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Nurses and doctors as diplomats in the COVID culture wars

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By: Ann Lawrence O’Sullivan, PhD, FAAN, CRNP; Sharon Y. Irving, PhD, CRNP, FCCM, FAAN, FASPEN; June Treston, DNP, CRNP; Jeffrey C. Lerner, PhD; Norbert Goldfield, MD

Gallup polls report that nurses and physicians are the two most trusted professions in the nation. This trust, along with knowledge, clinical skills, and empathy with patients and their families position us to serve as pandemic diplomats delivering a vaccine against the misinformation and disinformation causing hospitals to fill and families to worry and grieve.

As noted by the American Hospital Association and Russell and colleagues, learning a patient’s COVID-19 status has become the first and most pressing question health professionals ask. Every day we see unvaccinated and unboosted people among the patients we treat for diabetes, asthma, and other conditions. We see pandemic-related depression, behavioral changes, and substance use disorders along with increased challenges in accessing these critical services.

When we speak with patients about obesity or hypertension, we gently point to these conditions as additional risk factors for worse COVID-19 outcomes and give people space to broaden the conversation. We assure them that we keep close track of the latest pandemic safety information, and we discuss other vaccinations and the patient’s overall health.

Is this a more teachable moment than earlier in the pandemic? It’s unclear:

  • Will the number of young children entering hospitals spur a new openness among those who have hesitated or resisted vaccination and boosters?
  • Will the continuing drumbeat of over 975,000 COVID-19 deaths plus pandemic-related excess deaths produce this result?
  • Will the rapid rate at which Omicron spread to the unvaccinated convince them to finally get the vaccine?
  • Will the grief among families and friends or a growing recognition of possible lasting effects of infection (long-COVID) register?
  • Or will those who are set in their ways remain dismissive since the Omicron waves have caused a milder illness, and other variants have yet to emerge?

Diplomatic efforts by nurses and doctors at an individual patient level need to be buttressed by presenting and explaining the message to sitting and aspiring politicians. Nurses can actively craft, tailor, and deliver messages to patients and families, but also, crucially, to broader public entities such as school boards and workplaces. According to Our World Data, the United States is behind other well-resourced nations in gaining the health outcome benefits of a less politically polarized approach to healthcare in general and specifically to COVID-19 protection measures. Our politicians need to recognize that this matters!

It is a lot to ask of work-stressed nurses and doctors to take on diplomatic roles that go beyond individual patient encounters. We are already overworked. But taking personal actions to address the problems is a better approach than grumbling or sinking into despair.

Professional nursing organizations, notably the American Nurses Association, have long taken strong stances on the need to adopt and adhere to COVID-19 protective measures. For healthcare professionals seeking guidance, organizations like Ask Nurses and Doctors, founded by Dr. Norbert Goldfield, work to identify and support political candidates with proven or potentially effective health policy programs.

The most recent COVID-19 wave is abating, but a sense of relief may be premature. Politicians are rarely health professionals, and frequently they respond only to crises. This crisis, and its long and broad tail of consequences, is still unfolding. Nurses and other health professionals on the front lines, and those in teaching or policy positions can seize the moment to actively support a more reflective, effective, and sustainable response.

References

American Academy of Pediatrics and the Children’s Hospital Association. Children and COVID-19: State Data Report. March 10, 2022. downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%203.10.22%20FINAL.pdf

American Hospital Association. Environmental Scan. 2021. aha.org/system/files/media/file/2021/11/2022-Environmental-Scan.pdf

American Nurses Association. ANA response to COVID-19 pandemic. nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/ana-covid-19-statement

Ask Nurses and Doctors. asknursesdoctors.com

Centers for Disease Control. COVID data tracker weekly review. March 25, 2022. cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Kostival DA. Perils of COVID-19: Managing stress during pandemic. Philadelphia Medicine. 2022 issuu.com/nhgi/docs/philly_med_winter_2022issuu/s/14449769

Our World in Data. Coronavirus (COVID-19) vaccinations. March 28, 2022. ourworldindata.org/covid-vaccinations

Padamsee TJ, Bond RM, Dixon GN, et al. Changes in COVID-19 vaccine hesitancy among black and white individuals in the US. JAMA Netw Open. 2022;5(1):e2144470. jamanetwork.com/journals/jamanetworkopen/fullarticle/2788286

Russell C, Ali F, Nafeh F, Rehm J, LeBlanc S, Elton-Marshall T. Identifying impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): A national qualitative study. J Subst Abuse Treat. 2021;129:108374.

Saad L. Military brass, judges among professions at new image lows. Gallup. January 12, 2022. news.gallup.com/poll/388649/military-brass-judges-among-professionals-new-image-lows.aspx

Shefska D. As new variants of the coronavirus emerge, reaching the vaccine-hesitant takes on new urgency. The National Academics of Sciences Engineering Medicine. February 4, 2022. nationalacademies.org/news/2022/02/as-new-variants-of-the-coronavirus-emerge-reaching-the-vaccine-hesitant-takes-on-new-urgency

Villarruel AM, James R. Preventing the spread of misinformation. Am Nurse J. 2022;17(2):22-6. myamericannurse.com/preventing-the-spread-of-misinformation

Ann Lawrence O’Sullivan, PhD, FAAN, CRNP, is a professor of Primary Care Nursing and Pediatrics at the University of Pennsylvania Schools of Nursing and Medicine. Sharon Y. Irving, PhD, CRNP, FCCM, FAAN, FASPEN, is an associate professor and Vice-Chair in the Department of Family and Community Health at the University of Pennsylvania School of Nursing. June Treston, DNP, CRNP, is director of the Family Nurse Practitioner Program Track at the University of Pennsylvania School of Nursing. Corresponding author Jeffrey C. Lerner, PhD, is President Emeritus of ECRI and Adjunct Senior Fellow, Leonard Davis Institute of Health Economics at the University of Pennsylvania. Norbert Goldfield, MD, is founder of Ask Nurses and Doctors.

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