Facilitating an Interprofessional Course on Climate Change and Public Health Preparedness.

In this paper, we share the theories that guided the design of an interprofessional education course on Climate Change and Public Health Preparedness and how the course supported students' professional interest and action competence as they move through their education and into their professional work in the context of our unfolding climate crisis. The course was guided by the public health emergency preparedness domains and was built to allow for students to explore applications of the content for themselves and their own profession. We designed the learning activities to support personal and professional interest development and help students move into perceived and demonstrated action competence. For the evaluation of our course, we asked the following research questions: What kinds of personal and professional commitments to action did students propose by the end of the course? Did these vary in depth and specificity and by the number of credits they enrolled in? In what ways did students develop personal and professional action competence over the course? Finally, how did they show personal, professional, and collective agency related to the course content on adaptation, preparedness, and mitigation of the health impacts from climate change? Using qualitative analysis guided by action competence and interest development theories, we coded student writing from course assignments. We also conducted comparative statistical analysis to assess differential impacts for students who enrolled for one versus three credits. The results show that this course design supported students' progression of knowledge and perceived ability in specific individual and professional collective actions to reduce the health impacts of climate change.

Healthcare Impacts Associated with Federally Declared Disasters-Hurricanes Gustave and Ike.

People impacted by disasters may have adverse non-communicable disease health effects associated with the disaster. This research examined the independent and joint impacts of federally declared disasters on the diagnosis of hypertension (HTN), diabetes (DM), anxiety, and medication changes 6 months before and after a disaster. Patients seen in zip codes that received a federal disaster declaration for Hurricanes Gustave or Ike in 2008 and who had electronic health records captured by MarketScan® were analyzed. The analysis included patients seen 6 months before or after Hurricanes Gustav and Ike in 2008 and who were diagnosed with HTN, DM, or anxiety. There was a statistically significant association between post-disaster and diagnosis of hypertension, X2 (1, n = 19,328) = 3.985, p = 0.04. There was no association post-disaster and diabetes X2 (1, n = 19,328) = 0.778, p = 0.378 or anxiety, X2 (1, n = 19,328) = 0.017, p = 0.898. The research showed that there was a change in the diagnosis of HTN after a disaster. Changes in HTN are an additional important consideration for clinicians in disaster-prone areas. Data about non-communicable diseases help healthcare disaster planners to include primary care needs and providers in the plans to prevent the long-term health impacts of disasters and expedite recovery efforts.

Social support, educational, and behavioral modification interventions for improving household disaster preparedness in the general community-dwelling population: a systematic review and meta-analysis.

Background: The efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown. Objective: To ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness. Design: Systematic review and meta-analysis. Methods: Databases, trial registers, reports, and websites were searched, and citation trails followed utilizing replicable methods. Individual, cluster, and cross-over randomized controlled trials of non-institutionalized, community-dwelling populations and non-randomized controlled trials, controlled before-after, and program evaluation studies were included. At least two review authors independently screened each potentially relevant study for inclusion, extracted data, and assessed the risk of bias. Risk of bias was assessed using Cochrane's RoB2 tool for randomized studies and ROBINS-I tool for nonrandomized studies. Meta-analyses were applied using a random-effects model. Where meta-analysis was not indicated, results were synthesized using summary statistics of intervention effect estimates and vote counting based on effect direction. The evidence was rated using GRADE. Results: 17 studies were included with substantial methodological and clinical diversity. No intervention effect was observed for preparedness supplies (OR = 6.12, 95% 0.13 to 284.37) or knowledge (SMD = 0.96, 95% CI -0.15 to 2.08) outcomes. A small positive effect (SMD = 0.53, 95% CI 0.16 to 0.91) was observed for preparedness behaviors, with very low certainty of evidence. No studies reported adverse effects from the interventions. Conclusion: Research designs elucidating the efficacy of practical yet complex and multi- faceted social support, educational, and behavioral modification interventions present substantial methodological challenges where rigorous study design elements may not match the contextual public health priority needs and resources where interventions were delivered. While the overall strength of the evidence was evaluated as low to very low, we acknowledge the valuable and informative work of the included studies. The research represents the seminal work in this field and provides an important foundation for the state of the science of household emergency preparedness intervention effectiveness and efficacy. The findings are relevant to disaster preparedness practice and research, and we encourage researchers to continue this line of research, using these studies and this review to inform ongoing improvements in study designs.

National Estimates of the Reserve Capacity of Registered Nurses Not Currently Employed in Nursing and Emergency Nursing Job Mobility in the United States.

