Author Archives: Roberta Lavin

COVID-19: Were we Preapred?

Author: Ron Hilliard, MSN, RN

My name is Ron Hilliard, MSN, RN and I have dedicated much of my career to disaster preparedness and nurses being ready to respond. The COVID-19 pandemic put a whole different perspective on being ready for a major event. I am driven to understand the implications of the COVID-19 pandemic that occurred early this year and I would like to invite a discussion with nurses from the field to understand what they experienced and how we can work together to strengthen our response.

In 2001, I was detailed to establish and manage the HRSA Hospital Preparedness Program to respond to Bioterrorism in Texas under the Texas Department of State Health Services. For over 5 years there was a great deal of federal funding pushed into state public health to prepare for bioterrorism. This included training and equipping health care and public health to be ready if something happened. Great strides were made in expanding public health capabilities and health care, specifically hospitals, being able to handle surge if a biological outbreak occurred. This took a lot of time and effort by many to get to a point we felt like we were ready. Yet, it seems we have had to start all over to prepare for a large-scale disease outbreak while the COVID-19 pandemic is evolving. 

That raises a lot of questions. How did it have a direct effect on nurses? Please share what you have experienced from the aspect of being prepared for this event.

  • What did you, as a nurse, experience in being personally ready for the COVID-19 outbreak and your response to the pandemic?
  • What advice can you give to other nurses, especially those new nurses that are struggling with entering the profession and facing a major disease outbreak at the same time?

It was 20 years ago that states started preparedness efforts for such events. Over the years, we had no major events that pushed us to fall back on those preparations and the readiness posture fell off the radar with the effort to sustain those preparations not staying as a priority. The result was we were not ready for a large-scale event. We first saw the gap in preparation for a biological event with the Ebola incident in Dallas that occurred in 2017. A large number of personnel that led these initial efforts have all pretty much retired and the historical experience has been lost.

I hope we can take this opportunity to learn from each other and promote activities that will make us stronger.

What Nurses Need to Know about the Coronavirus (2019-nCoV)

We have all been hearing about the coronavirus that originated in Wuhan, China for a few weeks and like most Americans were probably not too worried until it was shown to be able to spread by person to person contact. As of today, there are 5 known cases in the United States with over 2700 cases and 81 deaths in China alone. Since December the virus has spread to France, Japan, Malaysia, Nepal, Singapore, South Korea, Taiwan, Thailand, United States, and Vietnam.

How it Spreads

It is not fully known how coronaviruses are spread or if there will be a sustained person to person spread. Currently, China is reporting sustained person to person spread. In the U.S. there are no reports of sustained person to person spread, but if it does occur then it would be possible to see such cases in hospitals and clinics.

How easily a disease spread is of equal importance. For example, measles is highly contagious and spreads easily. CDC list the immediate risk for the coronavirus as low.

Symptoms

Symptoms may appear between 2 and 14 days after exposure. The most common symptoms are:

  • Fever
  • Cough
  • Shortness of breath

Prevention and Treatment

The prevention recommendations at this time are the same as they would be for the flu or other respiratory illness.

  1. Wash your hands often.
  2. Don’t touch your eyes, nose, or mouth if you haven’t washed your hands.
  3. Avoid close contact with sick people
  4. Stay home if you are sick.
  5. Cover your cough.
  6. Clean surfaces and things you touch often.

Treatment is supportive. There is no specific antiviral treatment at this time.

For More Information

Research Request from Disaster Nursing Researchers

Hello!

We are nurse researchers who are interested in exploring the experiences of nurses who have volunteered for more than one disaster relief effort. Much of the research highlights the negative personal effects resulting from disaster relief volunteerism. We are conducting a small qualitative study in the hopes of having a better understanding of the reasons why so many nurses continue to volunteer after their initial disaster relief deployment.

If you are a registered nurse and have participated in more than one disaster relief effort, we invite you to participate!

Data collection will be through phone interviews, which will take approximately 30 minutes. No names will be used in the reporting of the data and the information you provide will be kept strictly confidential.

Please email or call if you are interested in participating. We are happy to answer any additional questions you may have!

Thank you,

Stacy Christensen DNP, APRN christensenste@ccsu.edu 860-463-2964

Linda Wagner EdD, RN lwagner9092@gmail.com 860-965-7665

Melissa Masse APRN mcaprn@gmail.com 860-748-0070

 

Zika and Flint Water Public Health Emergencies: Disaster Training Tool Kits Relevant to Pregnant Women and Children

 2019 Jun 20. doi: 10.1097/JPN.0000000000000418. [Epub ahead of print]

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

PMID: 31233449

 

DOI:  10.1097/JPN.0000000000000418

Disaster Nursing: From Theory to Practice

By: Cole Edmonson DNP, RN, FACHE, NEA-BC, FAAN

It’s been just over two and a half years that the SADN Practice workgroup has been meeting monthly under the guidance of the SADN organizational structure.  The Practice workgroup has included a consistent and engaged team of a dozen nurse colleagues, who have dedicated not only their time but their talents as well. Many of the members have experience responding to major disasters, teaching disaster education and are compelled to communicate their experience in ways that strengthen and support our national nursing workforce in preparedness, response, and prevention to various disasters.

As described by a collective group of disaster nursing experts (Veenema et.al 2016), the focus of the Practice workgroup is to achieve actionable steps towards the following recommendations:

Practice 1.1 Health care and related organizations support clinical nursing practice during disasters to reflect crisis standards of care and address common barriers to the willingness of nurses to respond to a disaster.

