Associated Press Photo

Though the latest Ebola outbreak is mostly confined to three West African countries, three cases – two of them nurses who cared for a patient from Liberia with the virus – have been confirmed in the United States. That pales in comparison to the number of people who have died from the virus in West Africa – 4,484 as of October 18. With such knowledge, we have little reason to panic. And, with the influenza season at our heels, we have larger concerns to contend with: two hundred thousand people are hospitalized every year from the flu, and between 3,000 and 49,000 people die.
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html

http://www.cdc.gov/flu/keyfacts.htm

But it makes sense that nurses in the US are vocalizing their concerns about the Ebola virus and lack of adequate personal protective equipment. Among the 18 million health care workers employed in the United States, registered nurses comprise nearly 3 million. Nurses are the primary caregivers of hospitalized patients. http://www.cdc.gov/niosh/topics/healthcare http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet

According to the CDC, the “natural reservoir” of Ebola has yet to be identified, so the process of a human being infected is not known. But researchers believe the “first patient becomes infected through contact from an infected animal.” Ebola is spread through direct contact with body fluids, such as blood, vomit, semen, feces, and breast milk, as well as contaminated needles, and infected mammals – i.e. humans. Insects cannot contract the virus.
http://www.cdc.gov/vhf/ebola/transmission/index.html?s_cid=cs_3923

Since nurses, and other health care workers, are exposed to all kinds of body fluids, they are at the highest risk of getting sick when caring for patients with Ebola. If nurses become ill from the virus, who will care for the millions of patients who are hospitalized every year for various other illnesses? The CDC recommends the following personal protective equipment (PPE): disposable gloves, gowns, goggles, and a face mask in the event body fluids splatter. In cases where there is a large amount of body fluids, double gloving, booties, and leg coverings may be required.
http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html

But is this enough? The typical hospital gown is made of cotton material, easy for fluids to seep through. Perhaps double gowning is a good idea, but what if your hospital unit runs out of gowns?

The nurses who cared for the dying patient in Dallas wore full PPE, including Tyvek suits – heavy-duty outfits that look like space suits – and a face shield and respirator mask. They even wore three pairs of gloves and booties. Yet, they became infected. Because the suits were too large, and exposed the necks of the nurses, the CDC recommended they secure the neck of the gowns with tape.
http://bigstory.ap.org/article/f5d8d9bb2f2a44d59dd10042d3e0e57b/existing-protocols-might-not-be-enough-ebola

National Nurses United, the largest union of registered nurses, has reached out to hospitals, advocating for better PPE, training on how to properly use the equipment, and adequate staffing to appropriately care for Ebola patients.
http://www.nationalnursesunited.org/pages/nursing-practice-patient-advocacy-alert-treatment-of-patients-with-ebola

What is your hospital doing to protect your nurses, and patients?

For more information on the CDC’s most recent guidelines when caring for Ebola patients go to:
http://www.cdc.gov/media/releases/2014/fs1020-ebola-personal-protective-equipment.html

The first time I changed the strings on my fiddle, I started by removing all four of the old ones at the same time, thinking that would be a good time to give my fiddle a thorough dusting. But what I hadn’t considered was the sound-post, until it collapsed after I removed the strings (fortunately, it did not slip into one of the F-holes – the long, curlicue-like openings in the top of the fiddle). That’s why it’s strongly advised to change one string at a time. Which string to start with is not critical, but most fiddlers prefer to start with the G-string (I start with the E string, because that’s what my fiddle instructor taught me after I confessed to her my oversight). You never know when a string will pop out of its slot and break, so it’s a good idea to have an extra set of strings in your case. Hope this helps.

For steps on how to change fiddle strings, go to: http://www.violinonline.com/changingstrings.htm

When it’s a cold, rainy day what better place is there to be than in a bookstore, slouching back in a cushy couch, nibbling on delicate pastries, and letting someone read to you? That’s how fifteen individuals, who were mutually interested in learning more about traumatic brain injuries, spent their Saturday afternoon this past weekend. As the hard rain tapped against the windows of Westwinds Bookshop in Duxbury, Massachusetts I spoke to them about TBIs, then read from my essay, “Invisible Bruise,” published in Chicken Soup for the Soul: Recovering from Traumatic Brain Injuries. Though I relayed a dump truck full of statistics, and read my story, my wish was to engage the audience in an honest discussion of the broader issues related to TBIs, inspiring them to pass on to others their new knowledge of this often misunderstood injury. And that’s exactly what evolved from my talk and reading: a couple, whose daughter sustained a TBI in a car accident last spring, shared their concerns about her suffering from depression. Another woman, with a granddaughter who is recovering from a TBI, asked about how one qualifies for disability insurance. The actor Chris Cooper, and his wife Marianne Leone, who has written a memoir about their disabled son Jesse who suffered a brain hemorrhage related to prematurity, spoke about the roadblocks they encountered when advocating for him to be included in classrooms with able-bodied students. The discussion continued for several more minutes, some vocalizing their thoughts about we view individuals with disabilities, even in the context of those who have not suffered a TBI, followed by others asking how TBI survivors cope with the loss of their careers.

