ZIKA VIRUS: Pregnancy and complications- important notes for health care professionals

Zika infection, an emerging mosquito-borne virus is prompting worldwide concern for global health agencies due to its rapid spread and worrying connection to neurological birth disorders. According to Margaret Chan, the World Health Organization (WHO) Director-General "The level of alarm is extremely high."

Epidemiology

The virus is transmitted to humans through Aedes mosquitoes bites. It is a single-stranded RNA virus of the Flaviviridae family, genus Flavivirus. Zika virus was first isolated in 1947 from rhesus monkeys and subsequently identified in humans 1952 in Uganda and Tanzania. The name comes from Zika forest in Uganda.

Aedes species mosquito also transmit dengue and chikungunya viruses. Aedes species usually bite during the morning and late afternoon/evening hours.

Mode of transmission

1. Perinatal, in utero (Rarely)

• In rare cases, a mother already infected with Zika can pass on the virus to her newborn at time of delivery.
• It is possible that transmission could occur from mother to fetus during pregnancy.
• No reports of Zika virus transmission through breastfeeding to infants. Infected mothers are thus still encouraged to breastfeed because of the benefits from breastfeeding.

2. Sexual or transfusion transmissionSpread of Zica virus through sexual contact and blood transfusion has been reported.

Who is at risk?

Anyone living in or visiting an area where the virus has been reported should be considered at risk and evaluated.

Nearly 1 in 5 people infected with Zika virus develop Zika. Outbreaks have been reported in Southeast Asia, Latin American countries, the Caribbean islands and the Pacific Islands.

Symptoms

Clinical findings commonly reported include acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other usually reported symptoms include muscle ache and headache.
Clinical illness is generally mild with symptoms lasting several days to a week. Need for hospitalization is rare with low fatality course.

Diagnosis

The virus can be isolated in the blood for few days following infection or longer.

Zika virus diagnosis is done through PCR (polymerase chain reaction) and virus isolation from blood samples.

Zika viruses cross-react with other flaviviruses such as dengue, West Nile and yellow fever making serology testing tedious. 

Laboratory testing

If laboratory testing is needed, the following order should be made:

• IgM, IgG and PCR for Zika virus
• Acute serum (taken within 5 days of symptom onset) and convalescent serum (2–3 weeks later) should be taken.

The two samples are important to rule out false positive tests due to cross reactivity with similar viruses such as Dengue

Provide overseas travel details and clinical history including the onset day. Onset date is extremely vital to ensure most appropriate test is performed.

Treatment

No vaccine or medications are available to prevent or treat Zika infections. Treatment is generally supportive;

• Provide plenty of rest
• Encourage fluids intake to prevent dehydration
• Relieve fever and pain with medicine such as acetaminophen
• Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen to reduce the risk of hemorrhage until dengue has be ruled out.
• Prevent mosquito bites in the first week illness to avoid spread of virus. 

Recommendations for Pregnant Women at risk of Zika Virus

These recommendations are applicable for screening, testing, and management pregnant women returning from Zika virus transmission areas or considering travel to those locations

• Report and test all pregnant women who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications
• Testing is not indicated for women without a travel history to an area with Zika virus transmission.
• Monitor fetal growth and anatomy in pregnant women with laboratory evidence of Zika virus infection
• There is no specific antiviral treatment for Zika virus; supportive care is recommended.
• Serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks in pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid.
• Refer  for expertise in pregnancy management to a maternal-fetal medicine or infectious disease specialist

Although incidence of Zika virus infection in pregnant women is currently unknown because of limited data infection can occur at any trimester. 

Complications in pregnancy

Zika virus infections have been associated with poor pregnancy outcomes and congenital malformations in new born infants; notably microcephaly, fetal losses, Guillain-Barré syndrome among others

The full spectrum of outcomes that might be associated with Zika virus infections during pregnancy is unknown and requires further investigation.

Zika virus testing in newborn

Zika virus RT-PCR and serology assays can be performed on infant serum or serum

Cerebrospinal fluid (CSF) specimens are considered only if available for PCR; however, CSF specimens should not be obtained for the sole purpose of Zika virus testing. Other testable specimens include blood samples from placenta and umbilical cord.

Histopathologic examination and immunohistochemical staining can be performed. Zika virus RT-PCR on fixed and frozen tissue should also be considered.

