Monday, August 2, 2021

A topic that affects Nursing Education

 


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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