Article Content


Drawing a line

Can I look up my patient's public online presence, such as Facebook posts? I'm worried that he's still drinking excessively.-T.G., VT.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

In a word, no. Just as you set professional boundaries in the workplace, you need to maintain them when using electronic media, even if you're motivated by genuine concern for a patient or former patient. The same is true even if the patient initiates the contact, such as sending you a friend request through Facebook. You need to be careful not to blur the line between your professional and personal life. Besides undermining your relationship with the patient, you could also violate the patient's right to privacy and confidentiality if you share information you've gained this way.1


Becoming friends on social media may end up putting you in a very uncomfortable position if the patient or even other friends of the patient have complaints or issues with the hospital. If you make any comments or post any photos that could be construed as unprofessional, you could potentially face sanctions or consequences from your employer or the Board of Nursing.


The best practice is to carefully follow your facility's policies and procedures on using social media.



1. National Council of State Boards of Nursing. A nurse's guide to the use of social media. [Context Link]



Why isn't it more effective?

My patient asked why she should get an influenza vaccine each year when "they don't work anyway." Why are they less than 100% effective?-R.C., IOWA


The influenza vaccine is changed annually based on the strains of virus expected to be most prevalent in the upcoming flu season.1 In some years, the vaccine is a better match with the predominant viruses than others. Consequently, the vaccine's effectiveness varies from season to season. According to recent studies, receiving a vaccine that's well matched with circulating flu viruses can reduce the risk of illness by 50% to 60%.2 Even if illness occurs, it may be milder in those who've been vaccinated. Vaccination can also reduce the risk of hospitalizations and deaths. During the 2011-12 flu season, it was associated with a 77% reduced risk of hospitalization in those age 50 or older and 71% reduced risk in adults of all ages.2


Antigens contained on a virus are responsible for initiating an immune response, or antibody production, in the host infected with the influenza virus. These antigens help experts determine what the mix of each year's particular influenza vaccination should contain. However, antigens can shift or drift, changing the properties of the virus and leading to acute illness in a person who hasn't developed antibodies against that particular strain. Antigenic drift is the term for slowly evolving changes in the virus's antigens; an abrupt change resulting in a new hemagglutinin or neuraminidase protein is termed antigenic shift. Changes in these subtypes can lead to pandemics because no vaccine or individual immunity will exist.3


Due to antigenic drift, immunity acquired in a previous year by active disease or vaccination won't necessarily protect an individual in the next influenza season. Antigenic drift is one reason why vaccine components can change from year to year. During the 2014-15 season, the vaccine was only 19% effective due to antigenic drift.4


The CDC follows about 2,000 influenza viruses each year to determine not only what mix should go into each season's vaccination but also to determine the effectiveness of the vaccination. The CDC works closely with the WHO because influenza affects people worldwide. Tell patients that even though the vaccine isn't 100% effective, receiving it is still the best way to protect themselves against influenza and its complications.



1. CDC. Selecting viruses for the seasonal influenza vaccine. 2015. [Context Link]


2. CDC. Vaccine effectiveness-how well does the flu vaccine work? 2015. [Context Link]


3. CDC. How the flu virus can change: "drift" and "shift." 2014. [Context Link]


4. Appiah GD, Blanton L, D'Mello T, et al. Influenza activity-United States, 2014-15 season and composition of the 2015-16 influenza vaccine. MMWR Morb Mortal Wkly Rep. 2015;64(21):583-590. [Context Link]



Publishing a letter

Do you have any tips for getting a letter published in a professional nursing journal?-D.W., GA.


Nursing journal editors are always happy to receive a well-written letter that opens a discourse or increases nursing knowledge. If you think nurses would benefit from some insight you've gained from your experience that wasn't included in an article, you could add to the body of knowledge by writing a letter focused on that aspect. Or you may have read something from a reputable source that wasn't included and you want to pass it on. Any facts or statistics that aren't general nursing knowledge should be supported by a current reference.


As a rule, you should write about an article that was published very recently because readers will still be familiar with it. Consider commenting on an article that discussed a controversial issue, such as assisted suicide, because editors try to publish many viewpoints on such issues.


What should you avoid? Overly long personal stories aren't appropriate for a letter and are best published elsewhere. Complaints about an employer or colleague aren't likely to be published.


Finally, make sure to follow journal guidelines for letters, which usually appear on the opening page of the letters section. Editors prefer e-mail over snail mail for convenience. Make sure to include your full name and credentials, home city and state, and daytime phone number.


Even if your letter isn't selected for publication, it may influence the journal's policies, subjects, or style for years to come. Good luck and happy writing!