Chapter 16 And 17 Study Guide

Question 1

What is the framework for global health nursing assessment?

Answer 1

-The slogan, think globally and act locally, captures the essence of caring for our interconnected world

-When community/public health nurses (C/PHNs) partner with the community client to assess health status, one useful guide is the universal imperatives of care

-For instance, determining how many nurses a community needs depends in part on knowing the characteristics of the community, the people, and the predominant state of health

-These universal imperatives are reflected in the elements of the community assessment framework

-After completing a community assessment, C/PHNs determine which services to provide by referring to the core functions and 10 essential public health services to guide their care

Question 2

What are the elements of the community assessment framework?

Answer 2

-Patterns of care

-Demographic transitions

-Epidemiologic transitions

Question 3

What are the patterns of care?

Answer 3

-As with any assignment in nursing, our first task is to assess the client

-When the client is an entire population, the assessment can be quite substantial

-In this case, we can use a framework to guide our review

-Certain social conditions of living are known to influence and even determine health among all populations

-When the social determinants of health are reviewed together, we quickly learn about the client population and their knowledge, behavior, and values

-We also assess the health infrastructure within their country or region

-Data describing these patterns have proven to be good predictors of the overall health of a population

-Patterns allow us to design culturally appropriate care solutions affecting health, wellness, and illness of populations, both within and between countries and communities

-These patterns of demographics are recognizable and measured across populations

Question 4

What are the categories of patterns for care?

Answer 4

-Patterns of place or the lived environment

-Patterns of perceptions of health care

-Patterns of privilege or inequality

-Pattern of population health differences (demographics)

-Patterns of providers

-Patterns of procedures and interventions

-Patterns of partnerships

-Patterns of politics and policies

-Patterns of personal insight of health care workers

Question 5

What are the patterns of place or the lived environment?

Answer 5

-Rural

-Urban

-Climate influence

Question 6

What are the patterns of perceptions of health care?

Answer 6

-Influence of culture

-Influence views and acceptance of healing treatments

-Influence acceptance of nurses and other health care providers

-Affected by attitudes toward women

Question 7

What are the patterns of privilege of inequality?

Answer 7

-Living conditions, including access to nutritional food and clean water

-Daily functioning including physical safety

-Quantity and quality of education for children, especially girls and women

-Level of health literacy

-Preference of learning style

-Access to employment

-Access to affordable health care resources

-Informed health care decisions, including who lives or dies

Question 8

What are the patterns of population health differences (demographics)?

Answer 8

-Birth rates (fertility)

-Infant and child survival rates

-Life expectancy rates

-Rates of infectious and communicable diseases

-Rates of noncommunicable diseases and chronic illnesses (morbidity)

-Death rates (mortality)

Question 9

What are the patterns of providers?

Answer 9

-Traditional healers

-Trained community health workers

-Community health nurses

-Midwives and physician extenders

-Physicians

-Differing education levels and requirements for licensure

Question 10

What are the patterns of procedures and interventions?

Answer 10

-Sustainable and culturally appropriate

-Primary care

-Health promotion

-Primary prevention

Question 11

What are the patterns of partnerships?

Answer 11

-Peripheral health unit and health station

-District hospitals

-Public health and governmental health care agencies

-Nonprofit and nongovernmental organizations (NGOs)

-Universities

Question 12

What are the patterns of politics and policies?

Answer 12

-Universal health care

-Access to treatment and pharmaceuticals

-Payment to providers

-Local health care policies

-Municipal governments

-National governments

-International collaboration

-Cooperation versus conflict or violence

Question 13

What are the patterns of personal insight of health care workers?

Answer 13

-Personal health and physical well-being

-Personal values and cultural beliefs, including religious beliefs and attitudes

-Personal knowledge of community health nursing theory and practice

Question 14

What are examples of primary prevention?

