LETTERS

Pregnant with H1N1 Influenza

Dear Editor: The article in your journal by Verkler on a pregnant woman with H1N1 influenza is very interesting. 1 In fact, the H1N1 influenza is a present public health threat. Infection in pregnant women is possible and can be problematic. 2 H1N1 influenza prevention in pregnant women by vaccination is suggested. 3 Torres-Ramírez 3 noted that “Pregnant women should receive the vaccine in any trimester of pregnancy, but especially in the last to prevent maternal and fetal complications as well as elevation of perinatal mortality.” However, if the H1N1 influenza prevention is not successful, the important consideration is the management of the infected case. Calvo Aguilar et al 4 noted that “H1N1 influenza infection has a high fatality rate in late pregnancy.” The role of emergency nursing to support care and disease control is very important. 5 On the other hand, encouragement and education for emergency nurses who must work with H1N1 influenza should not be neglected. 6—Viroj Wiwanitkit MD, Visiting Professor, Hainan Medical University, China; Visiting Professor, Faculty of Medicine, University of Nis, Serbia; Adjunct Professor, Joseph Ayobabalola University, Nigeria; Honorary Professor, Dr DY Patil Medical University, India; E-mail: [email protected] http://dx.doi.org/10.1016/j.jen.2014.08.002

REFERENCES

added a new dimension of knowledge to the topic of workplace violence in the emergency setting. I applaud the authors for exploring the experiences and aftereffects of assault on our profession. 1 Sadly, I recognized the study’s findings related to pervasive acceptance of workplace violence in my own organization. 1 As an emergency nurse in Texas, I celebrated when our governor signed House Bill 705 into law in 2013, making assault against ED personnel a third-degree felony. 2 However, legislature alone will not change the dismissive culture that predominates emergency departments today. Nursing leadership will need to drive cultural change at the executive and organizational level. The Joint Commission recognized leadership’s responsibility for establishing a culture of safety, noting that leaders singularly control the resources needed to exert cultural transformation. 3 In addition, leadership is responsible for implementing effective practices and policies. 3 Whereas many organizations use education or training to mitigate workplace violence, the measures are often 1-dimensional and fail to compensate for the multifaceted nature of violence. 4 As a result, employees and particularly emergency personnel are left vulnerable. I challenge nursing leadership to establish zero-tolerance cultures for workplace violence and to implement effective interventions and policies. Then and only then will the idea that “nobody cares” and “nothing changes” begin to work itself out of ED culture.— Victoria Doby, MHA, BSN, RN, Assistant Service Manager, OB/ GYN Intermediate Care Center, Parkland Health and Hospital System, Dallas, TX; E-mail: [email protected]

1. Verkler JL. A pregnant 26-year-old with H1N1 influenza [published online ahead of print July 9, 2014]. J Emerg Nurs. http://dx.doi.org/10.1016/j.jen.2014.04.018. 2. Wiwanitkit V. Obstetrical concern on new emerging swine flu. Arch Gynecol Obstet. 2010;281(2):369. 3. Torres-Ramírez A. Pandemic influenza caused by A (H1N1) in pregnant women. Ginecol Obstet Mex. 2010;78(2):121-7. 4. Calvo Aguilar O, Canalizo Mendoza YR, Hernández Cuevas MJ. Influenza H1N1 in obstetric population of a general hospital in Oaxaca. Ginecol Obstet Mex. 2011;79(6):344-50. 5. Khan N. Reducing ‘swine flu’: the midwife’s role. Pract Midwife. 2011;14(11):25-7. 6. Phillips KP, O’Sullivan TL, Dow D, Amaratunga CA. Infectious respiratory disease outbreaks and pregnancy: occupational health and safety concerns of Canadian nurses. Prehosp Disaster Med. 2011;26(2):114-21.

Leadership’s Role in Eliminating Workplace Violence and Changing Perceptions in the Emergency Department

http://dx.doi.org/10.1016/j.jen.2014.08.013

REFERENCES 1. Wolf L, Delao A, Perhats C. Nothing changes, nobody cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care. J Emerg Nurs. 2014;40(4):305-310. 2. HB 705, 83rd Leg, R.S. Sess (TX 2013). Open States Web site. http:// openstates.org/tx/bills/83/HB705/. Accessed July 21, 2014. 3. Governance Institute. Leadership in Healthcare Organizations: A Guide to Joint Commission Leadership Standards. Governance Institute; 2009. 4. Bentley TA, Catley B, Forsyth D, et al. Understanding workplace violence: The value of a systems perspective. Appl Ergon. 2014;45(4):839-848.

Response

Dear Editor: Dear Editor: The article “Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care” by Wolf et al 1

January 2015

VOLUME 41 • ISSUE 1

We appreciate the comments of this reader. The purpose of the study was to better understand the antecedents to violence and the environment in which violence takes place in emergency settings. Our findings suggest that cultural

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Leadership's role in eliminating workplace violence and changing perceptions in the emergency department.

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