Culture of Safety and Preparedness: Benefits of Applying a Daily Mitigation Mindset in the Hospital Setting.

AIM: Utilizing the subjective experience of nurse executives who have supervised nurses during a major disaster in a hospital setting, this study aims to describe the subjective experience of nurse executives (NE) who have supervised nurses' responses to major disasters. This paper will focus on strategies to support nursing response to disasters, specifically to strengthen resiliency and the ability to maintain function despite the shock of a disaster, including those caused by climate change. METHODS: Semi-structured interviews were conducted with 11 hospital-based nurse executives who supervised nurses during some of the worst natural and human-made disasters in different regions of the United States. A phenomenological approach was used to analyze and describe emerging themes from the qualitative data. RESULTS: Three nurse executives demonstrated theme saturation for mitigation steps to augment traditional disaster readiness activities: (1) Assessment of human infrastructure: daily skills needed during disaster response; (2) Identification and study of failure points and metrics; (3) Strengthening human infrastructure: rectifying deficiencies; and (4) Monitoring metrics and making corrections during conventional periods. CONCLUSION: Mitigation steps may improve outcomes in hospital function during conventional times; therefore, these steps may improve resiliency and the ability to maintain functions during major disasters, including climate change.

Alternative Mental Health Interventions for Hispanic Women With Breast Cancer: A State of the Science Review.

Introduction: Current disadvantages in accessing healthcare services, particularly mental health resources, result in increased psychological dysfunction among Hispanic women with advanced breast cancer. Little is known about using alternative nonpharmacological therapies for Hispanic women experiencing psychological distress secondary to a breast cancer diagnosis. This state-of-the-science paper synthesizes current culturally appropriate alternative therapies that effectively address depressive symptoms, anxiety, and psychological distress among Hispanic women with breast cancer (HWBC). Methods: The search criteria included published articles that used alternative interventions to address psychological needs among HWBC. Ten studies met the inclusion criteria. Results: Four alternative interventions were identified in the literature that significantly met the cultural mental health needs of HWBC. Mindfulness and technology use were the two interventions most studied in this review. Conclusion: Evidence indicates that alternative therapies for mental health improve overall quality of life. Further research to attenuate psychological distress is needed to meet mental health needs among HWBC. Innovative methods such as the use of technology and mindfulness as well as integrating personalized care are crucial to address the cultural needs of HWBC.

Increasing Faculty Resources and Student Capacity Through Shared Faculty Expertise.

BACKGROUND: The ongoing nurse faculty shortage has resulted in a need for schools of nursing to become both innovative and creative in their approach to nursing education. A literature review revealed some schools of nursing across the United States are sharing faculty for undergraduate and pre-licensure nursing programs. PURPOSE: The purpose of this pilot project was to explore the effectiveness of a shared faculty content expert in a live-streamed lecture modality to improve nursing schools' access to high quality specialty content. The feasibility and satisfaction of sharing a course and faculty between two independent schools of nursing were evaluated. METHODS: An online synchronous format was utilized to share a mental health nursing course between two independent schools of nursing. RESULTS: Results indicated that theoretical classroom content and experiences can be shared and delivered synchronously among schools of nursing; however, challenges existed related to scheduling conflicts. Additionally, technology issues were found to negatively impact the student experience at times. CONCLUSION: Given the challenges identified in the project, an asynchronous content delivery modality may be a more advantageous option. Future research is needed to identify ways to mitigate the challenges experienced.

Nurse Executive Experiences With COVID-19: Now We Know-We Are Not Going Back.

We conducted semistructured telephone interviews with 2 hospital-based nurse leaders who supervised nurses during the initial phases of the COVID-19 pandemic in northeastern region of the United States. These interviews are a subset of a larger study with 11 nurse executives who supervised nurses during both natural and human-made disasters in different regions of the United States. Qualitative data were analyzed using a grounded theory approach, followed by a content analysis of emerging themes. Participants shared several key concepts: deep commitment of nurses in an extensive range of roles and responsibilities during tragic events; an emphasis on educational needs to best prepare nurses for disaster response; the importance of organizational strategies and definitive policies for supporting nurses' response and recovery; and mental/emotional health support as essential for nurses to cope with the events. The nurse executive participants reported many opportunities to enhance nurses' knowledge and skill set to augment care in the hospital. A team-based approach that leverages the expertise of team members to strengthen the health care team is implemented and demonstrates positive patient outcomes.

Ready to Respond: A Survey of Interdisciplinary Health-Care Students and Administrators on Disaster Management Competencies.

