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Public Health and Ethics Intersect at New Levels With Gerontological Nursing in COVID-19 Pandemic.

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A melia cares for her parents, who live nearby. Her father, Samuel, has dementia and develops a dry cough, a fever of 100.8°, shortness of breath, and increased confusion (delirium… Click to show full abstract

A melia cares for her parents, who live nearby. Her father, Samuel, has dementia and develops a dry cough, a fever of 100.8°, shortness of breath, and increased confusion (delirium superimposed on dementia) and agitation. Amelia and her mother, Sarah, take Samuel to the local hospital where he is met at the door by staff dressed in masks, gowns, gloves, and face guards. He is swept into the emergency department (ED), screaming at Amelia to take him home. Amelia and Sarah are told the hospital has restricted visitors and they must wait at home for an update. Th ey leave, distraught and worried about Samuel. Amelia is concerned about her mother’s health and potential transmission of the virus to her young family. Th ey return to their homes, under state orders to shelter in place, at a loss for what to do next. Th e United States and other countries are currently facing a pandemic of respiratory disease spreading from person to person caused by a novel (new) virus—coronavirus. Coronaviruses are a large family of viruses that are common in people and many diff erent species of animals, including camels, cattle, cats, and bats. Th e disease has been named coronavirus disease 2019 or COVID-19. A pandemic is a global outbreak of disease. Pandemics happen when a new virus emerges to infect people and can spread among people sustainably. Because there is little to no pre-existing immunity against the new virus, it spreads worldwide (Centers for Disease Control and Prevention [CDC], 2020). At the time of this editorial, the complete clinical picture with regard to COVID-19 is not fully known. Reported illnesses have ranged from very mild (including little or no reported symptoms) to severe, including severe respiratory illness requiring intubation and even resulting in death. Although information to date suggests that most COVID-19 illness is mild, what we know about this disease is rapidly evolving as we learn more and study the data that are becoming available from cases in the United States and beyond. Th ere are some reports that the number of serious symptoms related to COVID-19 may be higher than previously reported (McMichael et al., 2020). Importantly, individuals of all ages with severe chronic medical conditions (e.g., heart disease, lung disease, diabetes) are at higher risk of serious illness with COVID-19 (Zhou et al., 2020). All 50 states have reported cases of COVID-19 to the CDC. Th e virus that causes COVID-19 is infecting people and spreading easily from person-to-person. Th e virus appears to spread much easier than infl uenza. For up to date information on COVID-19 from the CDC, including current cases, how to protect yourself, and what to do if you are sick, visit their website (access https:// www.cdc.gov/coronavirus/2019ncov/index.html). Th e predominant focus of health system readiness has been on ramping up hospital services from more available and rapid testing to caring for critically ill patients on ventilators. Emergency plans are in play for addressing supply chain issues, personnel, surge capacity, and protecting the safety of health care workers. Given the interrelatedness of all health services and the general community, communityand state-level planning are essential to address collective strategies that minimize transmission, expedite care in the appropriate setting, assure adequate human and material resources, and promote physical and mental health in the face of this crisis. Health systems are establishing ethical guidelines allocating scarce resources, particularly in light of the current projected shortage of ventilators and staff to support critically ill patients requiring intubation. Th ese discussions bring to the fore the value of life in the context of distributive justice (White & Lo, 2020). Clinicians face diffi cult conversations and may require additional preparation for these encounters, such as that provided by

Keywords: disease; health; gerontological nursing; covid pandemic; virus

Journal Title: Journal of gerontological nursing
Year Published: 2020

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