Nurses have long been at the forefront of pandemic education and
treatment, dating back to antiquity, nurses heave waded into the field to
fearlessly treat the sick when even clergy were afraid to do so. While Florence
Nightingale was not the first nurse, her work in the Crimean War is notable for
its work in the art of healing as much as for bravery. In 1854, she took 38
volunteer nurses right into the heart of the conflict to care for wounded and
dying soldiers. Nightingale was the first to organize the discipline of nursing
and to insist upon cleanliness of the healing environment, and started the
standardized training of nurses. An expert statistician, Nightingale was able
to track which treatments were successful and was able to share her findings,
making a huge impact on the survival rates of the soldiers in her care.
(Neal-Boylan, 2020) Whenever there is a pandemic, nurses leave the comfort of
their homes and families and head right into the danger in their service of
others, and many indeed die in the effort themselves. Nurses are repeatedly
ranked as trustworthy among the other professions. The purpose of this paper is
to explore a current issue that is having an impact upon the profession of
nursing. Namely, that of the impact of the Coronavirus (Covid-19) pandemic that
is still causing new infections and death, despite the availability of
vaccines. There is even vaccine hesitancy among some healthcare workers, and
this is particularly dismaying as the Delta variant of the virus has started to
become the dominant strain responsible for the more recent surge of disease.
Description of the issue
In addition to working hard to care for victims of Covid-19,
nurses and other healthcare workers are also having to battle the tidal wave of
healthcare misinformation that is like a second plague, spread by social media
and causing otherwise thoughtful people to decline a vaccine that has been
proven to be safe. This has caused the World Health Organization to declare the
anti-vaccine movement to be a grave danger to public health worldwide. The
organization ranks this risk as being as dangerous as climate change and
threatens to undermine 100 years of using vaccines safely to prevent millions
of deaths annually. (Trimble, 2019)
Even as more and more information about the dangers of the
highly-virulent Delta variant becomes available, the unvaccinated seem no
closer to being part of the solution by getting vaccinated, and indeed seem to
take fewer precautions. The lack of concern appears to be unmoved by reports of
the danger they are in, and the danger that getting infected would pose to the
more vulnerable members of their families and communities. The unvaccinated are
also more likely to forego other precautions such as wearing a mask.(Enten,
2021)
History and background
of what led up to the issue.
Countless healthcare workers find themselves working long days
caring for those infected with Covid-19, and then find themselves going online
in their off hours and battling misinformation. Baseless claims spread like
wildfire, partly because there is no fact-checking process or peer review to
contend with as with scientific findings. It should also be noted that those
who would promulgate falsehoods often greet fact-checkers with vitriol and
threats of violence. Some doctors report that, while there are protocols and
science for dealing with the disease, there are no such protocols for dealing
with the endless barrage of memes, pseudoscience YouTube videos posing as
factual, and anti-vaccine demonstrators, such as the group that blocked traffic
outside Dodger Stadium to temporarily close down access to shots in
pandemic-ridden Los Angeles in February. (Chia, 2021)
Healthcare workers across the country have taken to sharing their
own personal stories from the front lines of the pandemic, in hopes of
combating misinformation, educating about the severity of the illness, and
mitigating fears that the public may have about the vaccines. But promoting vaccines in what has become a highly
polarized climate has become risky, as many advocates may find themselves the
targets of cyberattacks or literal threats to their physical safety. The harassment can be unrelenting and may
even include criticism from healthcare workers’ own families. Still, advocacy
for the public health is not for the faint of heart, but must be undertaken so
that patients may get the right information from a professional who cares.
(Chia, 2021)
Assessment of the issue
from leaders in nursing.