Practice 1.2 Establish a collective effort among nurse leaders to advance the practice of disaster nursing and public health emergency preparedness and response.

Practice members have delivered 7 presentations during the past two years for the national, county and local audiences on a range of topics that include; a disaster nursing call-to-action, personal preparedness, psychological resilience and the role of information technology in disaster preparedness. Six of our members were invited by the Emergency Nurses Association (ENA) to provide the evaluation for a mass casualty disaster drill during the 2017 ENA annual convention in St Louis, MO. We are currently working with the Girl Scouts to develop a disaster preparedness badge that could be integrated into the activities of the Girl Scout STEM camps and disseminated nationally. The promotion of personal preparedness serves as the cornerstone of most of our activities and we have identified the following website to use as a resource: https://dallascityhall.com/departments/officeemergencymanagement/Pages/Make-a-Plan.aspx

This past year we welcomed five new members: Including the transition of the chair position.

Cole Edmonson, D.N.P., R.N., FACHE, NEA-BC ( Chair ), June 2018

Chief Clinical Officer, AMN Healthcare

Kimberly K. Hatchel, DNP, MHA, RN, CENP, August 2018

Market CNO/Senior VP, Lexington One Health

Melinda Hirshouer, DNP, RN, MBA, MHSM, June 2018

Director of Inpatient Rehabilitation at Texas Health Presbyterian Hospital Dallas

Laurie G. Combe, MN, RN, NCSN

President-Elect, National Association of School Nurses

Nicole “Nikki” M. Ward, Maj, USAF, NC

HAF Junior Nurse Executive Fellow

Office of the Surgeon General

Medical Force Development (SG1/8AN)

We are honored to be part of the larger SADN group.  The work and success of each workgroup excite and motivates us to accomplish more.  We are all driven by a common purpose to assure nurses are prepared to competently and safely respond and lead in disaster scenarios.

 

Kimberly Hatchel

The experience of Kimberly Hatchel, Chief Nursing Officer

My name is Kimberly Hatchel and I was the Chief Nursing Officer at Sunrise Hospital and Medical Center – a Level II Trauma Center when the October 1st, 2017 Mass Casualty Incident – Active Shooter event occurred in Las Vegas. The event officially announced a little after 10pm, produced 24 hours full of actions aimed at saving human life.

At approximately 2225 the first private vehicle arrived at Sunrise carrying patients. This notation is significant as the number of patients shot in this event thrust those not injured into the immediate role of the first responder. Arrival patterns of patients were also uncertain as there was no ability to announce their arrival. At 2229 the first ambulance arrived carrying patients.  At 2300 the first patient was triaged to the ICU and by 2330 a code triage was called as the magnitude of the event was both being felt and understood. By 2359 five surgeries had been completed.

By 0112 over 100 physicians had responded and by 0200 over 200 nurses had responded. This number proved to be significant as the severity of patient injury required 1:1 nursing care of patients in the initial stabilization and transfer to surgery or ICU. By 0247 the Emergency Department had 228 patients in various stages of treatment in a 52-bed Emergency Department. By 0451 we had 167 patients discharged/transferred from the hospital. By 0545 the Clark County Corner arrived to clear the release of the non-surviving victims of the mass casualty shooting. By 1100 Emergency Department Operations had returned to normal. By midnight on 10/2 – 56 surgeries had been completed. There were 212 known victims treated and an additional 30 who elected not to remain and allow the more severely injured patients to be treated in the first few hours after the event.

The Level I trauma center had been put on diversion. This was the catalyst for the Level II to take twice as many patients.

 

Research Request from Nizar Said

Information for member nurses

RE: Psychological preparedness for disasters among nurses with disaster field experience (an Online Survey)

Dear Colleagues,

You are cordially invited to participate in a disaster preparedness study conducted by a PhD candidate, Mr. Nizar SAID, who is supervised by Associate Professor Dr Vico Chiang, and co-supervised by Professor Alex Molasiotis of the School of Nursing in The Hong Kong Polytechnic University.  The project has been approved by the Human Subjects Ethics Sub-committee (HSESC) of The Hong Kong Polytechnic University (HSESC Reference Number: HSEARS20190118001).

The disaster preparedness study has the purpose to investigate the outcomes of a psychological first aid (PFA) training programme, with the aim of this phase I as an online survey to 1) investigate psychological preparedness for disasters among nurses with disaster field experience, and 2) evaluate the extent of psychological preparedness of nurses with disaster filed experience in relation to self-efficacy, dispositional optimism, trait anxiety, and self-esteem.

The results obtained from this survey will be useful to inform the better structure of the PFA training for further study in the next phase. This study will involve completing a questionnaire, which will take you about twenty minutes to complete. The questionnaires contain five sections.

The study should not result in any undue discomfort. All information related to you will remain confidential and will be identifiable by codes only known to the researchers.

As a participant, you should have participation in at least one disaster relief work on-site or in the related clinical setting (e.g. hospital).

We would be very grateful if you may also further spread the online survey link for other nurses whom you know and have disaster filed experience to join the study.

In order to appreciate your participation in this survey, three free registrations for the upcoming Asia Pacific Emergency and Disaster Nursing Network (APEDNN ) conference in September 2019 at Hong Kong will be offered. If you would like to join this lucky draw, please provide your email address at the end of this survey.

The survey link: https://www.polyu.edu.hk/mysurvey/index.php/693374?lang=en

Sincerely Yours,

Mr. Nizar Said

MSN, BSN, RN

The NHDP-BC exam, a certification for disaster professionals

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

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
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