Running Head: TAKING PRECAUTIONS: PREVENTING THE SPREAD OF 1

INFLUENZA

Taking Precautions: Preventing the Spread of Influenza

Katie Riddiford

James Madison University

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Introduction

Nursing homes or long-term care facilities serve many older adults which can in turn

promote the growth and spread of germs. The prevalence of the influenza virus is high in these

facilities and can readily spread from person to person, especially since they are in such close

proximity to each other. It is important that the workers and the residents in these facilities

follow the necessary precautions when dealing with the influenza virus. The two main reasons as

to why an employee should be vaccinated is to protect the patient by doing no harm and to

protect public health in the event of a preventable infectious disease (Ottenberg, A. L., Wu, J. T.,

Poland, G. A., Jacobson, R. M., Koenig, B. A., & Tilburt, J. C., 2011). This is vital for

preventing the other workers and patients in these facilities from transmitting the virus.

Healthcare workers and visitors who may have asymptomatic or mild influenza illness can still

spread the virus, especially in closed settings. Many healthcare workers continue to work their

shifts despite being ill, which obviously will increase exposure to patients and other staff

members (Bridges, C. B., Kuehnert, M. J., & Hall, C. B., 2003). Yes, in most facilities it is

required for the healthcare workers to be immunized, but many of them may not be able to due to

allergies or they may put off getting their immunization until the last minute. The virus may also

be able to live on surfaces, so we want to enforce proper handwashing is being done by

healthcare professionals. Obviously, we want to be sure that the workers are limiting exposure to

their patients and not potentially making them sick by not complying and following the

necessary precautions that are required.

Background

During one of my clinical experiences at a local retirement community, my patient had

just come from the hospital due to a cholecystectomy. Since she had come from the hospital, she
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was on flu precautions, as all patients are for the first few days of their stay at the retirement

community. I went to my patient’s door and saw that she had droplet precautions box outside of

her door, filled with gloves and surgical masks. The certified nursing assistant, or CNA, came

around and I clarified with her if she was on precautions, she then explained to me that she was

in fact on droplet precautions. I then spent the rest of my clinical day making sure that I was

wearing a mask and gloves every time I came into contact with my patient. I saw that my CNA

had gone into the room without a mask or gloves on at one point, this made me confused. I was

confused as to why I had to wear precautions, and the CNA did not. I failed to say anything to

the CNA or my clinical instructor as I felt that it may have not been my place to say anything. I

should have at least told my professor and explained to her what I saw.

This made me have moral distress, as I knew the proper response to the situation would

be for me to talk to the CNA directly about the situation, but I did not speak to her because I did

not think it was my place to say anything as a first semester nursing student. This also caused me

distress because the CNA was in charge of taking care of more patients than me and could have

come into contact with the flu virus and spread it to her other patients. The vaccine does not

guarantee full immunity, it only reduces the risk of contracting the influenza virus. As healthcare

providers, we are to be non-maleficent and do no harm to patients. This made me uncomfortable

to see that another healthcare provider was not taking the proper precautions, but it also made me

uncomfortable to say anything to her as a first semester nursing student who has not had very

much clinical experience compared to a CNA who has been doing this for a living.

Methods/Findings

To analyze this situation, I will be using the James Madison University 8 Key Questions.

These questions are provided to every JMU student to provide us students with questions to ask
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during an ethical dilemma. These questions allow us to think on a deeper level to fully

understand the different ethical considerations of the situation (The Madison Collaborative,

2013). When talking about fairness, I can be fair by making sure that the patient is treated

equally just like all other patients being treated in the retirement community, and also treating the

CNA with respect and fairness as I would treat any other CNA that was working at any other

facility. When thinking about possible outcomes, the short-term outcome would be to tell the

CNA or my clinical instructor about the situation and to use protective measures. The long-term

outcome would be that the CNA would adhere to the precautions and prevent the spread of the

potential influenza virus to other patients and prevent them from getting infected with the virus.

When analyzing responsibilities, I as a nursing student and also the CNA that I was

working with, have the responsibility to keep my patient and other patients safe from harm and

to do no harm. Looking at character, I want to become a great nurse, so I should have thought

like a great nurse and advocated for my patient and told my clinical instructor, at the least, so that

they knew of the situation and could have then confronted the CNA about the situation and our

concern not only for my patient, but for other patient’s that we may come into contact with.

Liberty would play a role in this situation because the patient’s consent would play a role in this

situation. If the patient or other patients knew about the CNA possibly exposing other patients to

the flu, I do not believe that they would consent to that CNA taking care of them. Empathy is

displayed in this situation because I would advocate for my patient and want them to receive the

best quality of care, so if I knew that the CNA were not adhering to protocols and possibly

infecting other patients, I would say something to a higher authority to be sure that they were

taking the proper precautions. Authority plays a role in this situation because I think that

legitimate authorities would expect me to follow through with the precautions. When discussing
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rights that are in this situation, I think that it involves my right as a future nurse to stand up for

my patient and other patients in this facility to be sure that no additional harm could be brought

onto them, and that the CNA may have the freedom or right to not comply with the protocols for

droplet precautions, but legally as a healthcare provider she is supposed to be doing no harm to

her patients, and not following protocol is not the right thing to do when it comes to the safety

and health of the patients.

I believe that Provision 3 in the American Nurses Association would apply to this

situation, as it is my job as a future nurse to “promote, advocate for, and protect the rights, health,

and safety of the patient” (American Nurses Association, 2015). I, as the nurse, need to ensure

that my patient has a right to receiving the best quality care and is safe from harm.

Conclusion

What I learned during this experience, is to be sure to adhere to precautions, because you

are not only doing what is best for your patient, but also other patients that you may come into

contact with. Others can learn through this experience of the importance of not only taking

precautions, but to also treat each patient with respect and have the goal of doing no harm to

patients. If harm is done, health care providers are not living by the values that they are expected

to abide by. Looking back on the situation, I should have told my clinical instructor and the CNA

in a professional manner and address the failure to take precautions that I saw displayed. In the

future, I will make a different decision than before and will be sure to be a patient’s advocate, as

this is a key part of being a nurse. The reason why facilities have policies in place for precautions

is to protect the patients and prevent future spread of infectious disease, whether to patients,

staff, or visitors. Communication is key to adhering to the policies and educating to be sure that

all staff members are compliant and knowledge of the precautions.

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REFERENCES

American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive

Statements(View Only for Members and Non-Members). Retrieved November 06, 2017,

from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html

Bridges, C. B., Kuehnert, M. J., & Hall, C. B. (2003). Transmission of Influenza: Implications

for Control in Health Care Settings. Clinical Infectious Diseases, 37(8), 1094.

Ottenberg, A. L., Wu, J. T., Poland, G. A., Jacobson, R. M., Koenig, B. A., & Tilburt, J. C.

(2011). Vaccinating health care workers against influenza: the ethical and legal rationale

for a mandate. American Journal Of Public Health, 101(2), 212-216.

doi:10.2105/AJPH.2009.190751

The Madison Collaborative. (2013). Eight Key Questions. Retrieved November 06, 2017, from

https://www.jmu.edu/mc/8-key-questions.shtml