Category: Public health

Way Home Outtakes: Consider the Shopping Cart

Over dinner recently, my husband asked me if I was still writing blog posts. I replied, “No, not really.” When he asked me why not, I recounted how I had started writing this Medical Margins blog back in 2010 as I was processing my elderly father’s final illness and the insanity of the US healthcare system, especially related to end-of-life care. In my blog, I then moved on to trying to rekindle a passion for the rather problematic (to me) profession of nursing. Then, I became interested in the health humanities and the somewhat insular academic world of narrative medicine. And, always, homelessness. Fast-forward to today, and my writing time and energies go towards writing books on homelessness and health.

City Hall Park, Seattle. June 25, 2022. Photo credit: Josephine Ensign

I am a part-time, nine-month employee and professor. I live for my summers off now when I have uninterrupted time to write and be a grandmother. This past summer, I made good writing progress on my next book, tentatively titled Way Home, about the contemporary landscape of homelessness in Seattle and King County. Refining and tightening my storytelling approach to writing (with terrific assistance from an editor), I edit out passages I might love but which do not pass the “So what?” test. I keep these darlings in a Word file titled “Extra.”

COVID caught up with me this summer, along with a bad bout of COVID rebound, and yet I pushed myself to continue writing. Some of these fever-induced passages ended up in the “Extra” file. Here is one I like, although it most likely will not make it into the final book manuscript. The photograph, however, likely will.

Consider the shopping cart. Constructed of wire and plastic and supported by four wheels, the cart’s purpose is to carry store merchandise before and after purchase. The shopping cart, developed during the Great Depression by an American man for use in grocery stores by housewives, becoming super-sized and non-gendered, an exquisite symbol of capitalism. The shopping cart, appropriated by people experiencing homelessness, serving as container and conveyance for their remaining belongings, a somber symbol of the fallout from late capitalism.

Good Journalism on Homelessness

In the sea of bad journalism on homelessness, a few shiny good ones wash up on the shore. This (linked below) is one of the best, most thorough, and balanced articles on homelessness I have read. The inclusion of the history and place-based stories of Venice adds to its power. And the compassionate photographs by Glenna Gordon are stunning. Here in Seattle where we have one of our country’s highest rates of homelessness (along with NYC and San Fransisco), we have similar ongoing messy public debates about solutions. The business-sponsored “Compassion Seattle,” which is misleading and misguided seems headed for a vote in November.

“Los Angeles Goes to War With Itself Over Homelessness,” by Jaimie Lowe, New York Times, July 13, 2021.

Once a Nurse

Always a nurse, or so the saying goes. Events of the past year, and especially of the last week, have taught me the truth of that saying, at least on a personal level.

I am and have been over the course of my 39-year career (counting from when I first started nursing school), a public health nurse (TB and hypertension control nurse with the health department in Richmond, Virginia), an inpatient stroke/neuro ward nurse, a rehabilitation nurse, an HIV/AIDS nurse at an LGBTQ community clinic, a Health Care for the Homeless nurse and family nurse practitioner. I have been (still am) a nurse researcher, a nursing professor, and a writer who happens to be a nurse. Always a somewhat skeptical/critically-thinking nurse (still am), questioning our healthcare system, our profession of nursing, and our socio-political system as a country.

Ever since the COVID-19 pandemic became a reality over a year ago, like many people throughout the world, I have reassessed my professional roles. What’s essential and what’s not? Essential: teaching population health and health policy as well as possible to our future nurses; becoming even more politically engaged to speak up on important issues like racism in health care, gender-based violence, and hate crimes against LGBTQ people/people living homeless/Asian-Americans; growing my network of politically engaged, progressive nurses across the country; spreading evidence-based public health information about the pandemic/pushing back against the cacophony of mis-information and outright lies; thinking and acting like a public health nurse, which I have realized is the kind of nurse I have always been. Not essential: university internal politics; worry about being productive with the usual expectations of grant-writing and peer-reviewed journal writing. My pandemic mantra has and continues to be: accomplish less, experience more.

This past week, the day after my two-week post second Pfizer COVID-19 vaccine dose, I began volunteer work as a COVID-19 vaccinator at a local public hospital. I asked for and received an excellent nurse practitioner mentor to shadow at first to get up to speed on the proper vaccination protocol, then sat down at my assigned station and began talking with patients and giving them the vaccinations. Yesterday, the vaccination clinic nurse supervisor introduced herself (both of us behind masks, of course) as one of my public/population health students years ago. She said she is an acute care nurse who has been working on the frontlines of the pandemic “since day one.” I thanked her for her work as a hospital nurse and as a nurse supervisor for the vaccine clinic, and gently reminded her that she is doing vital public/population health nursing.

