Soothing the Swine Flu Pandemonium
Planning for a dip in the 'worried well'
When the first news about the novel A(H1N1) swine flu came out I pictured a waiting room full of coughing, sneezing patients. Instead, I got a large dose of something I’d only heard about — the “worried well.”
Patients came in without symptoms, wanting to be “checked for the flu.” All pandemic plans that I’d reviewed had cautioned us to prepare to handle phone calls for information, but I was unprepared for the volume of calls and visits we received.
Some were legitimate and, since it was already allergy season, lots of patients had difficulty distinguishing runny noses due to pollen from sneezing due to flu. And without testing we couldn’t tell seasonal flu from this new flu already circulating. Add to that the fact that I’m very close to the school where 52 students came down with flu in one day, and the location that had the fastest growing number of new flu cases, and it is easy to understand the heightened level of fear we were dealing with.
One patient who came in to be seen was a young man who had absolutely no symptoms but whose roommate had been diagnosed with swine flu at the Hong Kong airport. He worried because he’d walked through his roommate’s room and had no idea how long the incubation period was. I reassured him that he’d probably be fine. Another was a patient who had a runny nose, no other problems and wondered if it could be swine flu. More reassurance was given.
Some patients wanted to be seen because their mother/neighbor/brother/sister thought it would be a good idea, even without symptoms. Others demanded masks when they came in, and then no one wanted to sit in the waiting room near anyone else wearing a mask. I began to wonder if they thought I had a crystal ball and could detect the virus before any symptoms were apparent.
In the face of all this our director developed a protocol for flu phone calls, which allowed all nurses to give the same advice. We asked a number of triage questions: Did the caller have a fever, cough, sore throat, muscle aches or were they vomiting? Had the caller been in close proximity to anyone with the flu, or been to Mexico within the last two weeks? Did the caller have an underlying medical condition such as asthma or other respiratory illness? A neurological problem? Were they over 65? Had the caller already received a flu shot? Were they feeling short of breath, confused or experiencing chest tightening?
Finally, we posted information about who needed to come in to primary care services to be seen by a clinician: fever unable to be controlled with aspirin, acetaminophen or NSAIDs; cough with SOB; confusion; lightheadedness; symptoms worsening after two to three days. Otherwise, we advised an increase in fluids, plenty of rest and fever reduction.
Reassurance that they would be fine was what many were looking for, and reassurance that we would take care of them if they weren’t. All in all it was a busy few weeks, but possibly just a dry run for the future.
To review your pandemic plan, or for help developing a new one, see the Centers for Disease Control website. It has links to the WHO site and facts on patient information, clinician information and pandemic planning.
Centers for Disease Control
Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.
This article is from workingnurse.com.