For the flaring up of the flu: The nurses of the Maggiore Hospital in Milan hit by the Spanish fever.

In the last year of the Great War, Italy was also hit by the Spanish flu. The Civic Hospitals faced a deadly disaster with insufficient resources. All the heavy workload fell on the female nursing staff, who were the only ones able ensure the continuity of the hospital services. This study aimed to explore the impact of the influenza on the health of the nurses at the Maggiore Hospital in Milan during the second and third epidemic waves. Historical research was conducted between February and May 2020. Primary sources were retrieved from the historical archives of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and the daily newspaper Corriere della Sera. In the autumn of 1918, the Maggiore Hospital in Milan changed its organization to hospitalise patients affected by the influenza pandemic. Although the hospital managers wanted to protect their healthcare staff from the risks of contagion by means of prophylaxis rules, 388 lay nurses and 80 religious sister nurses were affected by this insidious disease. The second and third waves of the pandemic claimed 25 victims of duty. Remembered for their altruism and spirit of abnegation, the hospital community honoured their sacrifice, and the citizens expressed their gratitude.

Nurses on the front line: The 1918 influenza and COVID-19 pandemics.

ABSTRACT: Due to advances in science and medicine, nursing is far different today than it was in 1918. During a pandemic, however, skilled nursing care remains critical to patient outcomes. This article identifies and describes the experiences of US nurses during the 1918 influenza pandemic and compares them to the experiences of nurses responding to the COVID-19 pandemic.

Critical Care Considerations in Adult Patients With Influenza-Induced ARDS.

TOPIC: Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE: Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE: To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED: This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

Public health nurses' experiences during the H1N1/09 response.

OBJECTIVE: H1N1/09 was the first pandemic flu ever responded to with mass vaccinations. Public health nurses (PHNs) were pivotal in implementing the H1N1/09 vaccination clinics. With the ongoing threat of pandemic influenza and other viral outbreaks, much can be learned from these PHNs' H1N1/09 experiences. This study's purpose was to explore PHNs' experiences in the H1N1/09 mass vaccination clinics. DESIGN AND SAMPLE: In a qualitative interpretive description, 23 PHNs (16 immunizers, seven supervisors) who worked in a large Canadian municipal public health agency, participated in semistructured interviews. RESULTS: Three overarching themes were identified. 'Anticipating an Emergency' discusses participants' experiences learning about the pandemic response and their role preparation. 'Surviving the Chaos' reflects the challenges of the clinics, particularly during the first few hectic weeks of the response. 'Persevering Over Time' encompasses participants' experiences as they became familiar with clinics' operations and their own responsibilities. CONCLUSIONS: Participants' experiences have implications for future public health pandemic planning and research. Key recommendations include to communicate with PHNs in a timely manner about their clinic roles, and to provide PHNs with appropriate training to optimize clinics' operations. This will help support PHNs in their roles to protect the public and provide quality population care.

Optimization of Nursing-Specific Flu Alerts.

Clinical decision support interventions, such as alerts and reminders, can improve clinician compliance with practice guidelines and patient outcomes. Alerts that trigger at inappropriate times are often dismissed by clinicians, reducing desired actions rather than increasing them. A set of nursing-specific alerts related to influenza screening and vaccination were optimized so that they would "trigger" less often but function adequately to maintain institutional flu vaccination compliance. We analyzed the current triggering criteria for six flu vaccine-related alerts and asked nurse end users for suggestions to increase specificity. Using the "five rights" (of clinical decision support) as a framework, alerts were redesigned to address user needs. New alerts were tested and implemented and their activity compared in two different flu seasons, preoptimization and postoptimization. The redesigned alerts resulted in fewer alerts per encounter (P < .0001), less dismissals of alerts (P < .0001), and a 2.8% point improvement in compliance rates for flu vaccine screening, documentation, and administration. A focus group confirmed that the redesign improved workflow, but some nurses thought they still triggered too often. The five rights model can support improvements in alert design and outcomes.

