a particular interest in this topic, since I am potentially most exposed as a nurse to acquiring Ebola through patients shedding the virus in body fluids, and women are at high risk as typical care givers in the home and hospital. I have studied handwashing in hospital settings, with insight as to the gaps. So I will continue to perseverate here, and add my nursing voice to the choir of concerned healthcare professionals. Continue reading Ebola as a game-changer?