DiversityNursing Blog

An estimated 4%, or about 150,000, Nurses in the U.S. are Filipino, but comprise nearly a third of Registered Nurse deaths due to COVID-19.

Business Insider reported, Nurses of Filipino descent account for 31.5% of the workforce's COVID-19 deaths.

In California, where about 20% of Nurses identify as Filipino, they account for nearly 70% of COVID-19 deaths in the profession, according to the Mercury News. Statewide, Asian Americans make up about 5% of coronavirus cases and 11.7% of deaths, compared to their 15% of the population.

Zenei Cortez, an RN who works at Kaiser Permanente’s South San Francisco Medical Center and, as co-president of the California Nurses Association/National Nurses United worries that her fellow Filipino Nurses are less likely than other Nurses to demand workplace protections.

“Culturally, we don’t complain. We do not question authority,” Cortez said. Many Filipino Nurses feel a strong sense of group loyalty, or the importance of putting the welfare of the group over that of the individual; in Tagalog, the word is pakikisama. “We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare,” she said. “We treat our patients like they are our own family.”

It’s the lack of proper PPE that has pushed some Filipino Nurses to speak out, when in the past they stayed silent about their working conditions.

“What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out,” Zenei said. “We love our jobs, but we love our families too.”

Catherine Ceniza Choy, a professor of ethnic studies at UC Berkeley whose work has focused on the history of Filipino American Nurses said, Filipino American Nurses are more likely to work in higher risk roles such as the intensive-care unit, emergency medicine or telemetry, putting them directly in the path of COVID-19.

“Filipino Nurses, here specifically in the U.S., are concentrated specifically in in-patient critical care services,” Choy said. “Many of them are also caregivers at home, not only of children, but also their parents and other elders. And so part of the problem with the pandemic is these multiple layers of vulnerability and exposure.”

Jollene Levid and other volunteers have been keeping track of Filipino health care workers who've died from the disease worldwide. Their website, Kanlungan.net, which means shelter or refuge, is an online memorial with pictures and stories of those who've been lost.

The website reads "KANLUNGAN is intended to be a memorial to the transnational people of Philippine ancestry who make up a huge sector of the global healthcare system. This is to remember them as human beings, not simply as a labor percentage, a disease statistic, or an immigration number. And since the Internet is forever, we hope that KANLUNGAN will keep reminding the world of the skills, dedication, and the self-sacrifice demanded of health care workers so humanity may be healed."

Personal Protective Equipment (PPE) is essential for protecting healthcare workers on the frontlines of the COVID-19 pandemic. However, with prolonged use of PPE, comes skin damage.

According to a study by the Journal of American Academy of Dermatology, 97% of staff working in two different COVID-19 units reported PPE-related skin damage. The incidence increased when PPE was worn continuously for longer than six hours, and especially with N95 masks and goggles.

Hand irritation is common when frequently using gloves. The hands become irritated from constant sanitizing and hand washing. Also gloves trap moisture and heat, causing side effects such as eczema and dermatitis on hands. 

Pat hands dry or allow hands to air dry instead of rubbing to avoid further irritation. Also use warm water instead of hot because frequent use of hot water can lead to excessively dry skin. Moisturize but make sure the skin fully absorbs it before putting gloves back on. 

Nurses wearing air tight N95 and N99 masks for many hours often end up with red indentations on their faces. On the other hand, Nurses who wear non airtight masks have reported getting acne and evidence of skin irritation from pressure or chafing of the mask over the bridge of the nose.

Make sure your mask isn't too tight and is fitted comfortably on your face. You should relieve pressure regularly. If possible, try removing your mask, goggles, and or face shield at least every four hours. Relieving pressure for a few minutes to allow for normal blood flow can prevent lasting skin damage.

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

Researchers at MIT and Brigham and Women’s Hospital designed a new face mask that is believed to be as effective as N95 masks. 

There has been a dire need for N95 masks in hospitals across the nation. Essential workers were wearing the disposable masks more than once, often weeks at a time. 

Engineers and researchers hope to provide a solution to this shortage by designing a mask that can be safely reused. 

According to CNBC, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused.

Adam Wentworth, a Research Engineer at Brigham and Women’s Hospital said, "With this design, the filters can be popped in and then thrown away after use, and you’re throwing away a lot less material than an N95 mask." 

The mask is called iMASC, which stands for Injection Molded Autoclavable, Scalable, Conformable. The iMASC can be sterilized a couple of different ways. You can use a steam sterilize, put it in an oven, or soak them in both bleach and rubbing alcohol. 