Aside from personal advocacy such as the examples above, nurses
also have nursing organizations that undertake the work of making official
position statements and lobbying with legislators. Here is an excerpt from a
longer statement from the American Organization for Nursing Leadership:
"Now more than ever is the time to reflect on nursing’s role in addressing
the issues heightened by these events and to inform a progressive path forward
where nurses are well-positioned and prepared to meet the evolving needs of our
patients, communities and health care system." (American Organization for
Nursing Leadership [AONL], 2020)
The AONL and other organizations such as the American Nurses’
Association (ANA) serve the purpose of providing a cohesive voice for Nurses in
the United States. Though nurses have been asked, once again, to step into
harm’s way to fight this pandemic one patient at a time, nursing organizations
serve as the leadership and advocacy arm for the safety of nurses and the
patients they serve. They look at the studies, determine best practice in some
cases, and often represent the body of nurses at large when communicating with
legislators about healthcare policy-making. The AONL advocates for closing
healthcare disparities in the minority populations that are often the hardest
hit communities in the pandemic. They
also see an opportunity for nursing as a profession to make gains in status and
scope within the medical community as a result of the way nurses have stepped
up to the challenge of caring for the critically ill during the pandemic. Such
gains may be the kind of push needed to push recalcitrant (AONL, 2020)states
with restrictive Nurse Practice Acts to allow nurses, especially Advanced
Practice Nurse Practitioners, to work within the fullness of their educational
ability in the years to come, filling gaps in access to care. This is
especially true in smaller and rural communities which may be limited in
healthcare offerings.(AONL, 2020)
Personal assessment of
the issue and how it affects nursing education
While nursing organizations do not set forth specific mandates for
individual nurses to advocate for scientifically sound rejoinders to the
current trend of misinformation that is causing such harm to the public good,
it is in the interest of healthcare workers to utilize evidence based practice
when evaluating interventions for their patients. It should also be noted that
in the Nightingale Pledge, the Nursing equivalent of the Hippocratic Oath,
nurses promise to “never take or knowingly administer a harmful drug”.
(Pedagogy Infusion, 2021)As of the time of this writing, the current Covid-19
vaccines have been determined to be safe and effective. Given this and the concurring opinions of
Health Departments across the country, nurses should feel safe administering
the shots for the community and are tacitly expected to take the vaccine
themselves, in a gesture of choosing to be a good example to others.
Nursing Faculty are at the forefront of forming these attitudes of
generativity in their students. Because the textbooks that contain information
about Covid-19 have yet to be written, it is incumbent upon Nurse Educators to
keep abreast of the current state of Covid-19 research, such as it is made
available, and to integrate pertinent information into their curricula as it
unfolds. Nursing Faculty across the country are asked to encourage their
students to get vaccinated for their own protection as well as for the public
good.
Even Nursing Students are not immune to misinformation campaigns,
much to the consternation of the professors that are trying hard to teach the
students how to incorporate evidence based practice into the interventions that
they design for their patients. In this author’s own classroom, it was found
that among the students who have not yet taken the vaccine, there was a
persistent rumor that taking the Covid-19 vaccine would cause infertility.
Though baseless, the false information instilled enough fear that some of these
students will take needless risks to prevent this outcome, for which there is
no credible threat. No appeals with facts or assurances of safety would budge
this scary idea. Even in this small of a sample among educated science majors,
misinformation stands in the way of leading students in practices that would
benefit them greatly as they undertake their clinical rotations with high-risk
populations. This is to say nothing of the advice such stubbornly ill-informed
nurses may give to others who are considering the vaccine.
Recommendations to
remedy this issue
It is important to point out that there is big business in
misinformation and disinformation. Anti-vaxxer influencers represent 10 billion
USD as a result of their efforts to discredit settled science and keep people
too afraid to take vaccines, including Covid-19 vaccines. With millions of
followers willing to repost fallacious stories on social media, the lies stack
up, some layered with partial truths, to the point where sorting out the
objective facts becomes impossible. (Sigma, 2021)
Health Literacy is defined as the way that people understand
information about health and healthcare. The general population has lower
levels of health literacy than nurses do. Nurses really do need to be the
“experts”, since they are uniquely poised to share accurate health information
with patients and their families.
