Monthly Archives: January 2019

The NHDP-BC exam, a certification for disaster professionals

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By Bonnie McIntosh, BSN, RN, CEN, NHDP-BC

The ANCC just made available a new certification for disaster professionals. It is called National Healthcare Disaster Professional by Certification or NHDP-BC. The cost when I took it was $290.  I noticed that the price stayed the same even though the ANCC website said the cost would go up by $100 starting in 2018.

To qualify to take the test you have to be one of ten healthcare professions with 3 years of disaster experience in the last 10 years. The other requirements include certificates from completing FEMA web-based classes (IS 100.b, 200.b, 700.a, 800.b), and participated in a MCI exercise.

Just like any other certification exam, it is at a testing center.  The test has 175 questions – 150 are scored and you need 70% to pass. The ANCC does not give you a score but I called and the test is worth ‘500’ and passing is ‘350’. It is a long test time – you have up to 3.5 hours to complete it. I was able to complete the test in 2 hours and not rush.

To prepare for the test I used a web-based company called Exam Edge which was the only one I could find with practice questions. Comparing the actual test with Exam Edge, I found the ANCC test was a lot less wordy and had more questions related to HAZMAT levels, PPE levels, triage of victim scenarios, etc. For anyone liking alphabet soup, a whole lot of acronyms are used.

When you pass the exam, you will receive a certificate to frame for your office, a card to carry in your wallet, and a cool coin. I would recommend the certifications to anyone in disaster management.

Emergency Management Training in Post-Acute Settings

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by: Melinda Hirshouer

Hospital leaders must prepare for a variety of internal or external events that cause enough disruption to force normal operations into crisis mode.   If the employees designated to lead the hospital in its response to casualties, property damage, or suspending patient care are unprepared or make ineffective decisions, the crisis will quickly escalate to a disaster (Sternberg, 2003). In a 2008 study, Niska and Shimizu found that while greater than 95% of hospitals have emergency preparedness plans for chemical, biological, or natural disasters, only 73.37% of facilities were prepared for loss of utilities and 47.6% of hospitals were prepared to manage and shelter mobility impaired patients (Niska & Shimizu, 2011).  This is particularly important to post-acute areas as most of their patients would fit this description.

In the post-acute care setting, there is some reluctance by leaders to admit that these practice settings are also susceptible to the same types of crises as acute care hospitals. Post-acute care areas face additional challenges that come from having space, skill, and equipment to provide care for patients with physical and cognitive disabilities and having to contemplate a complex evacuation while maintaining their care or receiving patients from another unit or facility that may have been impacted. It is during these times of crisis, when the post-acute care staff members, including the nurses, look to their leaders for guidance and support.

As a part of my DNP program, I completed a scholarly project entitled Use of a Structured Emergency Management Training Protocol in a Post-Acute Care Setting.  The project intervention included providing a structured disaster training protocol specifically targeted to post-acute leaders.  The protocol included an introductory in-service, successful completion of four FEMA online training modules and participation in two tabletop exercises. The in-service was designed to expose leaders to emergency management in post-acute care areas and the brief tabletop exercises were developed to highlight specific post-acute care scenarios and set realistic expectations for the probability of an event occurrence.

The evidence-based practice project improved the number of post-acute leaders with emergency management training from 0%-92%.  Additionally there was an increase in the participants’ ability to retain knowledge from the training, with an increase of the mean number of questions correct (before the training was 9.5 compared to 16.3 after the training) which represented a statistically significant increase (p<0.001),   as well as an increase from 35% to 90% in the ability to complete critical tasks in the tabletop exercises.  Finally, there was a significant increase in the participants’ perception of their emergency management preparedness at the completion of the training with a mean level of readiness before the training of 2.4 compared to 8.2 after the training (p<0.001).  The project demonstrated that post-acute leaders were able to successfully complete emergency management training and apply the knowledge that they had learned.

Identifying that emergency management (EM) training is necessary is not enough to encourage completion.  The value of why this matters to me must be addressed in order to engage participants from the beginning.  Additionally, constructing the TTX so that there is a safe environment for the team to talk through the scenario and discuss solutions helps to reinforce a culture of learning and preparedness.  Current events that can be applied to TTXs and can be used to reinforce the importance of training also proved helpful.  Finally, as the FEMA modules ICS 700 and ICS 800 provided basic information on the structure of the ICS, the completion of these modules before ICS 100 and ICS 200 seemed to improve the participants’ understanding of the material that was being presented.  Leaders from acute care and post-acute care areas should be brought together for training and planning for any event whether natural or manmade, planned or unplanned that may cause a surge of patients into any area of the facility.

