Ohio Nurse - June 2021

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Page 22 Ohio Nurse June 2021 COVID-19 Vaccinations: Knowledge vs. Myth to Get Back to A New Normal Erin Morgan, DNP, FNP-BC Reprinted with permission from Tennessee Nurse May 2021 issue In Tennessee, the COVID-19 virus has infected 826,371 people, and 12,022 individuals have lost their lives as of April 13, 2021. The virus has become the third leading cause of death in the United States for 2020. Now that multiple vaccinations are more widely available, nurses can educate the public about their options and dispel the myths surrounding these important tools to decrease future COVID-19 infections and deaths. Nurses have remained the most trusted profession throughout the pandemic, and therefore, must use this position to inform the public about their vaccine options. Understandably, individuals may remain hesitant to obtain a new vaccine when they still have unanswered questions. Nurses have always provided detailed education to allow individuals to make the most informed choice for their health. Information surrounding COVID-19 vaccination is no different. Vaccine Options Currently, there are three COVID-19 vaccines approved for emergency use authorization (EUA) in the United States, two-dose Pfizer or Moderna Vaccines and the single-dose Johnson and Johnson-Janseen vaccine. Nurses should recommend individuals receive any vaccine that is available to them. The FDA has deemed all of the vaccines safe and effective to prevent infection and severe complications from COVID-19. This recommendation applies to all individuals, not just those who have co-morbidities. As more individuals are vaccinated against the virus, the number of available individuals COVID-19 can reside continues to decrease. mRNA Vaccines The Pfizer vaccine was first approved for use in December 2020, with the Moderna vaccine approval following shortly after. Both vaccines require two doses; 21 days between Pfizer doses and 28 days between Moderna doses. These two vaccines use messenger RNA to provide COVID-19 immunity. This mRNA technology has been studied for years and has already been used in some cancer treatments. These vaccines use mRNA to instruct cells to make a ‘spike protein’ similar to that of the COVID-19 virus. The recipient’s immune system responds to these new proteins by making antibodies. These new antibodies remain with the recipient to recognize the similar ‘spike protein’ if a COVID-19 infection occurs. The mRNA does not change the vaccine recipient’s DNA; instead, it trains the immune system how to respond if the virus is encountered. Side effects for the Pfizer and Moderna vaccines include pain or swelling at the vaccine site, fever, muscle aches, fatigue, or headache. These symptoms may occur after the first or second dose. Individuals who have had COVID-19 may have more side effects with the first dose. However, many individuals who have not had COVID-19 report more side effects after a second dose. Viral Vector Vaccine The Johnson and Johnson-Janssen vaccine is the most recent to receive approval. This vaccine is a single-dose injection that offers convenience and expediency compared to the other two vaccine options. This vaccine was tested later during the pandemic resulting in differing effectiveness data that should not be compared to the Pfizer or Moderna vaccines. Additionally, the Johnson and Johnson- Janssen vaccine was tested in locations where variants of COVID-19 were already circulating, affecting results of the study. The use of this vaccine was paused to examine six blood clotting events in women. Nevertheless, the Johnson and Johnson- Janssen vaccine has already been received by millions of individuals to date. The Johnson and Johnson-Janssen vaccine provides immunity through a viral vector instead of mRNA. Viral Vectors, non-infectious harmless viruses, are used to transmit information to the recipient’s immune system. The vector instructs the recipients’ immune system how to produce antibodies for the ‘spike protein’ recognizable on the COVID-19 virus. While considered effective after two weeks per the CDC, immunity increases up to 28 days past the single dose. Viral vector vaccines have already been used to treat cancer and the Ebola virus. Side effects are similar to the previous two vaccines and include pain or swelling at the vaccine site, fever, muscle aches, fatigue, or headache. The CDC recommends that women between the ages of 18-50 who receive the Johnson and Johnson- Janssen vaccine should be aware of the rare but increased risk of thrombocytopenia syndrome. Any individual who feels uncomfortable with this risk is recommended to obtain one of the other two vaccine options. Vaccine Hesitancy Many patients and fellow nurses have questions and concerns about these new vaccinations. These apprehensions are valid and may take time to overcome. One way to dispel myths and answer questions surrounding these vaccines is to provide evidence-based education from trusted sources and then let the patient or nurse choose for themselves. The process was rushed All medications and vaccines must go through an approval process with the FDA. All three vaccinations currently approved have undergone this process and received emergency use authorization (EUA). This approval does not mean that the steps for approval were shortened or skipped; instead, it provides approval for widespread use in the pandemic when benefit is