Category Archives: Disaster Preparedness

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.

Secondary Trauma: No Bruises Left Behind

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.

 

 

 

 

Crisis Standards of Care: Are You Familiar?

by: Denise M. Danna, RN, DNS, NEA, BC, CNE. FACHE

Due to such disasters as Hurricane Katrina, the tornado in Joplin, and various other
catastrophic events across the country and globe, the Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) create a committee to develop standards of care during disasters. As citizens, we frequently experience how our health care system and the infrastructure of a community can be overwhelmed in such catastrophic disasters.

Several reports were generated from the IOM committee on Crisis Standards of Care (CSC). The first report in 2009, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations developed a definition of crisis standards of care “as a substantial change in usual health care operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g. pandemic influenza) or catastrophic (e.g. earthquake, hurricane) disaster. This change in the level of care delivered is justified by specific circumstances and is formally declared by a state government, in recognition that crisis operations will be in effect for a sustained period. The formal declaration that crisis standards of care are in operation enables specific legal/regulatory powers and protections for healthcare providers in the necessary tasks of allocating and using scarce medical resources and implementing alternate care facility operations” (IOM, 2009). The second report entitled, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (IOM, 2012) developed CSC templates to assist and guide individuals and organizations in CSC planning and implementation (IOM, 2012). Some of the main reasons that CSC protocols are needed in catastrophic disasters are to ensure that critical resources are provided to those individuals who will benefit the most, conserve limited resources, and ensure that all individuals receive the same access to the best possible care.

Nurses play a vital part in participating in the development of CSC. I was asked to participate in an interdisciplinary task force charged with developing crisis standards of care protocol. My section was writing “Delivery of Care Guidelines for Essential Inpatient Nursing Care” (Louisiana Department of Health & Hospitals, 2011). In developing the essential inpatient nursing care guidelines, the ANA report, Adapting Standards of Care Under Extreme Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies (2008) was referenced. This report identified critical standards for healthcare providers that should always be maintained during a disaster (e.g. worker and patient safety, maintaining airway and breathing, circulation, control blood loss, and infection control (ANA, p. 16). Standards of care that could be adapted under extreme conditions included such activities as routine care (e.g. vital signs for non-acute patients), extensive documentation of care, and elective procedures (ANA, p. 16).

It is recommended that each hospital develop its own recommendations for providing essential nursing care during a catastrophic disaster that mirrors the community’s in which they live (Murray, 2012). Nurses serve an important role in disasters. Nurses should familiarize themselves with CSC and work within their organizations and communities to develop and implement CSC. During times of disasters, scarce resources may occur and nurses need to know how standards of care may be adapted while still providing safe, ethical and quality nursing care (Murray, 2012).

References

ANA (2008). Adapting Standards of Care Under Extreme Conditions: Guidance for
Professionals During Disasters, Pandemics, and Other Extreme Emergencies. Retrieved
from: http://www.homecareprepare.com/files/AdaptingStandardsofCare.pdf

Institute of Medicine (2009). Report Brief. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Retrieved from:
https://www.phe.gov/coi/Documents/Guidance%20for%20Est%20CSC%20for%20Use%20in%20Disaster%20Situations%20A%20Letter%20Rpt.pdf

Institute of Medicine (2012). Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Retrieved from: http://www.nationalacademies.org/hmd/Reports/2012/Crisis-Standards-of-
Care-A-Systems-Framework-for-Catastrophic-Disaster-Response.aspx

Louisiana Department of Health & Hospitals. ESF-8 Health & Medical Section. State Hospital Crisis Standard of Care Guidelines in Disasters (Version 1.2 September 2011).Retrieved from:
https://www.phe.gov/coi/Documents/LA%20State%20Hospital%20CSC%20Guidelines%20in%20Disasters.pdf

Murray, J. (2012). Crisis Standards of Care: A framework for responding to catastrophic disasters. AJN, 112 (10), 61-63.

Now is the Time, Personal Preparedness Can’t Wait!

On August 25, 2017, Hurricane Harvey made landfall in Texas leading to catastrophic flooding in Houston and surrounding areas.  Less than two weeks later, Hurricane Irma slammed into the Caribbean and Florida, causing flooding, damage, and widespread power outages.  Most hospitals in the impacted areas sheltered-in-place requiring nurses and other critical staff to stay at the facilities for extended periods.

While these disasters had some advance warning, many aspects of the disaster were uncertain including the extent and location of flooding, power outages, etc. Other disasters, such as tornadoes or earthquakes, strike with little or no warning. Previous studies have found that lack of personal preparedness, concern/fear for family and pets, concern for the effect of the disaster on self and personal property, and transportation difficulties pose major barriers to disaster response. Although many agree that healthcare organizations should address the personal preparedness of their employees, little is known about the degree to which the U.S. nursing workforce is personally prepared to respond to disasters for extended periods of time.

The Society for the Advancement of Disaster Nursing believes personal preparedness of the nursing workforce is paramount. This week, SADN members will be hosting a presentation on personal preparedness at the Emergency Nurses 2017 Conference in St. Louis, MO (Details below).

Title: Now is the Time, Personal Preparedness Can’t Wait!
Date: Thursday, September 14, 2017
Presentation time 3:15 PM – 4:15 PM
Room: 267

We hope conference attendees will be able to join us for this session.

For nurses who are not attending this conference, we recommend you undertake the following steps to get prepared as soon as possible:

  1. Assemble disaster supplies kit for home, work, and car
  2. Create a family disaster plan. Your family may not be together if a disaster strikes, so it is important to know which types of disasters could affect your area and have a plan in place that addresses how you’ll contact one another and reconnect if separated. Tailor this plan to any special needs your family has, including care of pets.
  3. Practice and update your plan regularly, just like a fire drill.
  4. Familiarize yourself with your organization’s emergency operations plan and know your role if a disaster strikes.

See https://www.fema.gov/media-library-data/20130726-1549-20490-4633/areyouready_full.pdf for more information on becoming personally prepared.

Alicia Gable, MPH