STUDY OBJECTIVE: In a large-scale disaster, recruiting from all retired and nonworking registered nurses is one strategy to address surge demands in the emergency nursing workforce. The purpose of this research was to estimate the workforce capacity of all registered nurses who are not currently working in the nursing field in the United States by state of residence and to describe the job mobility of emergency nurses. METHODS: Weighted population estimates were calculated using the 2018 National Sample Survey of Registered Nurses. Estimates of all registered nurses, including nurse practitioners who were not actively working in nursing as well as only those who were retired, based on demographics, place of residence, and per 1,000 state population, were visualized on choropleth maps. Workforce mobility into and out of the emergency nursing specialty between 2016 and 2017 was quantified. RESULTS: Of the survey participants, 61% (weighted n=2,413,382) worked full time as registered nurses at the end of both 2016 and 2017. At the end of 2017, 17.3% (weighted n=684,675) were not working in nursing. The Great Lakes states and Maine demonstrated the highest per capita rate of those not working in nursing, including those who had retired. The largest proportion of those entering the emergency nursing specialty were newly licensed nurses (15%; weighted n=33,979). CONCLUSION: There is an additional and reserve capacity available for recruitment that may help to meet the workforce needs for nursing, specifically emergency nurses and nurse practitioners, across the United States under conditions of a large-scale disaster. The results from this study may be used by the emergency care sector leaders to inform policies, workforce recruitment, workforce geographic mobility, new graduate nurse training, and job accommodation strategies to fully leverage the potential productive human capacity in emergency department care for registered nurses who are not currently working.

National Assessment of Nursing Schools and Nurse Educators Readiness for Radiation Emergencies and Nuclear Events.

Nurses will play a crucial role in responding to a public health emergency resulting from nuclear war or other large-scale release of radiation into the environment and in supporting the National Health Security Strategy. Schools of nursing are ultimately responsible for developing a competent nursing workforce prepared to assess a population's public health emergency needs and respond to these low-frequency but high-impact events. This responsibility includes the provision of specific content and training regarding how to respond and care for patients and communities in the event of a nuclear or radiation emergency. To date, however, there has been a lack of empirical evidence focusing specifically on nursing schools' capacity to prepare nurses for radiation emergencies and nuclear events, as well as perception of risk. This study employed a cross-sectional survey administered to a nationwide sample of nursing school administrators and faculty to assess content, faculty expertise, planning, and perception of risk related to radiation emergencies and nuclear events.

The Veterans Health Administration Registered Nurse Transition-to-Practice Program: A Qualitative Evaluation of Factors Affecting Implementation.

This qualitative evaluation was conducted to assess factors affecting implementation of the Veterans Health Administration Registered Nurse Transition-to-Practice program. Factors commonly mentioned in semistructured telephone interviews with Chief Nurse Executives, Program Coordinators, and their teams as affecting implementation fell into four primary domains: materials and support from the Office of Nursing Services, facility-level dynamics and resources, program-specific requirements, and program outcomes. Initiatives to provide support for program implementation are proceeding.

Call to Action: The Case for Advancing Disaster Nursing Education in the United States.

PURPOSE: Climate change, human conflict, and emerging infectious diseases are inexorable actors in our rapidly evolving healthcare landscape that are triggering an ever-increasing number of disaster events. A global nursing workforce is needed that possesses the knowledge, skills, and abilities to respond to any disaster or large-scale public health emergency in a timely and appropriate manner. The purpose of this article is to articulate a compelling mandate for the advancement of disaster nursing education within the United States with clear action steps in order to contribute to the achievement of this vision. DESIGN AND METHODS: A national panel of invited disaster nursing experts was convened through a series of monthly semistructured conference calls to work collectively towards the achievement of a national agenda for the future of disaster nursing education. FINDINGS: National nursing education experts have developed consensus recommendations for the advancement of disaster nursing education in the United States. This article proposes next steps and action items to achieve the desired vision of national nurse readiness. CONCLUSIONS: Novel action steps for expanding disaster educational opportunities across the continuum of nursing are proposed in response to the current compelling need to prepare for, respond to, and mitigate the impact of disasters on human health. U.S. educational institutions and health and human service organizations that employ nurses must commit to increasing access to a variety of quality disaster-related educational programs for nurses and nurse leaders. CLINICAL RELEVANCE: Opportunities exist to strengthen disaster readiness and enhance national health security by expanding educational programming and training for nurses.

Progress on a Call to Action: Nurses as Leaders in Disaster Preparedness and Response.

This article provides an update on the progress of the "Call to Action: Nurses as Leaders in Disaster Preparedness and Response." A steering committee, initiated, directed, and supported by the Veterans Emergency Management Evaluation Center of the US Department of Veterans Affairs, has undertaken the work of bringing together subject matter experts to develop a vision for the future of disaster nursing. The ultimate goal is to ensure that every nurse is a prepared nurse. As one result of this work, the Society for the Advancement of Disaster Nursing has held its inaugural meeting in December 2016.