demonstrated. Scientists were able to accelerate the development of these vaccines due to several factors. Scientists shared information between countries and between companies in an unprecedented effort to roll out multiple COVID-19 vaccine options at once. Cooperation occurred in the scientific community using methods that were already in progress, such as viral vector and mRNA technology, developed for a new purpose. Moreover, governments provided funding to help cover costs for the development of vaccines locally and abroad; in the United States, this was titled “Operation Warp Speed.” Additionally, many volunteers of varying ages and races enrolled in the vaccine trials decreasing the time to find participants. Finally, vaccine developers were able to move through the phases of vaccine development promptly. Phase 3 trials were completed relatively quickly due to the infectious and widespread nature of COVID-19, when many participants were exposed, proving effectiveness. All of these factors allowed multiple vaccines to be developed in a time of great need. Millions of individuals have received all three vaccines with few severe side effects. Extensive monitoring continues for each vaccine, which makes these vaccines the most scrutinized in recent history. During this writing, Johnson and Johnson- Janssen vaccine distribution was paused to examine the data for six patients who developed blood clots. The pause was brief; however, the examination demonstrates the ongoing commitment to safety surrounding these vaccines. It is understandable for individuals to have questions about a strongly recommended new therapy. Providing answers and resources to individuals who express concerns about the unprecedented process may alleviate their concerns. I’m healthy and don’t need it It is recommended that all individuals receive the COVID-19 vaccine when it is available to them. The risks associated with COVID-19 are higher than the risk associated with any side effects from the vaccine at this time, even for those who are young and healthy. Each time an individual becomes sick with COVID-19, there is a risk of severe disease to themselves and passing it along to others around them who can also become seriously ill. Vaccination is the safest way to obtain immunity to COVID-19 at this time. As more individuals become immunized, the virus will have fewer places to spread, decreasing overall illness and allowing a return to normal. I had COVID and don’t need the vaccine Scientists continue to study how long immunity to the disease lasts after a COVID-19 infection. While rare, it is possible individuals can become reinfected with the virus. Individuals who previously had COVID-19 may notice some side effects with the first dose of the two-dose Pfizer or Moderna series; however, most side effects remain mild. Each time an individual becomes sick with COVID-19, there is a risk of severe disease, long-term health effects, and spreading the disease to others who can also become significantly ill. Conclusion Tennessee’s quickest way to emerge from this pandemic is through public health measures nurses have pioneered for years: vaccinations, handwashing, and education. Nurses themselves may have concerns and questions about receiving a vaccine after a year of difficulty and division. Conversations about COVID-19 vaccines should be held in a spirit of acceptance and inquiry, allowing individuals to ask questions and feel comfortable about the choices they are making for themselves. Shaming and embarrassing individuals will only foster ongoing resistance and suspicion. Instead, nurses should focus on the benefits of vaccination: A quicker return to normal, protection of patients and loved ones, and the ability to gather with others who are vaccinated without masks. Reference websites for nurses: - https://covidvaccinefacts4nurses.org/ - https://www.cdc.gov/coronavirus/2019-ncov/ vaccines/vaccine-benefits.html - https://www.hopkinsmedicine.org/health/ conditions-and-diseases/coronavirus/is-thecovid19-vaccine-safe References available upon request. Join our team! The Metro Health System in Cleveland, Ohio is looking for RN’s with a passion for excellence! $6,000k sign-on bonus may be available. Visit www.metrohealth.org/careers to apply. Certus Healthcare Management is currently seeking PRN LPN's and RN's at new PRN rates! For more information contact econnelly@certushc.com
June 2021 Ohio Nurse Page 23 Failure to report changes in a patient’s condition Omobola Awosika Oyeleye, EdD, JD, MSN, MEd, RN-BC, CNE, CHSE Reprinted with permission from Nebraska Nurse May 2021 issue A nurse’s ability to recognize and respond to changes in a patient’s condition is a crucial element of professional nursing practice. Failure to respond appropriately to clinical changes can lead to complications and even death. 1 In a study that investigated the impact of communication in malpractice lawsuits, communication failure was a factor in 32% of cases involving nurses, with most involving poor communication with other healthcare professionals about the patient’s status. These cases often result in huge financial consequences in cost of care and legal damages. 2 Communication Communication of a patient’s status has been the focus of much attention and research, and various communication frameworks have been generated to facilitate clinical communication among healthcare professionals about patient status. 