Nurse Role in Preventing Ebola Stigma

During the first week of June 1981, the Centers for Disease Control and Prevention (CDC) published their weekly Morbidity and Mortality Report (MMWR) with a description of a rare lung infection in five previously healthy men. Within days physicians across the country were calling the CDC with reports of similar cases.1

Thirty-three years later, nurses are facing a similar dilemma regarding what they may perceive as a risk in providing routine care for patients who have been exposed or diagnosed with another potentially life-threatening infectious disease: Ebola.

For many, their fears were substantiated when Nina Pham, 26, and Amber Joy Vinson, 29, both critical care nurses at Texas Presbyterian Health Hospital in Dallas, contracted Ebola while caring for Thomas Eric Duncan, the first person diagnosed in the U.S. with the virus who died at the hospital on Oct. 8.

Evolution of a Disease Related Stigma

The MMWR report in 1981 was the first official reporting of what we now refer to as the acquired immune deficiency syndrome (AIDS) epidemic, which results from contracting the human immunodeficiency virus (HIV).2

Fifteen years later (1996), 500,000 cases of AIDS had been reported in the U.S. alone.

As the number of HIV/AIDS cases increased, so did reports of AIDS-related stigma, negative attitudes, and mistreatment of persons with this disease , which resulted in persons who feared they had been exposed to this virus, reluctant to seek testing and/or treatment.

Is History Repeating Itself?

During the mid-1990s, there were ongoing reports among “nurses regarding the risk of contracting HIV through routine nursing care.” Nurses struggled with what they believed to be “a conflict between professional obligation and personal risk”.3

Consequently, many nurses refused to care for patients infected with the HIV virus for fear of contracting the disease or carrying the virus home to their families.

Over time, through education regarding information on how this virus is spread and how to take proper precautions to prevent contracting or spreading the virus, fears and attitudes among nurses towards caring for patients with HIV/AIDS were changed.

Fast-forward to March 2014, when there were the first reports of 49 cases of Ebola in one West African country. Five months later, the World Health Organization (WHO) reported 3,685 confirmed or suspected cases of Ebola in West Africa.4

As Americans watched news reports of this apparently deadly virus, healthcare workers and laypersons alike expressed concerns about the devastation this virus was causing in a country that is approximately 3,400 miles from the U.S. eastern coastline.

Americans did not begin to openly express concerns about the spread of this disease until two healthcare workers, who contracted Ebola while caring for patients in West Africa, were returned home to the U.S. for treatment. Both were successfully treated and subsequently discharged from a hospital in Atlanta.

Similar to concerns about the spread of HIV during the 1980s and1990s, before Pham was infected in Dallas, nurses were already expressing concerns about caring for persons who may have been exposed to the Ebola virus or patients who have been diagnosed with this virus for fear of contracting the disease or spreading the disease from the hospital, to the community, and their families. Nursing is the largest sector of the healthcare professions.

In Nurses We Trust

According to the most recent Gallup poll, Americans rank nursing as the most trustworthy profession for the thirteenth time in 14 years.5 With trust, however, comes social and professional responsibility, and with responsibility comes accountability.

The Quality and Safety Education for Nurses (QSEN) project amenable with the Institute of Medicine (IOM) provides a list of competencies for nursing practices that address knowledge, skills, and attitudes that should be developed in all nurses.6

Nurses have a professional responsibility to learn the facts about the Ebola virus and should be held accountable for relaying accurate information about the Ebola virus. United Nations Secretary General Ban Ki-moon in 2008 stated:

“Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world. We can fight stigma.”7

Nurses Can Break the Cycle

With nursing being the largest component of the healthcare professions, disease and health-related stigmas can be negated through educational efforts. Nurses can help make the Ebola virus not become a silent killer.

Similar to HIV/AIDS, the Ebola virus is transmitted among humans through direct physical contact with infected bodily fluids. Ebola is not an airborne pathogen, is not spread by casual contact; therefore persons traveling by plane are not at risk for contracting this virus even if a passenger on the plane has been in contact with a person who has the Ebola virus.

According to WHO, this virus has circulated for two decades or more, yet the mode of transmission has not changed.4 Ebola is spread, in the same way as HIV, when blood or other body fluids contaminate another person’s open skin lesion or mucous membrane.8

Todd, a nurse epidemiologist reported: “We humans have a knack for taking any newly reported issue of legitimate concern entirely out of context, foregoing all common sense as we transform it into a danger of galactic proportions . the central questions in this tragic outbreak are the same for Ebola as for any other disease: how is the organism transmitted and what is the risk of protected or unprotected exposure to the infected person?” 8

Kinsman, Deputy Director of the Ume† Centre for Global Health Research in Sweden, reported local, national, and international responses to the 2000-2001 outbreak of Ebola in Uganda and concluded: “An important objective for any future outbreak control strategy must be to prevent excessive fear, which, it is expected, would reduce stigma and other negative outcomes. To this end, the value of openness in the provision of public information, and critically, of being seen to be open, cannot be overstated.”9

Accurate Information is Key

Encourage nurses to make a commitment to educating themselves rather than responding in fear. Seek information from reliable sources such as the CDC and WHO, rather than relying on information portrayed by the media alone.

As nurses, we have a professional responsibility to become knowledgeable regarding Ebola transmission, symptoms, and prevention. If we educate ourselves first, we can then educate our patients and the public to prevent history repeating itself in regards to stigma that is often associated with an infectious disease, particularly when it reaches epidemic proportion.

Stigma is the direct result of fear associated with inaccurate information or a lack of knowledge.

Trossman addressed stigma associated with mental illness and stressed the importance of advocacy and education to overcome stigma.10 The same strategies can be applied to break the cycle of sigma associated with the outbreak of Ebola and for that matter, any life threatening infectious disease.

References for this article can be accessed here.

Eileen Thomas is a nursing professor at American Sentinel University in Aurora, Colo.

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