BACKGROUND: A sense of competency and confidence in disaster management is linked to response willingness and efficacy. This study assessed current health-care student disaster competency curricula and resultant confidence. METHODS: A survey was sent to students and administrators in nurse practitioner (NP), master of public health (MPH), and medical/osteopathic schools (MD/DO), assessing curriculum coverage of 15 disaster management competencies (1-4, total 15-60), and confidence in performing 15 related behaviors (1-7, total 15-105). One-way analysis of variance with Tukey's post-hoc and Mann-Whitney U-tests were used to examine group differences. RESULTS: A total of 729 students and 72 administrators completed the survey. Low coverage of all topics was reported by both students and administrators (mean 24.4; SD 9.6). Among students, NP students (21.66 ± 8.56) scored significantly lower than MD/DO (23.32 ± 8.19; P < 0.001) and MPH students (26.58 ± 9.06; P < 0.001) on curriculum coverage. Both administrators and students expressed low confidence in competence, with students significantly lower (P < 0.001). NP students scored higher (63.12 ± 20.69; P < 0.001) than both MPH (54.85 ± 17.82) and MD/DO (51.17 ± 19.71; P < 0.001) students. CONCLUSIONS: Health-care students report low coverage of topics considered to be necessary disaster response competencies, as well as their confidence to execute functions. This may negatively impact willingness and ability of these professionals to respond effectively in a disaster.

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

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.

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.

From Brainstorming to Strategic Plan: The Framework for the Society for the Advancement of Disaster Nursing: A Work in Progress.

Professional health care societies play a critical role in promoting excellence in patient care, educating and certifying their members on evidence-based practices, and pursuing relevant research agendas to advance the science in the field. Disaster nursing is a subspecialty of professional nursing characterized by a unique knowledge base and set of skills and abilities not used in normal daily health care activities. A disaster or large-scale public health emergency creates a sudden, unanticipated surge of patients with health care needs that far exceeds the capacity of the health care system. This creates a significant burden and risk for the nurses participating in the response. Recognizing the critical need to define scope of practice and core standards for disaster nursing and to promote greater nursing leadership in disaster preparedness and response, a group of subject matter experts established a professional society to provide leadership and guidance. The strategic planning process as described by M. Kwestel et al was used as the overarching framework for describing the design, development, and implementation of the new society. Establishment of the Society for the Advancement of Disaster Nursing is a definitive step toward improving national nurse readiness in the United States.

Survivor Notification of Post-Disaster Mental Health Services: An Integrative Review.

This integrative review identifies notification methods for psychiatric mental health services for adult survivors of natural disasters for articles published from 2011 through 2016. Databases searched included Scopus, Cochrane Library, CINAHL Plus, Ovid MEDLINE, and Ovid PsycINFO. The search was limited to English language. Initially, 273 titles/abstracts were reviewed, and 18 articles were retained for synthesis. Communication occurs through formal means of health care provider referrals and online programs (72%); informal supports are friends, family and clergy (28%). Mental health providers have significant impact on disaster recovery by developing plans for communication.

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.

Education for Developing and Sustaining a Health Care Workforce for Disaster Readiness.

The United States needs a national health care and public health workforce with the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. This requires that all of our nation's nurses and health care providers have unrestrained access to high-quality, evidence-based, competency-driven education and training programs. Programs of study for disaster readiness in both the academic and service sectors are limited in number. Those that do exist may be based upon consensus rather than competency and be price prohibitive. They may fail to fully capitalize on existing educational technologies and may not be accessible to all providers. Nurse leaders are ideally positioned to recognize, advocate, and support the need for a broad array of learning options to strengthen the readiness of the health care workforce for disaster response. This article reviews current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.

A model of risk reduction for older adults vulnerable to nursing home placement.

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

Listening to and learning from older adult Hurricane Katrina survivors.

OBJECTIVE: The objective of this pilot study was to explore how Hurricane Katrina affected older adult disaster survivors. DESIGN AND SAMPLE: Participants for this descriptive exploratory pilot study were recruited from churches and senior centers on the Gulf Coast of Mississippi. Of the 224 participants, one hundred provided additional comments at the end of a forced-response questionnaire. MEASURES: Manifest content analysis was used to examine the participants' comments by identifying, coding, and categorizing their responses to the open-ended question. The codes were based on conditions and behaviors that might be exhibited by disaster victims. RESULTS: Themed categories were losses and needs, giving advice, justification for continuing to live in this disaster-prone region, deterrents and facilitators of home evacuation, spirituality and faith, manageability, bereavement, grief, anger, and natural debriefing. CONCLUSION: The strongest message of these survivors was the need to be heard by public health nurses, other public health officials preparing for disasters, and those in positions to render aid.