Community prevention strategies

• Wear long-sleeved shirts and long pants
• Use insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed. When used according to the product label they are safe for pregnant and nursing women and children older than 2 months Oil of lemon eucalyptus products should not be used on children under 3 years of age.
• If you use both sunscreen and insect repellent, apply the sunscreen first and then the repellent.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
• Use bed nets as necessary
• Stay and sleep in screened-in or air-conditioned rooms.

Reference:

• Besnard M, Lastère S, Teissier A, Cao-Lormeau VM, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, Euro Surveill  2014;19(13):pii=20751.
• Zika Virus: Centers for Disease Control and Prevention - http://www.cdc.gov/zika/
• Zika virus (New Zealand Ministry of Health)
• The Zika Virus: What You Need to Know- White House update- https://www.whitehouse.gov/blog/2016/01/27/zika-virus-what-you-need-know
• Zika virus: WHO media centre- http://www.who.int/mediacentre/factsheets/zika/en/ Accessed January 30, 2016

By Collins

Workplace Intimidation Defined

Workplace intimidation, also known as workplace bullying, occurs when a superior, peer or subordinate uses violence or blackmail to manipulate you or intentionally creates feelings of fear, inadequacy or awe.

Workplace intimidation includes illegal sexual harassment and discrimination, but is not limited to illegal behavior.                            `                            ``     

When people (nurses included) are afraid of intimidation such as harassment, even losing their jobs, they will do whatever is required to meet the boss’s explicit expectations. But there are caveats:

Despite recent attention which has been drawn to the importance of speaking out, often we hear from nurses facing difficulties of fear and intimidation. If this damaging culture of fear existing today among nurses is to end, then we must be able to encourage ourselves to speak out safely without fear of reprisal.

Interactions	·         Withholding information
	·         Posting documentation errors on bulletin boards for all disciplines to view and others to critique
	·         Intimidating others by threats of disciplinary procedures
	·         Writing critical and abusive letters or notes to co-workers
	·         Verbalizing harsh innuendos and criticism
	·         Using hand gestures to ward off conversation.
	·         Rolling eyes in disgust
	·         Having personal values and beliefs undermined
Power Disparities	·         Using shift/weekend charge positions to direct/control staff assignments/breaks
	·         Controlling co-workers’ behavior by reporting them to their supervisors for perceived lack of productivity and assistance
	·         Placing others under pressure to produce work and meet impossible deadlines
	·         Withholding knowledge of policies and procedures to get co-workers in trouble
	·         Using shift/weekend charge positions to direct/control staff assignments/breaks
Actions	·         Yelling at co-workers.
	·         Demanding co-workers answer the telephone, NOW!
	·         Refusing to mentor and guide new staff in their practice
	·         Refusing to help those who struggle with the unknown and uncertainty
	·         Refusing to help others in need of assistance
	·         Giving public reminders of incomplete/missed documentation or work

Whether it is responding to opinion in public domain, nursing blog, whistle blowing, expressing views in a nursing forum- nurses still 'fear' for repercussions that may follow

There are occasions where nurses have been bullied, ostracised or belittled when for trying to raise concerns even on behalf of their patients

Even if he is the owner, the workplace bully, does not act in the best interests of by bullying others. In some cases the bullied may come to believe that he/she is to blame for the way you are treated.

Consequences of fear and intimidation

Putting patient safety at risk

A key lessons from the Francis report was that front line staff must feel confident to raise concerns about patient safety without fear of reprisals Nursing staff want to provide excellent care, but sometimes the systems they work in do not allow this. Staff know what is safe for their patients and what is not.

Physical strain. Victims of bullying may show symptoms of stress-related illnesses syndromes such as nausea, headache, weight loss, insomnia, anxiety, depression, alcoholism, irritability, loss of libido, self. They may experience depression, high blood pressure or substance abuse problems and even have trouble sleeping at night and waking up in the morning. In extreme cases, workplace intimidation can lead to suicide.

 Decreased productivity

Employees managed via intimidation are often fearful at work and fail to meet expectations. Overall, Workplace intimidation is often lower productivity by decreasing staff morale and increasing internal frictions in the organization

 Isolation In an attempt to make the injured party feel inadequate, bullies may isolate their victim and created a climate of fear. The staff being bullied imagines the whole world against him…and feels totally isolated

Prevention

Managers are responsible for this. The question is, how does your manager create and maintain an inclusive environment where employees feel valued and respected.

