Nursing School Responds to Evolving Patient Needs with Vaccines, Virtual Care
By DAVID ENDERS
“Where the needs of the world and your talents cross, there lies your vocation.” Logic, combined with astute observation, accounted for all of Aristotle’s enduring philosophy. Those two qualities, combined with compassion, aptly describe patient care, and the role of the nurse in ending a pandemic.
“I need to sit down and write some scholarly work because there was nothing to guide us in this pandemic. Nothing,” says Cindy Sickora, DNP, RN, vice dean of practice and engagement, for the School of Nursing at UT Health San Antonio. “We need to document and learn from this. We want to make sure we are better prepared for the next one.”
The Centers for Disease Control and Prevention (CDC) estimate 675,000 people died from the Spanish flu in 1918, and the pandemic left more unanswered questions than answers. “Now we’re at more than 550,000 deaths a hundred years later, that’s appalling.
“The thing is, it’s not like we haven’t known a pandemic was coming. I used to teach a public health course and show students a video about the H5N1 bird flu, essentially about the world’s economic collapse due to a virus jumping from an animal to humans. And I taught them it was likely to happen in our lifetime, and sure enough it did. That was back in 2009, so this is not a total shock. We knew it would happen eventually, but we didn’t know what it would look like. Now we know what it looks like.”
Since March of 2020, students and faculty at UT Health San Antonio have performed some 28,000 COVID-19 nasal swab tests and given more than 159,000 vaccination shots. “For the most part, nursing and medical students have been working in the clinic daily,” Dr. Sickora says. “However, we’ve also had student volunteers representing dental, occupational therapy, physical therapy, respiratory therapy, physician assistants, pharmacy, and the School of Public Health.” Throughout all the virus screening, testing, and vaccination programs, Dr. Sickora says she is not aware of a single case of COVID-19 being transmitted by students or faculty on campus.
The School of Nursing responded early to the pandemic setting up screening stations in March 2020 with nursing student volunteers and staff working four-hour shifts, says Lark Ford, PhD, MA, MSN, RN, associate professor/clinical. “We started with 15 screening sites around campus with volunteers in full personal protective equipment and managed to reduce the number of manned sites to two currently, along with self-service temperature kiosks.”
If anyone screened had any of the symptoms on the list sanctioned by the CDC, they were instructed to call the UT Health Hotline, a special hotline set up by the School of Nursing. Nurses who worked the hotline were able to schedule an appointment at the on-campus COVID-19 testing site.
The Wellness 360 clinic’s shift to telehealth mode early in the pandemic was key in maintaining continuity, says Paula Christianson-Silva, DNP, APRN, FNP-BC, ANP-BC, assistant professor/clinical. “Early in 2020, we started doing a lot of telehealth appointments for people with COVID symptoms or who needed pre-procedure COVID testing, as well as return to work clearances for UT Health employees recovering from COVID.”
Final clearances were still done by in-person visits in order to listen to the lungs and confirm the patient’s cough was completely gone. About 40 telehealth visits a day were typical for the clinic early on because that was a mandatory first step before scheduled swab testing. “Everyone at the School of Nursing has really stepped up, from our deans to the housekeepers, to make this effort a success,” Dr. Christianson-Silva says. “I feel so honored to work with such a caring, hard-working group who live our mission of social justice every day.”
The need for COVID testing sites was realized even before it was declared a pandemic, says Maria Saldiva, DNP, APRN, FNP-C, clinical assistant professor. “On Friday, January 31, 2020, we received an email that Wellness 360 at the School of Nursing had been designated as the primary screening clinic for ‘the novel coronavirus’ for travelers arriving on campus from affected areas.” At that point, the virus was generating more questions than facts. Wellness 360 drew on experienced public health experts on campus, as well as developing CDC guidelines regarding PPE, testing procedures, and contact tracing to develop plans.
They also borrowed a page from South Korea’s successful management of the Middle East Respiratory Syndrome (MERS) by offering convenient and safer drive-through testing. “I’ll never forget the first day we offered drive-through testing,” Saldiva recalls. “Armed with conviction and some trepidation, we set up a small table right outside the School of Nursing, donned full PPE and began providing curbside COVID-19 testing to students and employees.” The make-shift operation quickly scaled up to a large tent in the School of Nursing parking lot and a system for delivering specimens to the lab for processing. The school partnered with The University of Texas at San Antonio to set up an ad hoc testing site in the UTSA athletics training room resulting in the football team missing only one of its 13 games due to positive tests.
By December 15, UT Health was administering vaccines and became a state vaccine hub by January 2021 adhering to CDC tiered appointment guidelines. “We recruit volunteers, set up operations, and monitor employees so that we can keep at least 18 to 20 vaccine stations open on a day-to-day basis,” Dr. Ford says.
The Nancy Smith Hurd Auditorium at the School of Nursing was a perfect fit logistically for vaccine delivery. “It’s a big, open area that allows us to arrange tables to separate people and also accommodates wheelchair and non-ambulatory patients. We have six observation areas (135 chairs) so we can observe patients for 15 to 30 minutes after vaccination.”
The vaccine hub, Dr. Ford adds, has had a positive influence on students working interprofessionally and eager for clinical experience. “I’ve had volunteers from all five schools at UT Health San Antonio. Many of these students have given more injections in one day than I have given in my 40 years as a nurse, and it’s allowed them to work alongside their classmates in a meaningful way. They are all living through a pandemic, and they are doing something about it, they are part of the solution. They can tell their grandchildren about it. It’s a historic moment.”
Public compliance and cooperation have not been an issue. “Everyone coming in really wants the vaccine, and they are very appreciative,” Dr. Ford notes. “That motivates me. They have also been compliant about wearing masks, even after the governor lifted the mask mandate. It’s remarkable.”
Vaccines also have been administered from the Wellness 360 Mobile Unit in underserved areas, Saldiva says. “We know that COVID-19 disproportionally affects individuals and families experiencing socioeconomic and health care disparities. This really underscores the school’s emphasis on supporting science-informed strategies to protect communities.”
Dr. Sickora says the process, while exhausting, has also been rewarding. “Between setting up the call center, the screening and testing sites, finding the right people to staff them, and making the vaccine hub work … before we started it all, I couldn’t sleep, it was such a big operation, not complex—just big. But as it turns out, it kind of runs itself as long as the right people are sitting in the right chairs.”
“UT Health demonstrated tremendous leadership, and it came directly from President Henrich (William L. Henrich, MD, MACP) with the team he put together very early. We had a team in place by March 3 of 2020, and we met every day after that for months, responding to surges or new scientific evidence. It’s been a tremendous team.”
The COVID-19 pandemic placed the whole world at risk for the same disease and exposed the most critical needs in trying to achieve social justice in health care. Rest assured nurses answered the call with logic and keen observation, delivered with a healing dose of compassion.