Nurses as Leaders in Disaster Preparedness and Response--A Call to Action.

PURPOSE: To develop a vision for the future of disaster nursing, identify barriers and facilitators to achieving the vision, and develop recommendations for nursing practice, education, policy, and research. DESIGN AND METHODS: A series of semistructured conference calls were conducted with 14 national subject matter experts to generate relevant concepts regarding national nursing workforce preparedness. An invitational daylong workshop hosted by the Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, was held in December 2014 to expand and refine these concepts. Workshop participants included 70 nurses, emergency managers, and a broad range of public health professionals. Conference call notes and audiotapes of the workshop were transcribed and thematic analysis conducted to outline a vision for the future of nursing in disaster preparedness and response, and to articulate an agenda for nursing practice, education, policy, and research to achieve that vision. FINDINGS: The group developed a vision for the future of disaster nursing, and identified current barriers and opportunities to advance professional disaster nursing. A broad array of recommendations for nursing practice, education, policy, and research, as well as implementation challenges, are summarized in this article. CONCLUSIONS: This project represents an important step toward enhancing nurses' roles as leaders, educators, responders, policymakers, and researchers in disaster preparedness and response. Nurses and the health and human service organizations that employ them are encouraged to engage in an expansive national dialogue regarding how to best incorporate the vision and recommendations into their individual lives and the organizations for which they work. CLINICAL RELEVANCE: Nurses comprise the largest healthcare workforce, and opportunities exist to strengthen disaster readiness, enhance national surge capacity, and build community resiliency to disasters.

Willingness, ability, and intentions of health care workers to respond.

Health care workers (HCWs) are a critical component of the emergency management cycle (prevention, mitigation, preparation, response, and recovery). The potential for large numbers of injured from either a man-made or natural disaster has resulted in the development of surge capacity plans and attempts to predict how many HCWs will be available to respond. Since 1991 (with the majority of the research published in 2002 and later), researchers have been conducting studies to learn about the willingness, ability, and intentions of HCWs to respond to disasters. Potential and real barriers to disaster response are being explored as well. This chapter focuses on research authored or coauthored by nurses. Nurse-authored research is just a portion of the growing body of knowledge in this area; however, the findings are consistent with other published works. HCWs are more likely to be willing and able to respond to natural disasters and less likely to be willing and able during infectious outbreaks or incidents with potential exposure to harmful agents (biological, chemical, nuclear, or radiological). HCW concerns include safety of self and family, availability of protective equipment, medicines and vaccines, and caretaking responsibilities (children, elders, and pets).

US Public Health Service Commissioned Corps Nurses: responding in times of national need.

The US Public Health Service (PHS) is one of 7 uniformed services operating for the nation. Nurses form the largest category of personnel in the PHS and are integral members of teams identified to deploy in times of national need. PHS nurses serve "in harm's way" to protect and defend the public health of the nation during national emergencies and disasters of great magnitude, such as 9/11, Hurricane Katrina, the H1N1 virus outbreak, and so forth. In this article, the authors discuss how active-duty Commissioned Corps nurses in the US PHS respond during times of national need. Military nurses may be asked to serve in war zones, participate in humanitarian missions, and care for military beneficiaries. By contrast, the role of nurses in the Commissioned Corps is to protect, defend, and advance the public health of the nation. PHS nurses are critical members of interdisciplinary health care teams organized to provide health care to diverse populations in the United States and abroad.

The National Response Plan: Health and Human Services the lead for Emergency Support Function #8.

On January 6, 2005, the National Response Plan (NRP) was introduced to standardize a national approach for responding to natural or man-made threats. The underlying structure for the NRP is the National Incident Management System, which establishes standardized training, organization, and communications procedures that can be used by multiple jurisdictions to interact in a disaster. The NRP clearly identifies authority and leadership responsibilities. The NRP organizes the government's emergency operations into 15 emergency support functions, of which Emergency Support Function #8 pertains to public health and medical services. The United States Public Health Service (PHS) Commissioned Corps is one of the seven uniformed services of the United States, and PHS officers can be deployed to help meet urgent public health needs when traditional mechanisms and resources are overwhelmed. The role of PHS nurses is presented.

Patient safety: a priority in the US Department of Health and Human Services.

This descriptive article provides information about some of the major patient safety initiatives within the operating and staff divisions of the US Department of Health and Human Services. The research for this article was done using the internet. Many health professionals and consumers turn first to the internet while researching a disease or new diagnosis, or while seeking general health information. It is important for nurse administrators to know what resources are readily available to help them implement regulatory requirements, what voluntary programs exist for reporting problems with medical products, what resources are available for consumers to make informed health choices, and where they can get information about specific Department of Health and Human Services programs.