Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey.

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Cognitive Interview Validation of a Novel Household Hazard Vulnerability Assessment Instrument.

BACKGROUND: Weather and climate disasters are responsible for over 13 000 US deaths, worsened morbidity, and $1.7 trillion in additional costs over the last 40 years with profound racial disparities. OBJECTIVES: This project empirically generated items for a novel survey instrument of household hazard vulnerability with initial construct validation while addressing racial bias in the data collection process. METHODS: Cognitive interviews facilitated understanding regarding the performance of drafted survey questions with transdisciplinary expert panelists from diverse US regions on unique hazard/disaster/event items. To prevent representation bias in data collection, those with Black and/or African American racial, biracial, or multiracial identities were over-sampled. Interview video recordings were qualitatively analyzed using thematic and pattern coding. RESULTS: A cognitive process mapped to themes of disaster characteristics, resources, individual life facets, and felt effects was revealed. We identified 379 unique instances of linked terms as synonyms, co-occurring, compounding, or cascading events. Potential for racial bias in data collection was elucidated. Analysis of radiation exposure, trauma, and criminal acts of intent items revealed participants may not interpret survey items with these terms as intended. CONCLUSION: Potential for racial bias exists relative to water dam failure, evacuation, external flood, suspicious packages/substances, and transportation failure. Hazard terms that were not interpreted as intended require further revision in the validation process of individual or household disaster vulnerability assessments. Several commonalities in the cognitive process and mapping of disaster terms may be utilized in disaster and climate change research aimed at the individual and household unit of analysis.

Emergency Nursing Workforce, Burnout, and Job Turnover in the United States: A National Sample Survey Analysis.

INTRODUCTION: Few studies have examined emergency nurses who have left their job to better understand the reason behind job turnover. It also remains unclear whether emergency nurses differ from other nurses regarding burnout and job turnover reasons. Our study aimed to test differences in reasons for turnover or not currently working between emergency nurses and other nurses; and ascertain factors associated with burnout as a reason for turnover among emergency nurses. METHODS: We conducted a secondary analysis of 2018 National Sample Survey for Registered Nurses data (weighted N = 3,004,589) from Health Resources and Services Administration. Data were analyzed using descriptive statistics, chi-square and t-test, and unadjusted and adjusted logistic regression applying design sampling weights. RESULTS: There were no significant differences in burnout comparing emergency nurses with other nurses. Seven job turnover reasons were endorsed by emergency nurses and were significantly higher than other nurses: insufficient staffing (11.1%, 95% confidence interval [CI] 8.6-14.2, P = .01), physical demands (5.1%, 95% CI 3.4-7.6, P = .44), patient population (4.3%, 95% CI 2.9-6.3, P < .001), better pay elsewhere (11.5%, 95% CI 9-14.7, P < .001), career advancement/promotion (9.6%, 95% CI 7.0-13.2, P = .01), length of commute (5.1%, 95% CI 3.4-7.5, P = .01), and relocation (5%, 95% CI 3.6-7.0, P = .01). Increasing age and increased years since nursing licensure was associated with decreased odds of burnout. DISCUSSION: Several modifiable factors appear associated with job turnover. Interventions and future research should account for unit-specific factors that may precipitate nursing job turnover.

Public health nursing workforce and learning needs: A national sample survey analysis.

OBJECTIVES: Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States. DESIGN: Secondary data analysis of the 2018 National Sample Survey of Registered Nurses. SAMPLE: Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce. MEASUREMENTS: Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed. RESULTS: Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting. CONCLUSIONS: Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.

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.

Generating Data Visualizations of Longitudinal Cohort Ambient Air Pollution Exposure: Report-Back Intervention Development in Participatory Action Research.

A civic engagement and data science design was used to develop a report-back intervention to address stakeholder concerns related to air emissions surrounding a coke oven factory near Buffalo, NY. This factory had historically emitted high levels of benzene pollution and ceased operation in October 2018 because of violations of the US Clean Air Act and US Resource Conservation and Recovery Act. Using publicly available air pollution and weather data, descriptive time series and wind-rose data visualizations were developed using open-source software as part of a two-page report-back brief. Data from two air toxics monitoring sites in this direction suggest that industrial sources were likely the major contributor to the benzene in the air at these locations prior to May 2018, after which traffic emissions became the likely major contributor. Wind-rose visualizations demonstrated that the wind typically blew toward the northeast, which was qualitatively consistent with locations of stakeholder concerns. With the factory closed, collective efforts subsequently shifted to address traffic emission air pollution sources, factory site cleanup, and ground and water pollution mitigation. Because this intervention utilized open-source software and publicly available data, it can serve as a blueprint for future data-driven nursing interventions and community-led environmental justice efforts.