I told my husband and family members (all, except my two-year-old granddaughter vaccinated now), that working as a volunteer public health nurse at the COVID-19 vaccination clinic feels like the most important and personally satisfying work I have done in my entire nursing career. Spread the word: These vaccines save lives and livelihoods. They give us hope.

(Please note: the photograph here was ‘staged’ and contains no patient or provider information.)

Past Presidents of the ANA Endorse Biden-Harris

Note: The following is a letter from eight past presidents of the American Nurses Association in support and endorsement of Biden-Harris in the 2020 election. It was shared with me today by past ANA president, Virginia Trotter Betts who asked that I share it widely. Nurses, nursing students, and everyone whose lives have been/are/will be impacted by a nurse need to read this. And vote for Biden-Harris in the November election.

Open Letter from American Nurses Association Past Presidents as signed below

The 2020 presidential election will be one of the most consequential decisions our nation has ever faced. Over the course of more than four decades, we, the undersigned past presidents of the American Nurses Association (ANA), led the nation’s nurses without deference to specialty or affiliation on matters of policy and politics. Instead, our work was grounded in the tenets of the ANA’s Code of Ethics for Nurses and the principles of its Social Policy Statement, venerated guideposts that establish nurses’ professional values and direct their practice, embodied in a commitment to serve all society. Our body of work compels us to speak out and express our support for the presidential candidate who we believe will best serve the people of this nation—Joe Biden.

We believe that Americans have a choice on the ballot this year between a candidate who will be inclusive and restore a moral compass with empathy for human beings or a candidate who has sewn chaos and division while showing no compassion for the American people. The Trump administration has us literally fighting for our lives as we face down the Coronavirus pandemic while sparring over our economic futures; access to affordable and equitable health care; racial equality; social justice; and immigration policy.

From bedsides to boardrooms, professional nurses across this country have always served the healthcare needs of our people. We know firsthand the value, knowledge, and skills nurses bring to the care of others. Perhaps more than at any other time over the past century, the COVID-19 pandemic has brought into focus the essential nature of nurses’ contributions to the health promotion, illness prevention, and compassionate healing of all people in need. It has also laid bare the lack of a coordinated national response to COVID-19, which has failed nurses and all Americans. A failure to promote and enforce life-saving coronavirus mitigation strategies through organized, consistent, and evidence-based guidelines and the silencing or denigrating of scientific and medical experts and institutions has denied critical public health safeguards for us all.

Utilizing nursing’s core principles, the eight of us have analyzed the positions of each party’s presidential candidate. Without question, the Democratic Party platform aligns best with nurses’ ethical values and numerous ANA positions on important issues such as promoting public health, healthcare access, ensuring racial equality and social justice, ending the epidemic of gun violence, providing humane treatment for those seeking refuge from danger, and securing a clean energy future, among others.

The choice is clear. As national nurse leaders, we strongly support Vice President Joe Biden for President. He will safeguard the future and health of our nation. Join us in support of the Biden-Harris ticket!

Signed, Past Presidents of the American Nurses Association in Support of Biden-Harris

Pamela Cipriano, RN, 2014-2018 Virginia
Karen Daley, RN, 2010-2014 Massachusetts

Rebecca Patton, RN, 2006-2010 Ohio
Barbara Blakeney, RN, 2002-2006 Massachusetts

Mary Foley, RN, 1999-2002 California
Virginia Trotter Betts, RN, 1992-1996 Tennessee

Eunice Cole, RN, 1982-1986, California
Barbara Nichols, RN, 1978-1982 Wisconsin

Teaching in the Time of Trump

As I prepare to teach public health to nursing students this fall, I am mystified by and angry at the absolute wreckage Trump has made of our public health system and of our country. How to teach in the climate of hate and discord and blatant disregard for basic human rights, for human lives, for the lives of our COVD-19 pandemic frontline nurses and other healthcare providers, for scientific evidence? How to teach in the time of Trump?

Back in January 2017, as Trump was being inaugurated President of the United States, white supremacist hate groups infiltrated our university campus. They spread virulent racism, hatred, violence, and intimidation across our campus, including inside our health sciences/hospital buildings. In some cases, they attached razor blades to the backs of flyers they posted in classrooms so that people who removed the flyers could be cut in the process. Two of our university students brought weapons–including a gun–to campus and shot and seriously injured a protestor at the ill-advised Milo event sponsored by the Republican student group–an event that was allowed to happen by our university administration. I wrote about this and subsequent white supremacist group activity on our campus in a previous blog post, “Teaching in a Time of Hate and Violence.”