In a study researchers had 20 healthcare workers wear the mask and perform a series of movements to see how it stayed in place. High ratings were given for fit and breathability. 

The study also showed the mask successfully filtered out a sugar solution in the air that was used to mimic aerosolized respiratory droplets.

According to FastCompany, researchers are beginning talks with the FDA about emergency use authorization, both for healthcare workers and the general public. The team is currently running both an environmental impact study and a cost-effectiveness study, and has estimated that its mask could cost just $15 and be used up to 100 times, making the cost per use likely less than a quarter, with the filter inserts less than a dollar.

There is no timeline yet as to when these masks will be available. 

Bonnie Castillo, is the Executive Director of National Nurses United (NNU) and a former Intensive Care Nurse. 

Back in January, Castillo was concerned by news reports about a virus that was devastating Wuhan, China. So she called for a meeting with the NNU's Director of health and safety and its industrial hygienist to go through scientific reports.

After learning more about the coronavirus, she directed her staff to investigate how prepared U.S. hospitals were for an outbreak.

According to the New York Times, Bonnie said, “As a Nurse, there are just times when it’s very intuitive. You just sense that something catastrophic is going to happen.”

The NNU contacted hundreds of hospitals asking for detailed information about how much personal protective equipment (PPE) they had. The union also surveyed thousands of Nurses asking how they felt about their health facilities’ readiness.

While the survey is ongoing, here are highlights as of March 3, 2020 tallying responses from more than 6,500 Nurses in 48 states, including the District of Columbia and the Virgin Islands.

Some highlights from the survey include:

• Only 44% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases.
• Only 29% report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 23% report they don't know if there is a plan.
• Only 63% of nurses report having access to N95 respirators on their units. 27% have access to PAPRs. 
• Only 30% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. 38% don't know.
• Only 65% report having been trained on safely donning and doffing PPE in the previous year.

At the beginning of March, Castillo’s team sent a letter to Vice President Mike Pence and the coronavirus task force coordinator Dr. Deborah Birx, warning that “the majority of U.S. health care facilities are completely unprepared to safely contain Covid-19.”

Then they asked the Occupational Safety and Health Administration (OSHA) to issue an “emergency temporary standard” for infectious diseases which would prompt employers to implement safety standards such as providing more effective N95 masks to Nurses working with coronavirus patients, instead of basic surgical masks. But OSHA didn't take Bonnie's advice.

The Centers for Disease Control and Prevention (CDC) then acknowledged that hospitals did lack sufficient PPE. So the CDC decided to loosen restrictions and required hospitals to provide their staff with only surgical masks, not N95 masks in many situations.

Castillo and her team were rightfully upset and decided to push publicly for more PPE. They held more than 350 socially distanced protests and 2 vigils in front of the White House for Nurses who died from COVID-19. 

"Nurses are not afraid to care for our patients if we have the right protections," Bonnie told NPR. "But we're not martyrs sacrificing our lives because our government and our employers didn't do their jobs."

After protests, some officials began allowing the N95 masks for all Nurses working with Covid-19 patients.

In May, House Democrats passed a stimulus bill that included some of the Nurses’ demands, including mass production of PPE through the Defense Production Act and an emergency temporary standard for infectious diseases.

Bonnie is still fighting for adequate PPE for Healthcare workers as the coronavirus rages on and concerns grow about a second wave of infections in the fall. She is an advocate and a cheerleader for all Nurses. It is imperative Nurses and all Healthcare workers get the PPE they need to protect themselves and their families, so they can provide care for their patients.

Nurses are being cheered around the world for their courage, compassion, and hard work fighting the coronavirus. We should always celebrate Nurses, especially now. 

WHO Director-General Tedros Adhanom Ghebreyesus said, "As you know, during the COVID-19, they're in the front line and they're risking their lives to save others, but not only during COVID-19. Nurses are a bridge between the health system and the community and they have been doing so ever since the Nursing profession actually started."

While we really can't ever thank Nurses enough, here are ways we can express appreciation for them.

1)    Stay Home - The most important way Nurses can be thanked is to stay home when they can.

2)    Continue Social Distancing - Don’t get too relaxed about following social distancing measures.

3)    Donate - Much needed professional grade masks or other PPE.

4)    Cards, Signs, Social Media Posts – get creative and do something locally or nationally.