Disaster strikes! Long-term care resident outcomes following a natural disaster.

This report describes the outcomes of 17 long-term care residents who were participating in a nursing intervention study. The residents were evacuated for 5 days due to a severe summer storm that caused widespread power outages. These residents were seen the day of the storm and three times per week for 2 weeks following their return to the nursing home. More than half of the participants had significant changes in their NEECHAM Confusion Scale scores (n = 11) and modified Confusion Assessment Method scores (n = 9) scores, suggesting the onset of delirium. Two participants were hospitalized within the 2 weeks of the evacuation. One participant died unexpectedly. This report provides a rare look into the negative effects of a short-term evacuation due to a natural disaster.

Exploring incentives for RNs to return to practice: a partial solution to the nursing shortage.

Although many have suggested strategies to resolve the nursing shortage, few have considered inactive RNs. This pilot study investigated reasons why nurses leave the practice, the type of work environment and resources necessary to entice RNs to return to practice, and the specific skills required to assist RNs in feeling confident and competent to return to practice. Herzberg's Two-Factor Theory was used to study motivation and hygiene factors enticing RNs to practice. A screening questionnaire was sent to 1,004 randomly selected RNs in Missouri to determine who were licensed but not practicing. Fifty-two full questionnaires were mailed and 33 (63%) were returned. Quantitative data were analyzed using SPSS, whereas qualitative data were coded and analyzed using manifest content analysis. The lack of motivators such as recognition of one's work and achievements was one reason why RNs left the practice. The hygiene factors of money, improved working conditions, refresher courses, and health insurance would motivate RNs to return to practice. Those wishing to entice inactive nurses to practice will need to offer sign-on bonuses or make the hourly wages and benefits package very competitive. This study indicates that nurses value flexible working hours, part-time opportunities, consideration of family lives, and positive relationships with administrators.

Disaster planning: are gerontological nurses prepared?

This article is a review of basic, but important information about disaster planning considerations for older populations. The recent hurricane experiences in the South confirmed how critical this planning is, and the importance of early evacuation in saving lives. This is highlighted when comparing the official responses during Hurricane Katrina and Hurricane Rita. Advance preparations result in more control and safety in a dangerous situation. In New Orleans, the delay in evacuation of older adults resulted in panic and confusion, without an easy solution. Those who could not be easily evacuated remained, sometimes at great cost. Gerontological nurses need to advocate for the planning and resources that would assist older adults in a safe and early evacuation if indicated. Adequate support personnel, transportation, and pre-positioned supplies should all be in place for use following a disaster event. Rescue is more costly than evacuation, in both resources and human suffering, and places both rescuers and victims at risk. Each individual, facility, and community needs disaster and evacuation plans that are widely disseminated in advance of any disaster. These plans must address the unique needs of older adults. Hurricane Katrina demonstrated the importance of evacuation before the impact of disaster. When individuals have advance notice of an impending disaster, evacuation can be conducted in a more orderly, planned way to get older adults to safety. Hurricane Rita proved that even advance evacuation is not problem-free, but is well worth the effort. Each facility needs to be prepared to be self-sustaining, to "shelter in place" for at least 72 hours. This requires having the resources and supplies to support at least minimal safe function. However, facilities in locations that could be isolated for longer periods of time should consider having even more supplies in reserve. Recent events may prompt gerontological nurses to ask themselves, their facilities, and communities--Are we prepared?

Faculty practice and roles of staff nurses and clinical faculty in nursing student learning.

The perceptions of staff nurses and clinical nurse faculty on the roles they play in nursing student learning were examined. The study also sought to explore how faculty practice status affected these perceived roles. Nursing schools with generic baccalaureate nursing programs in the middle Atlantic region composed the study population. A convenience sample of two schools that expected their undergraduate clinical faculty to engage in faculty practice and two schools that did not expect faculty practice participated in the study. Clinical faculty members (15) and nursing education administrators (4) from each school participated, as well as staff nurses (22) and nursing service administrators (4) from each school's related hospital. Focus groups and individual interviews were conducted. Manifest and latent content analyses were used to examine the issues. Staff nurses who worked with practicing faculty reported fewer instances of role overload, conflict, and ambiguity than when they worked with nonpracticing faculty. Lack of clear communication and delineation of expectations among administrators, staff, faculty, and students were cited as major factors in perceived role problems. Administrators, faculty, and staff nurses viewed high student/faculty ratios as a causative factor in the faculty's inability to meet all teaching objectives with students.