References

  • Niska, R. W., & Shimizu, I. (2011). Hospital preparedness for emergency response United States, 2008.  Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
  • Sternberg, E. (2003). Planning for Resilience in Hospital Internal Disaster. Prehospital and Disaster Medicine,18(4), 291-299. doi:10.1017/S1049023X00001230

Secondary Trauma: No Bruises Left Behind

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By Elizabeth Fiegel DNP, MSN, RN NEA-BC

I know that when I inventoried nine full oxygen tanks just this morning they were all there in the rack.  I have looked everywhere and for the life of me, I cannot determine where three of the nine might have gone.  If there is not at least a full rack, we will simply not have enough to last throughout the night. These patients desperately need oxygen to survive.  Then I checked everywhere, and our supply of saline has also run critically short; we certainly had at least a full case just this morning, and will not be getting another delivery until after the hurricane has passed, maybe for many days.  We have an emergency room full of patients who might need this saline for their critical injuries.  What am I going to do?  I must report back to the incident command center and I am confident that the supplies were correctly inventoried, and ready for the storm just this morning.  Surely, I will be held to blame, I feel my heart racing, my mouth is dry and the sweat droplets are forming on my brow, the room is spinning. Oh no, I must sit down for just a moment; I am not sure… I just can’t hold back the tears and can’t do this anymore.  As I hold my face in my hands, in this very dark room, my pillow now stained with my tears, I suddenly realize that my husband is gently rousing me from my deep sleep and this terrible nightmare. Then, I recall that I was just reliving the hurricane preparations at my local hospital, where I had worked for seven twelve hour shifts in a row after volunteering at the emergency shelter.  It has been over two months since the hurricane, and I still cannot sleep through an entire night, and have had trouble focusing at work.  My husband is worried about me and I just don’t seem to find joy in anything right now.Fiegel photo-3.jpgFiegel-photo-2.jpg

This story is an example of secondary trauma suffered by a nurse who volunteered during a major hurricane.  She had been a nurse for over 35 years during some of the worst hurricanes ever to hit the gulf coast.  She was a seasoned nurse with a clinical background in emergency and trauma care.  She had seen some of the worst types of injuries and nothing seemed to faze her; she could tolerate blood and traumatic injuries with the best of them. Clinicians, however, are not immune to Secondary Trauma, which is defined as trauma-related stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, or the event itself (SAMHSA, 2014).  Secondary Traumatization is also referred to as compassion fatigue (Figley, 1995) and vicarious traumatization (Pearlman and Saakvitne, 1995).

As Hurricane Florence struck a heavy blow to the east coast this last month resulting in devastation and loss of life, I am reminded that healthcare workers respond to disasters often in a moment’s notice in the dark of night and leave their family and personal needs behind to care for others.  They put in long hours without sleep and work under grueling conditions, even neglecting their own health and safety at times.  The combination and interaction of systemic and traumatic stresses place nurses and others working in the health care field at an increased risk of suffering from serious negative stress effects in the areas of physical, emotional, cognitive, behavioral and interpersonal well-being (Rosh, 1996).  There are no bruises or scars in Secondary Trauma; the signs of Secondary Trauma are often missed in healthcare providers but demonstrate themselves as:

  • Fatigue
  • Sleep disturbances
  • Changes in appetite
  • Chronic muscle tension
  • Sexual dysfunction
  • Irritability
  • Fear of impending doom
  • Isolation
  • Replaying events in one’s mind over & over
  • Difficulty making decisions or problem-solving

According to The International Society of Traumatic Stress Studies (2018), there are effective strategies for preventing and reducing the effects of stress reactions, and preventing secondary traumatic stress in healthcare providers:

  • Eat nutritiously and regularly every day
  • Get adequate sleep each night at least 6-8 hours
  • Exercise regularly for at least 30-60 minutes each day
  • Be aware of your stress level; take precautions against exceeding your own limits, by practicing mindfulness, yoga or meditation
  • Acknowledge your reactions to stressful circumstances; allow yourself time to cope with these emotions, seek personal or group therapy
  • Take scheduled vacation or days off in between work shifts

Some organizations attempt to reduce the incidence of secondary trauma in healthcare workers by offering formalized post-event debriefings. Structured events allow for a review of readiness to response and evaluation of reactions to the events themselves.   Practice guidelines on debriefing formulated by the International Society for Traumatic Stress Studies (2018) conclude there is little evidence that debriefing prevents the effects of secondary trauma. The guidelines do recognize that debriefing is often well received and that it may help (1) facilitate the screening of those at risk, (2) disseminate education and referral information, and (3) improve organizational morale. However, the practice guidelines specify that if debriefing is employed, it should be conducted by experienced, well-trained practitioners, not be mandatory, utilize some clinical assessment of potential participants, and be accompanied by clear and objective evaluation procedures.   Currently, many mental-health workers consider some form of stress debriefing the standard of care following both natural (earthquakes) and human-caused (workplace shootings, bombings) stressful events  For individuals who demonstrate serious signs and symptoms of Post-Traumatic Stress Disorder, and/or harm to themselves or others, individual therapy and immediate crisis intervention may be needed (Dept. of Veterans Affairs, 2018).

Disaster response is often a well-coordinated event by healthcare workers and first responders, rending lifesaving aid to millions of others, providing hope to the hopeless, and compassion to the heartbroken; truly, this has been evident during and after Hurricane Florence, Katrina, and many other natural disasters. Understanding the etiology of Secondary Trauma, early recognition of signs and symptoms and strategies to avoid the negative impact of Secondary Trauma can result in healing for both the healthcare worker and those they aide.  While valuables, personal treasures, and homes can be lost, lives can be restored and healthcare workers and first responders play a unique and important role in recovery; providing for their health and wellness is essential in disaster management.