Managing boundaries between professional and lay nursing following the influenza pandemic, 1918-1919: insights for professional resilience today?

AIMS AND OBJECTIVES: To examine lay-professional nursing boundaries, using challenges to the New Zealand nursing profession following the 1918-1919 influenza pandemic as the example. BACKGROUND: The influenza pandemic of 1918-1919 had an overwhelming international impact on communities and the nursing profession. After the pandemic, the expectation for communities to be able to nurse the sick reflects today's increasing reliance on families to care for people at home. It similarly raised questions about the profession's role and professional boundaries in relation to volunteer or lay nursing. In New Zealand, the postpandemic challenge to build community lay nursing capacity tested these boundaries. DESIGN: Historical research. METHODS: Analysis of historical primary sources of official reports, newspaper accounts, articles in New Zealand's professional nursing journal Kai Tiaki and the memoir of Hester Maclean, the country's chief nurse. Interpretation of findings in relation to secondary sources examining similar historical tensions between professional and lay nursing, and to the more recent notion of professional resilience. RESULTS: Maclean guarded nursing's professional boundaries by maintaining considerable control over community instruction in nursing and by strenuously resisting the suggestion that this should be done in hospitals where professional nurses trained. CONCLUSIONS: This historical example shows how the nursing profession faced the perceived threat to its professional boundaries. It also shows how competing goals of building community lay nursing capacity and protecting professional boundaries can be effectively managed. RELEVANCE TO CLINICAL PRACTICE: In the context of a global nursing shortage, limited healthcare budgets and a consequently increasing reliance on households to provide care for family members, this historical research shows nurses today that similar issues have been faced and effectively managed in the past.

Factors influencing the decision to comply with nurse recommendations to take or avoid influenza vaccination.

Influenza is a major cause of morbidity and mortality. Although vaccination is an efficient means of prevention, low rates of vaccination are reported periodically. The study aimed to examine factors affecting acceptance of nurses' recommendations to take or avoid influenza vaccination. Study design was quasi-experimental with a 2 × 2 between subjects design: two variables were manipulated and two were not. The research variables were expertise (of nurses and respondents), type of recommendation (to vaccinate or not) and respondents' a-priori intention to vaccinate. Data were collected from 374 respondents. The study was scenario based, differing in nurse expertise and type of recommendation. After each scenario, the respondents were requested to indicate their a-priori intention to vaccinate and to complete questionnaires on epistemic authority (EA) attributed to the nurse, and of self-epistemic authority (SEA). There is a general tendency to avoid vaccination. Intention to vaccinate correlated positively with nurse recommendations, respondent a-priori intention and nurse expertise. A significant three-way interaction between respondents' SEA, nurse recommendations and nurse expertise was found. The nurse's recommendation has the strongest effect when the nurse is an expert and the respondent perceives him/herself as having high self-EA. The results highlight the importance of patients' sense of knowledge for assuring their co-operation and compliance with medical recommendations.

Australian general practice nurse's knowledge, attitudes and practices regarding influenza vaccination: a cross-sectional survey.

