Mental Health and Health-Related Quality of Life Among Nephrology Nurses: A Survey-Based Cross-Sectional Study

Nephrology nurses face health and wellness challenges due to significant work-related stressors. This survey, conducted online between July 24 and August 17, 2020, assessed the psychological well-being of nephrology nurses in the United States during the COVID-19 pandemic (n = 393). Respondents reported feeling burned out from work (62%), symptoms of anxiety (47% with Generalized Anxiety Disorder-7 [GAD-7] scores ≥ 5), and major depressive episodes (16% with Patient Health Questionnaire-2 [PHQ-2] scores ≥ 3). Fifty-six percent (56%) of survey respondents reported caring for COVID-19 patients, and 62% were somewhat or very worried about COVID-19. Factors, including high workload, age, race, and the COVID-19 pandemic, may partially explain the high proportion of nephrology nurses who reported symptoms of burnout, anxiety, and depression. Copyright© by the American Nephrology Nurses Association.

Out of the frying pan and into the fire

Background After fleeing to Pennsylvania during the NYC pandemic, a patient avoided COVID-19, but contracted West Nile Virus (WNV). WNV is an arthropod-borne arbovirus that first appeared in North America in 1999. 80% of those infected are asymptomatic, 20% develop febrile illness, and < 1% develop neuroinvasive disease. We present a case of WNV in an older adult who developed neuroinvasive disease with associated movement disorder and bladder dysfunction. Case description: An 87 year old woman with history of hypothyroidism, CAD, CVA, atrial fibrillation, CKD, and mild cognitive impairment presented to a hospital with altered mental status (AMS). She stabilized and was discharged home. Due to reoccurring fevers and AMS, she was readmitted with a temperature of 101.5F. Physical exam showed obtundation, grimacing upon palpation of suprapubic region, unintentional tremor in upper extremities, and negative Brudzinski and Kernig signs. Labs were unremarkable. Chest x-ray, and contrast (CT) angiogram of chest were negative;non-contrast CT abdomen showed no source for infection. MRI of the brain showed chronic changes suggesting microvascular ischemic disease, chronic small left cerebellar infarct and moderate parenchymal volume loss. Given AMS and history of suspected recent insect bite, patient was empirically treated for viral, bacterial, and vectorborne meningitis. Fevers persisted and patient's mental status fluctuated. Lumbar puncture was suggestive of viral meningitis. Eventually, West Nile Virus IgM was positive in CSF, IgG was negative. Other serologies were negative. Antibiotics and antivirals were discontinued. Mental status slowly improved but due to persisting urinary retention she was discharged home with an indwelling urinary catheter. Eventually both the urinary retention and tremors resolved. Conclusion: WNV neuroinvasive disease is suspected to follow viral penetration of the blood-brain barrier and direct invasion of neurons. This patient's WNV meningoencephalitis was confirmed by detection of WNV IgM in CSF. Her symptoms included AMS, dyskinesia/tremors (present in up to 90% of WNV-seropositive patients), and acute urinary retention (bladder dysfunction occurs in 3-63% of patients with neuroinvasive disease).