I thought it couldn’t get much worse than that, but, of course, it has. Trump’s complete bungling of our country’s response to the COVID-19 pandemic has led to the deaths of over 200,000 people in the US and to the deaths of over 2,000 frontline nurses and other healthcare workers who were denied proper personal protective equipment in caring for patients with COVID-19. And, with Trump and Trump appointees politicizing/meddling with public health institutions including the Centers for Disease Control, there is now even more public distrust of and confusion over scientific, evidence-based public health individual and community level recommendations. Public health officials across the country are receiving death threats from Trump supporters.

I am dismayed by the decision by the current leadership of the American Nurses Association (ANA) in deciding to ‘sit out’ this election, in pretending to be politically neutral by not endorsing the clear choice of Biden-Harris to lead our country out of the current public health, economic, and social mess Trump has made. Shame on you ANA for being so spineless. History will not be kind to your choice.

Trump is now doing the theater piece of establishing the 1776 Patriotism in Education Presidential Commission to push for revisionist and white supremacist education throughout our country. Trump does not want the history of slavery in our country taught or anything else resembling (the truth) and having to do with anti-racism.

In addition to teaching the basic principles and practices of public health nursing, this year I will teach even more to civic engagement, the importance of being an informed citizen, of voting, of speaking up for what’s right–not only for individual patients our nursing students will care for, but also communities, our entire country, and our world. The two required textbooks will include one basic textbook on public health nursing and How to be and Antiracist by Ibram Kendi.

COVID-19 Health Inequities

So proud of our University of Washington nursing students for using their talents and experiences to speak out on important health policy current event issues. This is just one of the student group digital storytelling health policy videos they produced for my spring quarter 2020 healthcare systems course. They consented to me sharing it. I will share additional health policy student-produced videos in future posts. This one is especially relevant to the current outcry across our country about racism, hate crimes, and police violence against black and brown people.

Nuts: How We Treat Nurses

May is National Mental Health Month. May is National Nurses Month. The World Health Organization declared 2020 the Year of the Nurse and Midwife. This year, instead of having the typical weeklong recognition of nurses the second week of May (Florence Nightingale’s birthday being May 12th), the American Nurses Association declared the entire month nurses month.

Week one focuses on self care: “Nurse self-care is more vital than ever now as we face the COVID-19 pandemic and its accompanying stress, isolation, and anxiety.” They include links to daily self-care tips on rest/sleeping, nutrition, and exercise—and a way to sign up for a daily “hope-filled message.” Relaxation techniques. “Mindfulness while wearing an N95 Mask.” Building resilience. Safety at work with a focus on anti-bullying efforts. Obviously, these resources and webpages were designed before the COVID-19 pandemic struck our country and frontline nurses, physicians, and emergency personnel could not access sufficient N95 masks and other personal protective equipment–to be mindful and resilient in.

Self-care is important but insufficient. Access to high quality, low-barrier, affordable, confidential, and non-stigmatizing mental health treatment for nurses is an absolute requirement under any circumstances. But especially now when what we are asking our nurses to do—and all nurses, not just ICU and emergency department nurses-—is emotionally taxing and traumatic at unprecedented levels. And now, during a time of a public mental health and substance use disorder crisis, as the American Public Health Association has declared. And states that continue to have antiquated and punitive state licensing laws for nurses and other healthcare providers, requiring providers to reveal any and all mental health treatment, those state laws need to be changed so that they aren’t an additional barrier to to mental health treatment. (see: “Why don’t doctors seek mental health treatment? They’ll be punished for it” Kayla Behbahani and Amber Thompson, Washington Post, May 11, 2020)

Recommended training resources:

Northwest Center for Public Health Practice has a three-module free, self-paced online training on disaster response, including “Stressful effects of disasters on workers.”

Johns Hopkins Bloomberg School of Public Health has an excellent six-hour interactive online training program “Psychological first aid.”

Teaching Health Politics and Policy in the Time of a Pandemic

Where to begin? For one thing, I will begin by acknowledging that I still have a job, and I have a job that can be done from the “shelter in place” comfort of my own home here in Seattle. These are privileges that I am acutely aware that many others in my neighborhood, city, country, state, and world do not have. These are privileges that homeless people I work with do not have.

I will not complain about having to “pivot” (but oh how I loathe that over-used term right now!) and convert a new health politics/policy course from an in-person class format to completely online within a week’s time. I will not complain that the hastily-added Zoom feature on our course websites is already crashing and our spring quarter has not yet begun.