3,4 Widely used examples include SBAR (situation, background, assessment, and recommendation) and ISBARR (introduction, situation, background, assessment, recommendation, and read back). In some cases, however, it is not about the nurses’ ability to communicate with primary care providers. Rather, they are about the competence and decisionmaking skills needed that enables a nurse to assess a patient’s condition and determine the appropriate intervention, including when to escalate care and seek the expertise of appropriate personnel. Barriers to Communication Many factors can play into why nurses may not communicate a patient’s status promptly or at all. These include a busy schedule, a reluctance to “bother” the primary care provider, or a failure to recognize the circumstances under which a primary care provider should be notified due to a lack of clinical competence. 2 Nurses need to recognize the severity and emergent nature of a patient’s condition. A nurse’s failure to recognize an emergency indicates a lack of competence in nursing fundamentals and a lack of knowledge about the possible physiologic consequences. This gap in knowledge can contribute to a catastrophic deterioration in the patient’s condition. Critical thinking extends beyond mere information, attentiveness, and assessment. How do nurses acquire the decision-making and critical-thinking skills necessary for their practice? The clinical competence needed to make decisions, especially in acute situations, develops over time as the nurse advances from novice to expert. 5 Implications for practice To determine appropriate interventions and recognize when it is necessary to escalate care, nurses must: • accept only patients that they are capable of caring for. 6 • develop the education and skills necessary to recognize when the interventions they initiate are not effective. 1 • escalate the patient’s care to a more experienced nurse or the healthcare provider when they find that a patient’s status change is beyond their capability. 7 • follow the facility’s chain of command. A nurse’s vigilance, recognition of an urgent situation, evaluation of changes in the patient’s condition, and steps taken to escalate appropriately should be evident in the medical record.8 Documentation should include the persons consulted and the actions that resulted from the consultation. 9 • be aware that nurses can be held legally liable for actions they omit as well as actions they fail to take in a timely manner. 7 Guidelines for practice Keep these general guidelines in mind: • When documenting adverse events, follow your facility’s policies and procedures. The record should be objective, including only clinical facts without any guesses, assumptions, speculations about the cause of the event, or personal opinions. 10 • Listen to family members’ concerns. They are often at the bedside much longer than the clinical staff. They know the patient and are likely already engaging in the care of the patient at home. They are a valuable source of information and their concerns should be taken seriously.11 • Nurses should consider carrying their own liability insurance, both for the purposes of legal liability and for any disciplinary actions taken by the board of nursing. 12 The failure to report changes in a patient’s condition can have serious health consequences for the patient as well as legal and financial implications for all involved in the care of the patient. But by meeting the standards of professional nursing care, nurses can and should avoid these costly consequences. REFERENCES 1. Massey D, Chaboyer W, Anderson V. What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature. Nurs Open. 2016;4(1):6-23. 2. Crico Strategies. Malpractice risks in communication failures. 2015 Annual benchmarking report. www.rmf. harvard.edu/Malpractice-Data/Annual-Benchmark- Reports/Risks-in-Communication-Failures. 3. Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation. www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx. 4. Cudjoe KG. Add identity to SBAR. Nurs Made Incredibly Easy. 2016;14(1):6-7. 5. Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-407. 6. Buppert C. A “safe harbor” for unsafe nursing assignments. Medscape. April 26, 2019. 7. Nurses Service Organization. Failure to report changes in the patient’s medical condition to practitioner. 2012. www.nso.com/Learning/Artifacts/ Legal-Cases/Failure-to-report-changes-in-thepatients-medical-condition-to-practitioner. 8. Thielen J. Failure to rescue as the conceptual basis for nursing clinical peer review. J Nurs Care Qual. 2014;29(2):155-163. 9. American Nurses Association. ANA’s Principles for Nursing Documentation: Guidance for Registered Nurses. Silver Spring, MD: American Nurses Association; 2010. 10. Austin S. Stay out of court with proper documentation. Nursing. 2011;41(4):24-29. 11. Sherman DW. A review of the complex role of family caregivers as health team members and secondorder patients. Healthcare (Basel). 2019;7(2):63. 12. Brous E. Reciprocal enforcement and other collateral issues with licensure discipline. J Nurse Pract. 2017;13(2):118-122. This article has been adapted for space and originally appeared in the November 2019 issue of Nursing © 2019 Wolters Kluwer Health, Inc. This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurs-es’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insur-ance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247- 1500. www.nso.com.
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