1. When the Unimaginable Occurs: Lessons Learned in Managing Clinical Students during the Ebola Crisis
Nurse Educator Conference in the Rockies
Ronda Mintz-Binder DNP, RN, CNE
Carrie Edwards RN, PhD, CA SANE
July 14, 2017

2. Session Disclosure 1) Approval Statement
This continuing education activity was approved by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State Division. Approval # 72-17
2) Criteria for Successful Completion
To receive contact hours, participants must check-in to the session using the barcode scanner, attend the entire session and then complete both the session evaluation and full conference evaluation by July 31, 2017.
3) Conflicts of Interest
This educational activity does not include any content that relates to the products and/or services of a commercial interest that would create a conflict of interest.
4) Commercial Support
There is no commercial support being received for this session.

3. Session Evaluation To evaluate this session, please do the following:
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4. Objectives
Review and discuss the timeline of 3 critical events that occurred with clinical students on the unit with diagnosed Ebola patient.
Explain the 3 phases of The Transactional Model of Stress and Coping Theory in relation to students processing the Ebola patient scenario.
Create 2 faculty-driven interventions to assist students through a clinical experience crisis.

5. The Ebola Crisis History/Background Etiology Prevalence Symptoms
A rare, but deadly virus that causes
bleeding inside and outside of the body
History/Background
Etiology
Prevalence
Symptoms
Outcome

6. Ebola Background Arrival in Dallas Students in Crisis
Ebola Virus - cdc.gov

7. The Ebola Crisis In Dallas
History/Background
Timeline
Managing Students
During Crisis
Lessons Learned

8. History/Background
Texas Tech University Health Sciences Center School of Nursing – Lubbock, Texas
Second Degree BSN Accelerated Program

9. TTUHSC Second Degree BSN Accelerated Program Information
Overview
Admission Requirements
Prerequisites
Degree Plan
Cost

10. TTUHSC Second Degree BSN Accelerated Program – Dallas Campus
History/Background
Students
Faculty
Location

11. The Ebola Crisis in Dallas - Timeline
September 25, 2014 – Thomas Eric Duncan presents to the ER at THR Presbyterian Dallas – was treated & discharged
September 28, 2014 – Mr. Duncan returns to the ER
September 29, 2014 – Mr. Duncan is admitted to ICU
October 8, 2014 – Mr. Duncan succumbs to the disease

12. The Ebola Crisis in Dallas – Timeline ‘Cont
October 10, 2014 – 1st Nurse develops fever
October 12, 2014 – Nurse test positive for Ebola & THR closes hospital to all “non-essential” personnel
October 13, Local Universities (TWU & UTA) pull students from hospital. TTUHSC stays as the hospital considered our program “essential”
October 15, 2014 – 2nd Nurse test positive for Ebola
October 16, 2014 TTUHSC removes students from hospital
October 18, The 3 students who had been in MICU were required to self monitor for up to 21 days after their shift (so only required to monitor for remaining 4 days till the 20th) One of the students reports a fever ranging from Reported to CDC command
November 1, 2014 – TTUHSC students return to the hospital

13. The Ebola Crisis in Dallas – Managing Students in Crisis
What we did:
September 30, TTUHSC SON correspondence to follow up on the situation and students
October 14, 2014 – Dallas faculty ed students to address the situation and concerns. Also offered info on EAP for students (assistance/counseling program available to students free of charge).
October 16, 2014 – Students are removed from clinical and TTUHSC makes formal statement. Attended Dallas Health Department Emergency Preparation meeting and City Hall meeting. Distributed #Presbyproud buttons.
October 17, Students are given a journal assignment to reflect on how the Ebola experience had affected their thoughts and feelings as well as those of their coach. They were to address fears/concerns/questions along with thoughts about nursing in general.

14. Journal Assignment
Assignment was made optional – 8/10 students chose to participate
Retrospective Study - IRB Approval Obtained
Study Aims
To better understand the thoughts and feelings of nursing students experiencing an unexpected crisis during their clinical rotations.
To identify ways nursing educators can better handle student fears in stressful situations, offer support/assistance, facilitate learning and make appropriate recommendations for follow-up after surviving an unimaginable crisis during clinical rotations.
To learn what impact an unexpected nursing clinical experience can have on future nursing practice.

