Editor's note: While the media focus on Ebola has largely been on Texas Health Presbyterian Hospital Dallas, as of this writing patients with Ebola have also been treated at Emory University Hospital in Atlanta, the University of Nebraska Medical Center in Omaha, and the National Institutes of Health Clinical Center in Bethesda, Maryland. No transmissions have been reported at these last three hospitals.
On September 16, President Obama met with the Emory University Hospital infectious diseases team as part of a visit to the Centers for Disease Control and Prevention (CDC) in Atlanta. While discussing the outbreak of Ebola virus disease that has brought, as of this writing, three American patients to Emory, he commended the medical team and gave a special shout-out to the nurses: "Sorry doctors, but having been in hospitals, I know they are the ones really doing the work."
The three patients included physician Kent Brantly and medical missionary Nancy Writebol, both of whom were treating Ebola patients in Liberia when they contracted the disease and have since recovered and been discharged, and a third patient, whose name hasn't been released, who arrived September 9 and has since been discharged.
Indeed, the nursing staff at Emory hasn't only been crucial to the care of the Ebola patients treated there, they've been an important voice in the development of the safety protocols that will be used from here on. Emory's inclusion of nursing input could serve as a model for other hospitals addressing the challenges of caring for patients with this complex infectious disease.
Emory University Hospital is equipped with a specially built isolation unit, designed to treat patients with serious infectious diseases caused by either airborne contaminants or those spread through contact. Set up in collaboration with the CDC after September 11, 2001, the unit is one of just four of its kind in the country. Since the unit opened, a core group of about 12 nurses has been on standby, making preparations that include twice yearly practice with the CDC and the Department of Defense.
It's this level of preparation that helps to counter the fears that accompany the Ebola virus. "It's important to acknowledge that every person involved in caring for these patients [is a volunteer]," says Nancye Feistritzer, vice president of patient care services and chief nursing officer at Emory University Hospital. "The core group of staff knew they were going to be included and understood the nature of the risk." When the team needed to be expanded before the arrival of the second patient, a number of the critical care staff came forward and were trained in rigorous safety protocols. "Our focus on creating a safe working environment gave people a sense of comfort," says Feistritzer.
The nursing team was central to creating that sense of safety. Their insights helped determine the level of protection that was needed and types of personal protective equipment (PPE) that would be worn in the isolation room. The CDC recommends contact and droplet precautions, which at a minimum means gowns, face shields, masks, and gloves. But Ebola presents unique contact risks related to bodily fluids (including large quantities of diarrhea and vomit), and Emory decided to go with a full jumpsuit. A hood with built-in airflow was added for comfort.
"If you've ever been in an N95 surgical mask, it gets a little hot," says Sharon Vanairsdale, a clinical nurse specialist on Emory's communicable diseases unit. "Your glasses can fog up. The hoods we wore had constant airflow and were actually very comfortable."
Regular training keeps the nursing staff familiar with donning and doffing the gear and performing complicated nursing tasks, such as starting ivs while wearing double gloves and extra layers.
A typical shift in the care of an Ebola patient consists of four hours inside the isolation room itself, with another four hours of supporting care in the anteroom just outside. Daily "family meetings," at which the team discusses clinical care and any procedures that need revising, follow these shifts.
As important as good communication is for the staff, it's just as crucial for the public. "Initially, there was a great deal of concern [in the community and] across the country," says Feistritzer. The Emory team relied on transparency to mitigate that concern. "We had town hall meetings, wrote e-mails, and created a Web page," she says. "We wrote a letter to other patients in the hospital to communicate that they were safe." The team ensured that the staff on all patient care units had accurate information to give to patients and families regarding the hospital's extensive protective measures, in order to calm any fears they might have about contracting the disease.
For the nurses, bringing the human element to the room was an essential part of the job. They had to find creative ways to connect with the patients and get them moving, says Feistritzer. Small gestures, like a handwritten note on a board in a patient's room saying "We're glad you're here" or games of Nerf basketball or even an on-the-spot manicure as a patient began to recover, went a long way in establishing personal connections. Daily check-ins with the patients' families, who could see their loved ones only through a window from the next room, were important as well.
When asked about the fear and anxiety that come from treating patients with such a deadly, highly contagious disease, Vanairsdale is matter-of-fact. "It's Ebola. It's natural to get a little bit nervous. But we got into nursing to care for patients. It was the right thing to do to take care of these patients."-Laura Wallis