Nurse Action Needed to Manage H1N1 Flu

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Influenza type A (H1N1) virus (“swine flu”) will not be going away any time soon, health officials say, and healthcare providers, including nurses, should prepare themselves not only for patients with the illness, but also for questions and concerns from the public, and requests to help state and local health departments identify potential new cases.

At this point, nurses should keep practicing and taking the same precautions as they would with an outbreak of any other kind of influenza, as well as keeping themselves up-to-date about the new virus and national and state guidelines for dealing with it, says Elda Ramirez, RN, PhD, FNP-BC, FAANP, and assistant professor of nursing and head of emergency care in the department of acute and continuing care at the University of Texas School of Nursing at Houston.

These include asking patients who are coughing or sneezing to wear a mask, wiping down surfaces and chairs, frequent hand-washing, and offering anti-bacterial creams or gels to patients.

The federal government has issued a public health emergency, and health officials say they expect to see many more cases in coming weeks.

“The normal flu season will be extended at least six-to-eight weeks,” says Bonnie Sorensen, MD, chief deputy director of the California Department of Public Health. The new flu may eventually disappear for good, or it may return, she says.

The illness has hit hardest in Mexico. So far, most cases of swine flu reported in the United States have been mild, though health officials say they expect to see more moderate and severe cases and deaths as the disease progresses. Reports of hospitalizations and deaths are “not necessarily an indication of how severe this is going to end up to be,” says Gil Chavez, MD, deputy director of the Center for Infectious Disease for the California health department. “It’s behaving, on average, like what we see with seasonal influenza.”

The CDC is asking clinicians to take nasal swabs or washes of patients with symptoms of upper respiratory illness to be tested for the swine flu virus. Nurses should also ask detailed questions, such as whether the patient has traveled outside the country, if they’ve been in a crowded place, or if they’ve come into contact with anyone who might have swine flu, Ramirez says.

State health officials are currently working with hospitals, clinics, and private practitioners to identify patients who may have more severe cases of swine flu. The CDC is also distributing tests that will allow states to identify the virus at their own laboratories rather than waiting for a CDC confirmation of swine flu.

CDC guidelines currently say treatment with antiviral medication should be considered for patients who test positive for the flu, or positive for a virus strain that cannot be identified as another type of flu. The swine flu virus has proven susceptible to Tamiflu (oseltamivir) and Relenza (zanamivir), but resistant to some other antivirals.

As the outbreak progresses, nurses have a responsibility to inform themselves as much as possible about swine flu, even if they live in areas where no cases have been reported, says Nancy Berlinger, PhD, MDiv, deputy director and research scholar at the Hastings Center in New York, and an adjunct lecturer in health care ethics at the Yale School of Nursing.

“This is really a call to duty for nurses,” says Berlinger, co-author of “The Five People You Meet in a Pandemic—and What They Need from You Today,” which presents an ethical framework for pandemic planners: “Nurses may be in the role of educators and myth-busters. They need to know the facts, be calm, and not hypothesize on the facts.”

Nurses need to constantly check not only national sources such as the CDC: and WHO:
Web sites, but also state and local sources, including state health department Web sites, to find out whether or how the virus has presented itself in their area. As health experts and first responders, nurses will be expected to answer questions from relatives, neighbors, and friends as well as patients, she says, and they should be prepared.

Nurses also need to be aware of the plans their own institutions have for dealing with public health emergencies, such as how antivirals are stockpiled and who will they be given to, she says, and of how their institutions will communicate those plans to them.

“It’s a situation where nurses need clear guidelines on what needs to be done,” she says. Hospitals should also be planning what they can provide for their workers if schools are closed or transportation systems are shut down, she says, and communicate this to their staffs. “Nurses should feel backed up on these points, and they should press for it.”

Part of the nurse’s job is helping patients keep calm in the midst of a potentially frightening situation, Ramirez says. “People get viruses. They usually resolve themselves without any treatment whatsoever. I believe that nurses understand the microbiology of a virus. What nurses really have to do is to be able to communicate what symptoms are severe and not severe to the patient.”

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Cathryn Domrose is a senior staff writer at Gannett Healthcare Group.

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