Medscape article

Nurses and Pandemic Influenza- are we ready?

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http://www.medscape.com/viewprogram/6799


Basic, but well done article; it serves to inform and make the reader think. I hope my peers that read it will consider the choices they may have to make, Mental preparation is the most important type of prep, IMHO. Running the scenarios thru in our heads in advance will certainly help if the day comes when the choices really do stare us in the face.

And, if it encourages a little activism at the grass roots level on getting facilties to stock masks gloves and other important PPE-all the better....

Good read, I think that all nurses should read this full article linked above,and ponder the choices. CE's available at the link.

Laura

Page 5 of 5
bolding and italics for empahsis on some of the tough questions my own.

Nurses and Duty to Care
What are the duties and obligations of nurses during an influenza pandemic, faced with conflicting responsibilities to work and family? Can a nurse rightly refuse to care for an influenza patient? During a pandemic, nurses and other healthcare providers face a disproportionate risk of exposure to influenza compared to the general population, and may fear contracting influenza or transmitting it to vulnerable family members.[18,19] Balancing the demands of work with the need to protect and care for self and family may prove extremely difficult for many nurses. Some may feel the personal risk is too great and refuse to care for infected patients. The effects on the healthcare system could be profound.

According to Sokol, the phrase duty to care is too vague because its limits are undefined.[20] It is also ethically dangerous, for it could be used to pressure healthcare workers into working in circumstances that they consider morally, psychologically, or physically unacceptable.[20]

Laurie Badzek, Director of the American Nurses Association (ANA) Center for Ethics and Human Rights and a Professor of Nursing at West Virginia University, believes that "nurses should be thinking ahead and preparing for whenever the practice environment is challenged, whether it's influenza, or a flood, or a disaster like Katrina" (Badzek, Laurie. Personal Interview. February 26, 2007). But she isn't worried that nurses will flee during an influenza pandemic. "If you look throughout history," explains Badzek, "nurses have always been there. During wars, epidemics, and hurricanes, nurses stayed." In fact, Badzek notes, "nurses across the country will talk about just these issues at the American Nurses Association national policy conference on Nursing Care in Life, Death, and Disaster in Atlanta in June 2007."

Asked how individual nurses can make the difficult decisions that might be necessary during an influenza pandemic, Badzek responded, "Nurses must learn to use the tools they have, like their code of ethics. They aren't expected to lay down their lives. Nurses must care for themselves before they can care for others."

In their position statement, "Risk and Responsibility," the ANA acknowledges that some patients' health problems "may raise questions for the nurse regarding personal risk and responsibility for care of the patient."[21] To resolve this, the nurse must engage in critical thinking and ethical analysis. For example, caring for a patient with an infectious disease that may place the nurse at risk of harm is a moral duty rather than a moral option if all of the 4 following criteria are met: (1) the patient is at significant risk of harm, loss, or damage if the nurse does not assist; (2) the nurse's intervention or care is directly relevant to preventing harm; (3) the nurse's care will probably prevent harm, loss, or damage to the patient; and (4) the benefit the patient will gain outweighs any harm the nurse might incur and does not present more than an acceptable risk to the nurse.[21]

The nurse is morally obligated to care for all patients; however, in certain situations the risks of harm may outweigh a nurse's moral obligation or duty to care for a given patient. Each individual nurse, when faced with a potential for harm, must assess risk. Accepting personal risk exceeding the limits of duty is not a moral obligation; it is a moral option.[21]

Furthermore, the ANA states that "the nurse must base his or her assessment of risk on objective, current, and scientifically sound information. Conversely, on those occasions when the nurse has the potential for exposing the patient to risks related to the nurse's personal health problems, the nurse has the responsibility to assess the risk and has the moral obligation to care for or refuse to care for patients based on this assessment."[21]

The issue of duty to care is intimately linked with that of adequate personal protections. For many nurses, the question of whether or not they are willing to come to work or care for influenza patients may depend upon several things: the healthcare facility's handling of influenza patients, the provision of effective personal protections, and receiving a vaccine as soon as it becomes available along with antiviral prophylactic agents active against the epidemic strain.[13] It is incumbent upon healthcare institutions to provide adequate safeguards such as risk-reducing equipment and enforce protective procedures that minimize risk to nurses.[21]

The time for dialogue between healthcare employers and nurses is now, before we are in the throes of a pandemic, because many questions will surface once infected patients begin showing up at the door.[20] Open discussion regarding the limits of duty to care in the context of a potentially highly lethal influenza pandemic such as that which might be caused by the H5N1 virus must be permitted and facilitated.[22] Furthermore, there is a need for empirical social science research into this overlooked topic to illuminate the views not only of healthcare providers but also of patients and members of the public whose opinions about nurses' duty of care are also of great importance.[20]

The Bottom Line
If we experience an influenza pandemic caused by a lethal virus such as H5N1 avian influenza, nurses will face higher than average risks to their personal health, unprecedented demands for their skills and expertise, and scrutiny of their professional commitment.[22] The best ways for nurses to ensure that their risks are minimized and that they will feel safe continuing to perform their jobs during a pandemic are to become educated about the facts and implications of a potential influenza pandemic, to become familiar with their professional code of ethics, and to become involved in prepandemic planning efforts at their healthcare organizations.