Respect for subordinates is the most effective ways for a manager to prevent workplace bullying. This promotes culture of mutual respect within the organization. The manager should encourage team members to speak out if whether a victim or an observer of it. 

Organization policies against workplace intimidation can help, although least likely to be effective against subtle forms of intimidation. As a potential victim an employee should be able confront the bully whenever it does happen.

Inadequate training

Many nurse managers lack skills, training, and knowledge on how to deal with bullying events, and that complaints of bullying often go unnoticed or ignored.

Legal Options

Unfortunately, even obvious types of intimidation are difficult to litigate unless they amount to sexual harassment or illegal discrimination. It is often almost impossible and therefore prosecute, and therefore people who use intimidation and bullying tactics in the workplace usually get away with the abuse. Victims should always maintain a file of what is happening to them as evidence of occurrence may be required in the future.

5 Gifts for Nurses and Their Families

When we think of giving gifts for nurses and vice versa, we usually think of things to buy for people. Yet if you think back on gifts you've been given, it might not be the material gifts you received that are foremost in your mind. It might be the kind of gifts that deeply touched your heart and soul.

Here are five gifts of love that we can give to our fellow nurses and their families that can make a huge difference in their lives:

1. The Gift of Caring and Compassion

We all yearn to feel cared for, yet many of us withhold caring and compassion for others. A profound gift we can give to our loved ones is to listen with our heart. We should understand and accept rather than to judge, staying open to learning rather than protecting ourselves from being hurt.

Think about the last time someone actually listened to you and gave you understanding and acceptance. The feeling of being understood and accepted with caring and compassion is one of the best feelings in the world. Instead of focusing on getting this from others, why not focus on giving it to others? You might be surprised at how wonderful you feel in giving this gift to your family.

2. The Gift of Courage

One of the best gifts for fellow nurses and our loved ones is our own courage. This means having the courage to stand in our truth and to be honest about what we want and don't want. It is in knowing what we will do and won't do, what is and what is not acceptable to us. It means having the courage to take good care of ourselves, even if others don't like it.

It means not succumbing to our controlling behaviors that come from fear, anger, withdrawal, compliance, resistance. Instead, it is being honest and above-board about ourselves. It means being willing to face conflict for the right things, rather than give ourselves up to avoid it.

When we have the courage to face conflict and tell the truth, we not only provide our family with a role model for courage. We also provide opportunities for our loved ones to step up to the plate, in the face of truth, and learn to be courageous too.

3. The Gift of Service

 We are on this planet to learn to love and help each other. One of the best gifts we can give our family is being a role model of service. Helping others fills the heart and soul in ways that nothing else can. If children do not see their parents offering their services and helping others, they may never learn the great joy and fulfillment that comes from giving. One of the best gifts we can give to our family is to provide ways of doing service such as volunteer nursing.

4. The Gift of Creativity

All of us are born with various ways of expressing our creativity. Expressing creativity is a profound way of connecting with the spirit. Providing your family with many ways of expressing their creativity is a great gift. Creativity can be expressed in so many ways: cooking, crafts, building things, music, telling stories, writing, humor, photography and video. The possibilities are endless! Creative family projects are especially wonderful in creating family closeness.

5. The Gift of Lightness of Being

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Lightness of being—fun, joy, laughter, playfulness—is infectious. Our laughter and playfulness can help others take life less seriously and "lighten up."

Lightness of being is the result of the gifts of caring, courage, service and creativity. When we give these gifts, we feel a wonderful lightness within, the lightness that is the result of fully giving from the heart. Our own lightness of being can bring lightness into our whole family. Children love it when their parents are playful, fun-loving and joyful. Laughing together as a family is one of the most precious experiences in life.

These gifts are far more important than any material thing we can buy for someone. In fact, we might not be so focused on material gifts if we frequently give the gifts of love—of caring, compassion, courage, service, creativity, and lightness of being. And these gifts for nurses and their families are not just ideal for the holiday season. They should be shared every day.
Merry Xmas All!

Source:
Margaret Paul/ nursestogether