15. Themes Identified Mixed Emotions Nursing as a Calling Trust
Excitement/Jealousy
Fear/Worry/Concern
Nursing as a Calling
Trust

16. Mixed Emotions Excitement Jealousy Concern
“I had chills of excitement….I want to be part of history;”
“My thoughts included excitement to get the experience of observing or possibly providing care to the patient”
Jealousy
“When I heard a couple of my classmates were offered to provide care to the patient, I was a little jealous”; “I even wish that I had been assigned to care for the patient;”
Concern
“While I was thrilled to go to ICU clinical, my family, more specifically my sister, was concerned about my health and safety and even got on to me about going to clinical

17. Mixed Emotions Worry Fear
“I know that being pregnant my immune system is weakened so I was nervous I would be more susceptible to contracting this virus than others with a healthy immune system….my roommate worked on the unit the day one of the patients was there and I was worried he would somehow contract the virus and then I would contact it from him.”
Fear
“Once Nina Pham was confirmed to have Ebola, that’s when I truly started to question the safety of America, the safety of my hospital, the safety of those in my profession, and my own personal safety.”

18. Nursing as a Calling
“The nursing population at Presbyterian stood strong and faced the crisis head on, without fear. I admire the nurses I work with and strive to be as brave and cool-headed as they are…most of the nurses were scared for their ICU coworkers but remained PresbyProud;” “As far as my faith in the staff at Presby, I think they are wonderful and dedicated professionals. This Ebola scare has not shaken my faith in the staff at all;”
“I felt motivated and encouraged to always be the best nurse I can be throughout my career, and never back down. Those nurses on MICU have no idea, but the contributed something great to the next generation of nurses.”
“Do I truly want to risk my life to care for others? The answer I came to is a resounding YES.”; “I decided to be a nurse because of one reason: I want to be part of something greater than myself…with this in mind I no longer questioned my calling;”

19. Trust “I trusted the CDC and WHO, somewhat naively;”
“I knew my hospital was a good hospital and well equipped to handle a patient of this nature;”
Before going to bed, I sarcastically told my boyfriend, don’t worry, what are the chances I would actually get that patient? The chances are slim to none…and even if I was assigned this patient, I doubt my school would let me provide care!”

20. Transactional Model of Stress and Coping
Transactional Model of Stress and Coping (Lazarus & Folkman,1984) –when stressed 2 prong Appraisal system is initiated:
Primary Appraisal: (interpret the stressor)
Threat assessment
Challenge assessment
Harm or loss
Secondary Appraisal (analysis of available resources)
Coping abilities
Coping repertoire
Coping Strategies Launched to minimize response
Problem or emotion focused

21. Threat: fear/family/RNs dx/media
Understanding student responses within the context of the Transactional Model of Stress and Coping
Primary Appraisal:
Threat: fear/family/RNs dx/media
Challenge: attend? CDC changes? Safe? Other patients?
Harm/Loss: 21day/pregnancy/will I die?
Secondary Appraisal:
Coping assessment: reading/honored/#presbyproud
Coping Strategies:--(faculty enhanced)
maintained communication
answered questions
journaling
simulation exercise
attended community meetings

22. Activity: Processing a Crisis
Interactive Activity—10-15 minutes
Groups of 3-5 members
If confronted with an unknown, potentially deadly new virus or other crisis in your clinical setting:
A. What key elements should be in a policy regarding this issue?
B. How do you handle students in the clinical setting? Unit assignments? Communication with clinical setting?
C. When do you remove students from the clinical setting? What factors need to be considered?
D. What would be alternative assignments for students in this situation?

23. The Ebola Crisis in Dallas – Lessons Learned
What we learned:
Ethical Considerations
Student Parameters
Protocols
Interventions

24. When the Unimaginable Occurs
Questions????

25. References
American Nurses Association (2015b). Nursing World. ANA Position statement on risk and responsibility in nursing care. Retrieved from
Casey, D. A nurse’s obligation to patients with Ebola. Nursing2015, 45(11),
Copeland, L. (2014, October 14) Are US hospitals prepared for possible Ebola battle? USA Today, retrieved March 3, 2014 from:
Cullinane, S., & Thompson, N (2014, September 18). CNN: The deadliest outbreak of Ebola virus: What you need to know. Retrieved from:
Ferranti, E. P., Wands, L., Yeager, K. A., Baker, B., Higgins, M. K., Wold, J. L., & Dunbar, S. B. (2016, -). Implementation of an educational program for nursing students amidst the Ebola virus disease epidemic. Nursing Outlook, -(-),
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company.
McCarthy, M. (2014). US issues new guidelines for health workers caring for Ebola patients. British Medical Journal (BMJ), 349:6418, 1.
Shapiro, S. E., Martyn, K, Grant, S, & McCauley, L, (2015). Academic practice partnerships in the time of Ebola: Speaking with one voice for nursing. Nursing Outlook, 63(1),
Trautman, DE. (2015). Strategy, timing and collaboration: The academic response to Ebola. Nursing Outlook, 63(1),