The course I designed and will be teaching starting next week is a required course for all pre-licensure nursing students in our newly revised curriculum that rolled out this past fall. I have a cohort of about 150 students, a mixture of traditional BSN students and accelerated BSN (ABSN) students–meaning they already have a degree and complete their nursing courses in one academic year. The ABSN students will soon graduate and enter the nursing workforce. Many of them, as well as the BSN students, are already working as nurse techs in hospitals and nursing homes. Since most of them live and work in the Seattle area—the site of our country’s first COVID-19 outbreak and known community spread and mounting death toll along with the insane shortage of basic protective gear like masks—they know first-hand two lessons included in my course syllabus: 1) US healthcare is characterized by excess and deprivation (rich people still getting tummy tucks and facelifts while COVID-19 patients die from lack hospital beds/staff/ventilators), and 2) rationing of healthcare is already a reality even before the COVID-19 pandemic reached the US.

Luckily, I had this same cohort of students last fall quarter in a community/population health course which we now lead with instead of including as an afterthought as most nursing schools still do. As part of that course, I had them complete the excellent (and free!) online training modules on disaster preparedness (include mental health/PTSD in first responders) from the Northwest Center for Public Health Practice. I also had them write a narrative policy paper based on Health Affair‘s “Narrative Matters” series of essays. Many of their papers were excellent and based on current event public health/health policy topics.

For the spring quarter health politics and policy course I will have them work in teams (virtually, of course) of ten students and write and produce 8-10 minute personal policy and advocacy storytelling videos based on current event topics (including the pandemic). These are based loosely on the StoryCenter/Nurstory series of videos, although all of theirs are single person-single story videos. (One of my favorites is “Pride and Prejudice” by Maud Low on reproductive rights.) I am excited to see what they come up with and will–with their permission–share/link to some of their final participatory/narrative policy videos at the end of the quarter.

In yet another surreal moment in the midst of numerous such moments during this time, I am struck with the fact that by writing/thinking about “the end of the quarter” I have the simultaneous realization that—assuming my students and I are still standing (or sitting, or lying) by then—we will all have been even more profoundly and personally touched by this pandemic.

Views from Seattle-King County, COVID-19 Outbreak

Union Bay Natural Area, Seattle

Week #2 of the Seattle area COVID-19 outbreak with its dark cloud hanging over the city, the nation, and the world, here is what I know to be true:

  1. Know and follow credible, scientifically evidence-based public health recommendations such as washing your hands with soap and water for at least 20 seconds–or using alcohol-based hand sanitizer (if you are lucky enough to have bought some before every store sold out) and practice sensible social distancing…
  2. Nicely but firmly correct any misinformation and bigotry that comes your way.
  3. Only share information that is from verifiably credible, scientifically evidence-based public health experts. For me here in Seattle that includes Public Health–Seattle & King County and Washington State Department of Health.
  4. Avoid engaging in stupid, fruitless, politically or ideologically-charged arguments (repeat #2 above and this could be a positive way to practice a different kind of social distancing).
  5. Don’t just sit there (unless, of course, you are sick)–do something positive! Support our heroic front-line public health and health care workers like nurses, physicians, medics, and cleaning staff who are working around the clock to care for individuals, families, communities, and entire populations affected by this pandemic. Support our elderly, medically-vulnerable, and people experiencing homelessness. If you are able, volunteer to assist in these efforts.
  6. Remember to get outside or somewhere close to nature to smell the flowers.
  7. Be kind.
Burke-Gilman Trail near Children’s Hospital, Seattle

Nursing in the Time of Pandemics

Having come of age and been a nursing student during the early days of the HIV/AIDS pandemic, I have been feeling many moments of deja vu over the past month with the world-wide spread of the novel coronavirus and the accompanying COVID-19 illnesses. It is, of course, more than a distant global health issue now since I live, work, and teach nursing in Seattle-King County–site of the first death of a patient with COVID-19 and where experts now estimate at least 1,500 people are already infected. The two high-risk groups for severe complications and deaths from COVID-19 are healthcare providers and older people who have underlying chronic illnesses. I fall into one and a half of those categories, so I am concerned on a personal level.

But I am concerned on a larger level because I teach hundreds of nursing students and feel an urgent responsibility to help prepare and equip them to deal with this public health emergency. And not just the practical training and adequate access to the necessary medical supplies–on the use of personal protective equipment like face masks and goggles. But also the emotional and ethical preparation and support for processing a rapidly evolving, complicated pandemic. Acknowledgement that fear and anxiety are part of this but that we have a personal and professional duty to care for people despite that fear and without bias. I like the public health messaging that has gone out from our Public Health-Seattle & King County people: “Viruses Don’t Discriminate and Neither Should We.” Yet it goes beyond that, to an acknowledgement of weaknesses of our healthcare and public health system and resolve to do better, to learn from our mistakes–including from our mistakes in how we handled the HIV/AIDS pandemic. We cannot allow shallow, partisan politics, malicious misinformation, undermining of evidence-based public health interventions, and bigotry to fuel the spread of this virus.