AIMS AND OBJECTIVES: The aim of this study was to examine the knowledge, attitudes and practices of Australian general practice nurses (GPNs) regarding influenza vaccination. BACKGROUND: Despite the evidence for the benefits of influenza vaccination, vaccination rates remain sub-optimal. The knowledge, attitudes and practices of nurses both affects vaccination rates and the advice given to consumers. Given their significant role in opportunistic and planned vaccinations, GPNs are in an optimal position to positively influence vaccination rates. DESIGN: A descriptive cross-sectional survey was used. METHODS: GPNs were recruited by email to complete an online survey. The survey tool comprised the King's College Nurses' Influenza Vaccination Questionnaire and adapted demographic items. Data analysis used descriptive and inferential statistics. Open-ended questions were analysed using thematic analysis. RESULTS: Most of the 85 respondents had received the seasonal influenza vaccination in the last year (n = 67; 78·8%); fewer received the H1N1 vaccination (n = 54; 63·5%). Intention to receive vaccination was affected by previous vaccination. Those who had received the seasonal influenza vaccine in the last year had a higher total knowledge score. The seasonal and total influenza knowledge score was high, with lower scores on the H1N1 sub-scale. A positive correlation was identified between influenza knowledge and risk perception. CONCLUSIONS: This study highlighted the high level of knowledge amongst GPNs related to seasonal influenza, whilst identifying a knowledge deficit around the H1N1 items. It demonstrated that GPN's knowledge of seasonal influenza was related to vaccination status and risk perception. Further research is required to explore how this translates into the advice GPNs give to consumers. RELEVANCE TO CLINICAL PRACTICE: Influenza vaccination should be considered as a key topic for GPNs ongoing professional development. The evidence for links between education and vaccination uptake should encourage employers to facilitate opportunities for this training. Future efforts to increase vaccination uptake in nurses should promote the benefits of vaccination in protecting the individual rather than as a professional responsibility.

Nurses' knowledge, attitudes and practices regarding influenza vaccination: an integrative review.

AIMS AND OBJECTIVES: To critically analyse the literature describing nurses' knowledge, attitudes and practices regarding influenza vaccination. BACKGROUND: Influenza is a serious illness that has significant impacts on productivity, health outcomes and healthcare costs. Despite the recommendations for nurses to be vaccinated annually against influenza, the vaccination rates remain suboptimal. DESIGN: Integrative literature review. METHODS: An integrative review was conducted as described by Whittemore and Knafl (2005). A search of CINAHL, Cochrane Library, ProQuest Central, ClinicalKey, ScienceDirect, Wiley Online Library, and Informit was undertaken to identify relevant papers. Given the heterogeneity of included studies, a narrative approach was used to analyse the data. RESULTS: There was limited research available on this topic area, with only 10 papers identified as meeting the inclusion criteria. Five themes were identified: the relationship between knowledge and influenza vaccination, perception of risk, motivators for influenza vaccination, barriers to influenza vaccination and impact of demographics on vaccination. CONCLUSIONS: Despite the evidence for the protective effects of influenza vaccination, rates of vaccination among nurses remain sub-optimal. Nurses' influenza vaccination practices likely relate to their level of knowledge and perception of risk; the greater nurses' knowledge regarding influenza and influenza vaccination the higher their perception of risk and the more likely they are to be vaccinated. This also translates to the advice that they give patients with vaccinated nurses more inclined to recommend vaccination than those unvaccinated. RELEVANCE TO CLINICAL PRACTICE: The practices of nurses related to influenza vaccination may translate to the advice that they give their patients. Understanding the knowledge levels, practices and attitudes of nurses can assist in developing strategies to enhance education of nurses.

Preparing to respond: Irish nurses' perceptions of preparedness for an influenza pandemic.

INTRODUCTION: The aim of this research was to garner opinion on: the concerns of nurses in respect of the key issues that they may face in the event of an influenza pandemic; the perceived impact of an influenza pandemic on these nurses; and the current level of perceived preparedness in their hospital. Of particular significance is the fact that data for this study were gathered from nursing staff during a period when there was a heightened risk of an outbreak. METHODS: The data for this study were gathered using a structured, self-administered questionnaire, which was distributed to 127 nurses. A response rate of 72% was achieved. The questionnaire was based on the instrument used by Wong et al. in their 2008 study of preparedness for an avian influenza pandemic in Singapore. RESULTS: Although the results reveal a number of concerns raised by nurses, it is clear that the majority (90%) view treating and caring for influenza patients as core to their role. While recognising their professional responsibilities, they reveal apprehension about certain aspects of their work, such as an increased likelihood of infection, added workload and pressures, an increased concern for those close to them who could become infected as well as the overall increase in stress levels at work. The extent of professional and personal preparedness, together with the concerns and perceptions of nurses, could affect the hospital's overall capacity to respond and these concerns should be addressed by those responsible for the development of pandemic response plan.