Ethical & Legal Issues for Schools of Nursing During SARS: Lessons for Pandemic Planning Betty Burcher, RN, MSc Faculty of Nursing, University of Toronto.

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Presentation transcript:

Ethical & Legal Issues for Schools of Nursing During SARS: Lessons for Pandemic Planning Betty Burcher, RN, MSc Faculty of Nursing, University of Toronto CASN Council Breakfast: November 15, 2006

Discover the Possibilities SARS & the Faculty of Nursing Extraordinary impact on Faculty of Nursing Created SARS Fast Response Team “To protect the health and safety of our students, faculty and staff during the SARS situation.” Community of 670 individuals [May 2003]

Discover the Possibilities Impact on Education During SARS 1 BScN program: –Students suspended from hospitals for weeks, missed parts of rotations –Classes continued – Web-based learning, creative alternatives MN program: –Classes suspended week by week – Hospitals needed staff or prohibited intermingling with other health care workers

Discover the Possibilities SARS 2 - Our Turn 185 BScN students in 22 clinical sites 50 students & faculty in quarantine 8 students ill during quarantine and/or placement in level 2 or 3 units 2 students infected with SARS (from workplace exposures) Disrupted, delayed, extended or replacement clinicals but all completed!

Discover the Possibilities Lack of Information & Communication Lack of communication between: –university administration, –health sciences faculties, –hospitals and –public health No central “desk” for education sector Resorted to newspapers, scanning of websites, personal contacts, rumours, frequent back-door calls to Toronto Public Health & expertise of each other

Discover the Possibilities Issues Re Clinical Placements Truth-telling: did we have confidence in reported hospital status? Some hospitals delayed reporting their status to public health Inconsistent infection control practices across and within 22 clinical sites: we needed to be consistent for our students Who makes the decision? Clinical site, educational institution, local public health agency or the provincial MOH

Discover the Possibilities Issues Re Students Complex status of ill students: –Students (full-time or part-time), –Health care workers (full-time or part-time), –Ill patients in the health-care system, –Suspect SARS case or PUI [person under investigation]: surveillance from public health No occupational health services so we did it ourselves: –Privacy issues: faculty monitoring the health of students & other faculty –Confidentiality issues: quarantine, PUI & SARS cases: sharing information with h-c providers, workplaces, students & faculty –Classmate/faculty support versus stigma

Discover the Possibilities Decision-making Issues for Our SARS Team Decision-making: fear or evidence? What were our parameters of responsibility? No precedents for decision-making during a crisis Many students and part-time faculty were also hospital employees What was our risk-management and liability? Issues of communication within the faculty & university Repercussions of our decisions for relationships with our hospital partners

Discover the Possibilities SARS to Pandemic Planning Health sciences education sector advocacy post-SARS SARS was primarily a nosocomial infection Ontario health plan for an influenza pandemic [2006] Council of Ontario Universities U. Of Toronto Health Sciences Pandemic Planning Committee

Discover the Possibilities Summary: Legal Issues Clarity re authority, roles & decision- making responsibilities –Decision-making body in university –Decision-making body in Faculty with clear parameters –Risk-management & risk-communication expertise –Infection control, occupational health & disease surveillance

Discover the Possibilities Summary: Ethical Issues Privacy for students, faculty & staff Confidentiality for students & faculty Transparency & accountability Duty to care Planning, priority-setting & preparedness University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group (2005). Stand on Guard for Thee: Ethical considerations in preparedness for pandemic influenza. Retrieved from mic.pdf mic.pdf

Thank You