The importance of giving patients accurate information about
healthcare is vitally important. Nurses are trusted professionals and should know
better than to be duped by misinformation, but a small percentage may fall prey
to it nonetheless. Teaching students how to verify the credibility of research
studies that they encounter is one way to demonstrate that true scientific
findings are not disseminated via social media and streaming platforms such as
YouTube. Learning how to evaluate studies for relevance and veracity is an
important skill for any healthcare major to master. Including such instruction
in the nursing curriculum is key to creating students who know how to be
discerning about the information that they encounter.
Other types of learning that are essential for nursing students
are instruction in Critical Thinking and Logical Fallacies. These topics allow
students to pierce the veil of the poorly constructed and hyperbole-containing
assertions that are common in disinformation efforts whose main goal is to
scare people and cause emotional responses. A student who is trained to spot
logical fallacies will be less likely to fall for such cheap ploys.
Nurses need to be the adults in the room, and have a cool head
when explaining complex disease management and other health information to
their patients. Science subjects are not, once subjected to the rigors of
actual controlled study, likely to cause histrionic alarm. As nurses, one is
required to be a gentle voice of reason, calming the patient’s fears instead of
inflaming them with further erroneous information.
As Nursing Faculty, we ourselves need to make sure we are applying
the same rigor to the information that we present to our students. Scientific
findings may be changed if disproved by better science, and only that. Having
this attitude ourselves and not falling for the products of the rumor mill will
allow students to find the professorate a trustworthy source of information, as
they are learning to form their own conclusions from the available evidence.
Conclusion
Given that a percentage of the United States population is
currently being heavily swayed by fallacious information coming at them from
multiple sources, it may become a fact of life that nurses have to do their
work with critically ill patients, and then also contend with snarky memes that
seem to undermine their work. As much as it is a temptation to ignore such
slights against our profession as baseless, our communities do look to us for
guidance on such matters. As wearisome as it can become to have to swat away
such petty annoyances, to not do so is to leave dangerous misinformation
unattended in the fertile soil of the public’s collective imagination. Far
better to prune such baobabs when small, than to have to attempt a more
established tree with roots that run deep with the rot of information that is
wielded by unknown parties with an agenda designed to make us mentally weaker
and physically sicker.
References
American Organization for Nursing Leadership. (2020). The
Impact of COVID-19 on the Nursing Profession in the U.S. AONL. https://www.aonl.org/resources/covid-19/impact-of-covid19-on-nurses
Chia, A. (2021, February 24). ‘If not us, then who?’. Washington
Post. https://www.washingtonpost.com/lifestyle/2021/02/24/doctor-nurse-online-vaccine-rumors/
Enten, H. (2021, August 1). The data shows the
unvaccinated don't fear the virus, even as they are most at risk. CNN. https://www.cnn.com/2021/08/01/politics/unvaccinated-fear-virus-analysis/index.html
Neal-Boylan, L. (2020, May 11). Nurses on the front
lines: A history of heroism from Florence Nightingale to coronavirus. The
Conversation. https://theconversation.com/nurses-on-the-front-lines-a-history-of-heroism-from-florence-nightingale-to-coronavirus-137369
Pedagogy Infusion. (2021). The Florence Nightingale
Pledge. Retrieved August 1, 2021, from https://www.pedagogyeducation.com/Infusion-Campus/Resource-Library/General/Florence-Nightingale-Nurses-Pledge.aspx
Sigma. (2021). Addressing Vaccine Misinformation in
Nursing [Presentation]. https://sigma.nursingrepository.org/bitstream/handle/10755/21830/Slides.pdf?sequence=2&isAllowed=y
Trimble, M. (2019, January 6). WHO: Anti-Vaccine
Movement a Top Threat in 2019. US News. https://www.usnews.com/news/national-news/articles/2019-01-16/who-names-vaccine-hesitancy-as-top-world-threat-in-2019
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