<i>Editorial</i>

Although quarantine is a familiar historical practice in nursing, we have rarely encountered it in our experience either in practice or as the subject of academic inquiry. The recent SARS crisis in Toronto, however, has given us pause to reflect upon the meaning of quarantine and its effects on nurses. We are struck by the extent to which the term can illustrate a wide range of concerns and problems faced by nurses who gave care in hospitals where active SARS cases were being treated. We want to make visible these consequences of quarantine, recognizing that we occupy a safe and privileged position in the academy. Quarantine has been variously defined as, ‘(1) isolation imposed on persons or animals that have arrived from elsewhere or been exposed to, and might spread, infectious or contagious disease; (2) the period of this isolation; (3) any comparable period, instance, or state of isolation, esp. a boycott or severance of diplomatic relations intended to isolate a nation’ (Oxford). The etymological roots of the word arise from the Latin, ‘for 40 days’, and originally referred to the time in which a widow could remain in her husband's home before paying rent to his heirs. She had no rights to the property (Webster’s). The original medical–political application of quarantine referred to ‘a term (40 days) during which a ship arriving in port and suspected of carrying serious contagious disease was forbidden all intercourse with the shore’ (Webster’s). These varied meanings of quarantine apply well to the spatial, temporal, emotional and sociopolitical experiences of nurses during the SARS crisis. The procedure of quarantine, from its beginnings, seems to have been imposed from the outside, as a law or interdict, and resulted in, or at the very least represented, segregation, social and psychological isolation, stigma, reduced social status, and the potential powerlessness of those affected. The spatiality of everyday work and home life was severely disrupted for many nurses and resulted in severe relational and psychological isolation. Under normal circumstances, institutional nursing work is a relational, situational, embodied practice that is enacted close or proximally to the actual patient receiving nursing care. This relational nursing work was affected by the necessary quarantining procedures during the SARS outbreak (McGillis Hall et al. 2003). The encounters between nurses and patients were changed because the protective gear restricted touch not mediated by gloves. Facial expressions became limited to the eyes, speech became more difficult through the masks and hearing was reduced when both nurses and patients were masked. In addition, relationships with colleagues became more distant because everyone was required to maintain a distance of two meters. This made it problematic for nurses to share their experiences and to support each other either on the ward or during breaks and meal times. Communication at all levels became more restricted. The introduction of ‘work quarantine’ by the Toronto Public Health Department, for nurses and others who inadvertently had had unprotected exposures to SARS, further isolated nurses from family, friends and the greater community. During work quarantine these nurses were required to go directly to work from home and directly home from work, without stopping between destinations. They were forbidden from taking public transit; could not leave home unless they were going to work; were required to stay in a separate room from family as much as possible and wear a mask if they were at any time in the same room as a family member; and could not have visitors in their homes (NYGH 2003). The necessity for these nurses to continue to go to work and often to continue to care for those at home, while paradoxically quarantined, required that nurses engage in a complex and sensitive negotiation of personal proximity to others. For example, when it became known that nurses were under quarantine they were frequently shunned by some neighbors, delivery services, etc. Their children were stigmatized at school and in the neighborhood. If it was possible, nurses sent their families away and some took up residence in hotels or motels for fear of infecting their loved ones. One nurse described her feelings: ‘I am ordered into quarantine and feel as though such a restriction could apply only to some plague-threatened inhabitant of the Middle Ages’ (Ellacott 2003, 14). Unlike sailors of the past, the ‘shore’ to be avoided for these quarantined nurses was not a line on a distant horizon, but an ever shifting array of points of uninfected others. One nurse under work quarantine comments on her way of managing this difficult situation in the following way: The theme of isolation extends deeply into my personal life and I begin to feel most secure in my separateness. My connections with family and friends outside of work begin to dissolve in a new reality of apartness. I’m haunted by the specter of putting my family at risk and begin to withdraw from them. I lose a sense of common ground with anyone except those who know what it's like on the inside (Ellacott 2003, 15). In clinical situations of caring for quarantined or actual SARS patients, relational work became even more complicated by the time constraints and discomforts associated with donning and wearing layers of protective garb. In very infectious situations staff donned stryker suits, space suits that entirely covered them, segregating them bodily from everyone else. It took a great deal of time and care to get into and out of this protective gear without contamination. Medical and nursing procedures were difficult and awkward and took much longer to perform safely and correctly. In addition, much time was spent entering the hospital; nurses had to arrive much earlier for work to undergo the screening procedure of filling out forms, waiting in line, having their temperature checked, etc. This temporal effect was greatly increased if a nurse was deemed potentially infectious because of contact and put on home quarantine. Isolated and frightened, time passed very slowly for these nurses waiting for the symptoms to appear. Disturbingly, the term quarantine also aptly described the sociopolitical positioning of nurses during the second outbreak of SARS in May 2003. SARS re-emerged after the province had declared the virus contained and had relaxed infection control measures. Nurses, concerned that they were continuing to encounter new cases, raised concerns and warnings that were unheeded by those in authority. Some nurses were even mocked for continuing to wear protective gear. Nurses, after all, can be viewed as coming from ‘elsewhere’ in that they are not full members of the dominant medical and scientific community. Their perspectives must be held in abeyance or quarantined because they have the power to infect or disrupt the status quo. Nurses have reacted to this sociopolitical quarantining by demanding a full public inquiry into the SARS outbreak. The Registered Nurses Association of Ontario (RNAO) is calling for a provincial commission to inquire into the effectiveness and timeliness of the healthcare system's ability to respond to SARS and to protect the health and safety of healthcare workers and the public. Of particular concern was the lack of response to nurses’ warnings and the excessive reliance on casual, part-time and agency nurses that had an impact on the quality and availability of nursing services (RNAO 2003). These actions represent a coming out of quarantine by nurses in hopes of (re)-establishing diplomatic relations with our healthcare leaders and the public alike.

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