And so my wish was granted: the event was not only to acknowledge my writing, and my TBI; it was for everyone in that room, and for those beyond the room who could not make it.

I came away from the reading with more than the sunny feeling that others benefited from it. Most of the people who attended I had never met before, but by the end of the event, I sensed each individual’s unique energy. As one after another thanked me, they reached out to shake my hand, but I refused. Instead, I reached out and hugged each one of them. They hugged me back.

October 10, 2014: Donna O’Donnell Figurski, the host of the blog, “Surviving Traumatic Brain Injuries,” speaks with Melissa about her injury and recovery.

http://survivingtraumaticbraininjury.com/2014/10/10/survivors-speak-out-melissa-cronin/

Luis Grenada, a 16th century theologian, would probably not care whether or not newborns feel pain, for he called them “a lower animal in human form.” And during the early 20th century, the ignorance of the times drove researchers to stick newborns with pins, even while they were asleep, to determine whether or not they sensed pain. Their defensive frantic kicking apparently was not adequate proof. More studies were undertaken, more pinpricks. Because the newborns reacted with what one researcher called “diffuse bodily movements accompanied by crying,” she determined that they had “limited sensitivity to pain” (http://www.nocirc.org/symposia/second/chamberlain.html). But did these researchers take into consideration that mothers might have received anesthesia during labor, effecting newborns’ response to painful stimuli?

A 2011 British study concluded that the sensation of pain starts before birth, between 35 and 37 weeks gestation (http://www.livescience.com/15975-babies-feeling-pain.html). Continually sticking newborns with pins merely to prove they  feel pain is unnecessary, and cruel. As a neonatal intensive care nurse, my job, unfortunately, required me to poke babies’ heels for blood samples – I don’t need to share with you the more than unpleasant experiences.

Newborns may experience pain from surgery, and discomfort from the various tubes inserted into their bodies. Male newborns undoubtedly feel pain when circumcised. Dozens of studies, in which researchers have measured cortisol levels in babies, have proven so. They noted that this stress hormone increased as high as four times the levels prior to circumcisions (http://www.circumcision.org/response.htm).

So, if you’re a novice neonatal nurse, or a first time parent, here’s clear evidence that a newborn is experiencing pain:

Crying: At one time, people believed newborn cries were not purposeful sounds, but random noises. But when a newborn cries, I mean wails, his breath cut short, his face turning the color of an eggplant, you know he needs more than his diaper changed. With prolonged crying, newborns may turn cyanotic, or blue, from decreased oxygen levels.

Facial expressions: furrowed eyebrows with eyes squeezed shut. You might also notice their chins quivering.

Body Language: Kicking. Clenched fists. Flailing – arms and legs pulled in then stretched out. Premature babies often become quite and still, or floppy when in pain.

Vital signs: Increased heart rate and blood pressure. Decreased oxygen levels. A change in vital signs are particularly helpful when assessing premature or ill newborns in pain, as they do not have the energy to cry or flail like healthy newborns.

To help determine appropriate intervention, it’s common practice for nurses to score newborns’ discomfort (http://www.vuneo.org/nppainass.htm).

But how do you relieve newborns’ pain? If you’re a neonatal nurse, and the source of pain is evident – the newborn just woke up from abdominal surgery for instance – administration of narcotics might be warranted. Parents might worry that their newborns will become addicted to pain medication, but allowing babies to endure unnecessary pain comes with consequences: difficulty sleeping and eating, and physiological and structural changes in the nervous system. Babies might become hypersensitive to pain during future procedures (http://www.ncbi.nlm.nih.gov/pubmed/12391738). Different from addiction – a psychological issue – babies can become physically dependent on pain medication. To avoid withdrawal symptoms, nurses slowly wean them off medication.

Swaddling, breastfeeding, skin-to-skin contact with parents, sucking on a pacifier, and infant massage can also alleviate newborn discomfort (http://www.parents.com/baby/care/newborn/how-to-massage-baby).