5)    Gift Cards - Mary Babel, an RN in Jacksonville, FL suggests gift cards to restaurants that offer curbside pickup. Some people are donating gift cards for busy Nurses to buy their families food and some are donating gift cards to buy whole Nursing staff meals! 

6)    Care Packages – For local Nurses and Travel Nurses in over-stressed pandemic areas. To create a care package for Travel Nurses, think small like portable door locks, external battery chargers, collapsible or travel size containers, individual snack size items, power bars, etc.

7)    Compression Socks - Can make a difference in soothing aches and preventing swelling. It’s a gift that truly keeps on giving as 1 pair can last a long time providing many comfortable shifts.

8)    Cell Phone Sanitizer - According to Nurse.org, cell phone sanitizer is a 100% practical gift. Nurses can sanitize their contaminated cell phones and have one less thing to worry about as a possible source of infection.

We all like to feel we’re appreciated. Now is a great time to show all Nurses our appreciation. 

What Nurses Need to Know about COVID-19

All Nurses and the health care team must receive the highest level of protection to provide care for the individuals and communities in which they serve. It is essential to develop and educate ALL staff on preparedness plans that provide infection control procedures and protocols used within the health care facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within the facility. Here are some tips:

• Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19.
• Provide training to all personnel on screening and isolation procedures.
• Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), including the use of N-95 respirators, gloves, gowns, masks, eye protection, and face shields.
• Display clear signage with instructions for access and use of PPE.
• Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher.
• Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the healthcare facility if symptoms are present.
• Incorporate assessment questions to document a detailed travel and community exposure history when patients present with fever, cough, or respiratory illness. 
• Identify, in advance, airborne infection isolation rooms (AIIR) or negative pressure rooms, for quarantine and screening.
• Outline staffing protocols to facilitate care of patients with COVID-19 to minimize patient-to-patient and patient to health care worker transmission.
• Develop a telephone triage protocol for patients to access from home to minimize community based transmission.
• Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department. Click here for additional Recommendations for Reporting, Testing, and Specimen Collection and the fillable COVID-19 PUI case investigation form.
• For Patients Under Investigation (PUI), follow the Criteria to Guide Evaluation of PUI for COVID-19.

Isolation, Quarantine, Monitoring, and Hospitalization

The CDC recommends several steps for identification and maintenance of COVID-19 along with detailed guidelines for isolation precautions to prevent transmission. There should be a clearly displayed flowchart for early identification and assessment of COVID-19.

At this time, the modes of transmission include respiratory droplets from coughs and sneezes and transmission by touching the eyes, nose, or mouth after contact with an infected surface.

 Isolation Precautions to Prevent Transmission Guidelines

• Have masks available for PUI to don before entering the healthcare facility.
• Once identified, isolate the patient to airborne infection isolation rooms (AIIR) or negative pressure room and keep the door closed. Conduct the assessment in this room.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (goggles or a face shield).
• Don Personal Protective Equipment (PPE) before entering the room.
• Have guidelines for the proper use of PPE displayed throughout the healthcare facility.
• Have infection control personnel available to provide just-in-time training on proper PPE use.
• Notify your infection control personnel and the local and state health department of suspected cases.

Per the CDC, it is known that coronavirus is part of a large family of viruses that can cause illness in people and animals. It is known that COVID-19 is spread via respiratory droplets from coughs and sneezes. It is also possible to spread COVID-19 by touching your eyes, nose, or mouth after touching an infected surface. The CDC provides the following guidance to help prevent COVID-19 from spreading among people in homes and communities.

• • STAY HOME except to get medical care, do not use public transportation or taxis if sick.
  • Call first before visiting your healthcare provider. Notify them of your symptoms and the need for evaluation for COVID-19. Follow the instructions provided by your healthcare team.
  • Separate yourself from other people in your home, utilize a separate bathroom.
  • Wear a facemask as instructed if you are sick.
  • Use your elbow to cover your coughs and sneezes.
  • Wash your hands frequently with soap and water for at least 20 seconds.
  • Avoid sharing household items.
  • Monitor your symptoms.
  • For a full list of guidelines and recommended actions for preventing the spread of Coronavirus visit https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html

COVID-19 - Nurses Online and Printable Materials

https://www.nationalnursesunited.org/nurses-response-covid-19-printable-materials

Coronavirus disease (COVID-19) Situation Dashboard

https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

What To Say To Patients About Coronavirus Video

https://youtu.be/Yk6VX_Bktik