"How very little can be done under the spirit of fear." - Florence Nightengale

From March 1918 to June 1920 the world held its collective breath as an estimated 21 million people around the world, roughly one third of the worlds population, came down with the Spanish flu. In the United States alone, estimated death from the 1918 Influenza Pandemic range from 540,000 to over 675,000. This flu, a deadly influenza A virus strain of the H1N1 virus, attacked the young, healthy population of the world. In the fall of 1918, the pandemic came to a quick end thanks to the a combination of the virus mutating to a les deadly strain and the combined improved health care from doctors and nurses who saved thousands of lives. Nurses were pushed to the limit to save lives through out the entire pandemic.

On October 10, 1918, alone, 528 people died in Philadelphia. With most of the staff at the Philadelphia General Hospital sick, most of the care and treatment in the hospital was done by nurses. Lillian Clayton was the chief nurse at the Philadelphia General Hospital School of Nursing and is reported to have worked 48-hours at a time. So many nurses pushed themselves to exhaustion and as a result of their selfless service, they too became sick. Four nurses died. Lillian Clayton wanted the freshman nurses to go home and save themselves from exposure, but each nurse insisted on staying to help those in need. Six of those nurses died from the Spanish flu. The cases of heroic nurses during the pandemic go on and on.

Hurricane Katrina devastated parts of the U.S. Gulf states in August, 2005. 80% of the area was evacuated. The American Red Cross put out a call for 200 licenses nurses for help at service centers, urban and rural outreach areas, shelters, feeding sites, homes and hospitals. The results forced many to asses their current plans and eventually lead to a wake up call for hospitals and healthcare facilities to create better and updated disaster preparedness and response plans. Nurses reported dialyzing patients around the clock in the days and weeks following the Katrina. Nurses also worked to help people find clothes, food, lost family members and even transportation for people in need around the Gulf Coast area.

When disaster strikes, nurses are expected to go beyond the call of duty. During their daily duties, nurses understand the logical priorities involved in nursing in their facilities, but during a disaster other decisions need to be made, including evacuation, sheltering, transportation plans, building capacity considerations, and more. Other considerations for disaster planning for nurses include: patient identification, contingencies for disrupted power, equipment failure, medication supplies, and the emotional and psychological of long-term care patients. A report called "Caring for Vulnerable Elders During a Disaster: National Findings on the 2007 Nursing Home Hurricane Summit" goes on to make suggestions for disaster planning and nursing responsibilities.

Today the world is watching for word about the 2009 H1N1 pandemic, Swine Flu. Once again nurses will be faced with the task of carrying out their health care calling while facing potential illness themselves.

The new Influenza A (H1N1) virus is believed to spread through respiratory droplets expelled by talking, sneezing or coughing. Health care professionals, such as nurses, are encouraged to wear masks to reduce the possibility of contracting and transmitting the virus. Learning how to use protective face masks is critical.

Other suggestions for prevention include:

• Do not touch your mouth or nose
• Wash your hands with soap and water or an alcohol based hand cleanser often.
• Wash your hands after touching surfaces, patients, or door knobs, buttons, keyboards and the like.
• Avoid large crowds
• Avoid the time you spend with infected individuals
• Cover your nose and mouth when coughing, sneezing or yawning
• Throw away any used tissues (do not put them in your pocket)

Again, it is important for nurses in every health care center, clinic, hospital, and facility to review their pandemic disaster plan and, if one does not exist, strongly suggest the creation of a plan.

Vaccines to help battle the Influenza A (H1N1) virus are close to being available and it may be up to nurses to implement vaccination campaigns in hospitals and clinics. Understanding how to give the vaccination, the possible side effects and the answers to the questions coming from patients will be critical.

Do Nurses Have to Work During a Health Crisis?

The American Nurses Association (ANA) states: Nurses are obligated to care for all patients; however, in certain situations the risks of harm might outweigh a nurse’s moral obligation or duty to care for a given patient. There are limits to the personal risk of harm nurses can be expected to accept. Accepting personal risk exceeding the limits of duty is not a moral obligation; it is a moral option. (http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx)

This statement clearly defines that nurses should make sound decisions based on the information they have. It is expected that nurses would make their decision to help before a crisis, and in the UK the Nursing and Midwifery Council (NMC), the nursing regulator, states that it can legally call on midwives and student nurses to help during a large scale outbreak. According to the NMC midwives can extend their scope of practice to provide nursing duties as long as they are competent. Fear is often a factor when it comes to deciding whether or not to continue nursing during a pandemic. The majority of nurses feel that whether it is a small head cold or a pandemic outbreak, helping people get well during a time of illness is their focus and their calling. Fortunately there are places like Flu.gov that have information not only on pandemic flu preparedness, but other critical information that nurses can take back to their clinics and hospitals to help create disaster preparedness plans.

It is often too easy to forget the scope of responsibility that nurses have. Patients may take nurses for granted simply because they do not understand how important the culture of nursing is. However, in the time of disasters and crisis it is the nurse that stands out as the icon of care and healing, and who, like Florence Nightengale, will never be forgotten.

Article © My Nursing Uniforms.com / Young Lion Incorporated
Image Courtesy of Eneas from Flickr.