National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States.

INTRODUCTION: The goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. METHODS: We generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. RESULTS: Weighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DISCUSSION: By quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.

Racial Identity and Transcultural Adoption.

Transracial/transcultural adoption is defined as a child of one race or ethnic group placed with parent(s) of a different race or ethnic group. An estimated 2 million children in the United States were identified as adopted in the 2010 census, and approximately one-fourth of these were transracial adoptions. Both a history of adoption and a strong ethnic or racial identity are specifically associated with health-related risk and protective factors for psychosocial, academic, and health behavior outcomes. A patient with a history of transracial adoption presents unique and important considerations for culturally responsive nursing care. This article begins with nursing practice considerations for transracially adoptive patients and provides an overview of epidemiology; relevant trauma informed nursing care;. laws and racial identity formation, and a mental model of health disparities to guide future directions. We synthesize information relevant to nursing care of individuals who are transracially adopted and racial/ethnic identity formation, including socialization and a merging model to conceptualize identities. The article also discusses principles of trauma informed care and health disparities and future improvements in the context of this population.

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.

Home environment allergen exposure scale in older adult cohort with asthma.

OBJECTIVES: Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested. METHODS: Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately. RESULTS: The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R2 = .02) and quality of life (F = 6.45, p = 0.01, R2 = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = - 3.09, p = 0.004). CONCLUSION: The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.

RéSUMé: OBJECTIFS: Les expositions environnementales à domicile sont une source principale d'exacerbation de l'asthme. Il existe une lacune dans les modèles de soutien à la décision qui regroupent efficacement les scores d'évaluation de l'exposition à domicile pour des interventions ciblées et adaptées. Trois méthodes de développement d'une échelle d'exposition aux allergènes de l'environnement domestique pour les personnes atteints d'asthme (pondérée par réduction de dimension, non pondérée, basée sur un biomarqueur de précision) ont été comparées et la disparité raciale testée. MéTHODES: Les mesures de base d'une cohorte longitudinale de 187 personnes âgées asthmatiques ont été analysées à l'aide de capteurs d'humidité et de particules, de tests d'allergie et d'une liste de contrôle de l'environnement domestique. Les poids pour l'échelle de réduction des dimensions ont été obtenus à partir de l'analyse factorielle, appliquée aux charges > 0,35. Les échelles ont été testées dans des modèles de régression linéaire avec contrôle de l'asthme et résultats de la qualité de vie avec asthme. Les disparités raciales ont été testées à l'aide de tests t. La performance de l'échelle a été testée à l'aide d'analyses de régression non pondérées avec contrôle de l'asthme et résultats de la qualité de vie avec asthme, séparément. RéSULTATS: L'échelle pondérée empiriquement en 7 éléments a démontré les meilleures performances avec les associations de contrôle de l'asthme (F = 4,65, p = 0,03, R2 = 0,02) et la qualité de vie (F = 6,45, p = 0,01, R2 = 0,03) comme suit : preuve d'exposition aux cafards/souris, à la poussière, à la moisissure, à la fumée de tabac, ventilateur de salle de bain correctement aéré, auto-déclaration des cafards/souris/rats et accès à un aspirateur à filtre HEPA. Les animaux de compagnie à l'intérieur ont été mesurés sur une échelle séparée. Des différences raciales ont été observées (t = -3,09, p = 0,004). CONCLUSION: Les scores de l'échelle d'exposition aux allergènes de l'environnement domestique étaient associés à des disparités raciales. La reproduction de ces méthodes dans des populations résidant dans des logements à haut risque/à faible revenu peut générer une évaluation cliniquement significative et adaptée des déclencheurs de l'asthme. Un examen plus approfondi des variables qui traitent de la réactivité allergique et des résultats des biomarqueurs est indiqué pour améliorer le potentiel d'un score de prévention de précision.