Answer 14

-Providing childhood vaccinations and yearly flu shots

-Encouraging older people to install and use safety devices (e.g., grab bars by bathtubs, handrails on steps) to prevent injuries from falls

-Teaching young adults healthy lifestyle behaviors, so that they can make them habitual behaviors for themselves and their children

-Working through a local health department in consultation with a school district to help control and prevent communicable diseases such as measles, pertussis, or varicella by providing regular immunization programs and vaccine oversight

-Instructing a group of overweight individuals on how to follow a well-balanced diet while losing weight to prevent nutritional deficiency

-Teaching safe sex practices or the dangers of smoking/vaping and substance abuse

-Serving on a fact-finding committee exploring the effects of a proposed toxic waste dump on the outskirts of town

Question 15

What are examples of secondary prevention?

Answer 15

-Conducting community hypertension and cholesterol screening programs to help identify high-risk individuals and encourage early treatment to prevent heart attacks or stroke

-Encouraging breast and testicular self-examination, regular mammograms, and Pap smears for early detection of possible cancers and providing skin testing for tuberculosis

-Assessing for early signs of child abuse in a family, emotional disturbances among widows, or alcohol and drug abuse among adolescents

Question 16

What are examples of tertiary prevention?

Answer 16

-Treatment and rehabilitation of persons after a stroke to reduce impairment

-Postmastectomy exercise programs to restore functioning

-Early treatment and management of diabetes to reduce problems or slow their progression

-Insisting that businesses provide wheelchair access

-Warning urban residents about the dangers of a chemical spill

-Recalling a contaminated food or drug product

-Preventing injuries among survivors and volunteers during rescue in an earthquake, fire, hurricane, mass casualty incident due to gun violence, or even a terrorist attack

Question 17

What are demographics transitions?

Answer 17

-The next type of assessment is to determine the demographics of a population group by evaluating whether they are increasing or decreasing in number based on the balance between births and deaths and whether there are any migrations, such as rural-to-urban

-Demographic transition theory explains that population demographics in high-income countries changed slowly over several centuries

-As low- and middle-income countries began to evolve in the 20th century, populations changed more rapidly over a few decades

-“Long life, small family”: Starting in the 18th century, high-income Western European and English-speaking countries followed four stages in population change at a fairly slow rate
1. The final result for such populations today is a demographic with low fertility rates, an aging population, and decline in total numbers
2. Reasons for decline in mortality are thought to be from advances in public health, nutrition, medical care, and management of infectious disease

-“Short life, large family”: During the 20th century, low-income countries experienced a rapid growth in the total population, primarily from a rapid decline in deaths while birth rates remained high resulting in a very young population
1. Socioeconomic development in low-income countries also resulted in the movement of populations from rural to urban settings in search of employment while also gaining improved access to health
2. The availability of family planning has also had a stabilizing influence on population size

Question 18

What are the epidemiologic transitions?

Answer 18

-The third concept in our framework of population assessment is to evaluate epidemiologic transitions

-These are grouped according to the predominant health outcomes, or levels of public health, experienced by a society

-There are three eras of epidemiologic transitions of public health, named according to historical trends of health and health conditions as described in a classic articles by Breslow and Omran

-In high-income nations, these eras progressed sequentially

-However, in our world today, some countries may experience two or all three eras in different regions of their nation at the same time

Question 19

What are the different epidemiologic transitions?

Answer 19

-The Era of Infectious Diseases

-The Era of Chronic, Long-Term Health Conditions
1. The Era of Social Health Conditions

Question 20

What is the Era of Infectious Diseases?

Answer 20

-Throughout most of history, populations died from infectious diseases such as the plague, tuberculosis, puerperal fever, measles, and others

-The death rate was high, and life expectancy was not very long

-During this era, the birth rate was also high

-Families had many children because they knew that most children would die before adulthood and yet as adults aged, they depended on their children for care

Question 21

What is the Era of Chronic, Long-Term Health Conditions?

Answer 21

-With the advent of antibiotics, people survived common infections and started to live longer

-Because children survived into adulthood, the birth rate dropped

-As people survived infections and aged, they developed chronic, long-term illnesses such as heart disease, cancer, and arthritis

Question 22

What is the Era of Social Health Conditions?

Answer 22

-More recently, a new array of health conditions are affecting world populations

-These new problems are anchored in social issues, as reflected in the slogan, where you live determines your health

-The wealth or poverty of your neighborhood reflects whether the streets are safe, housing is adequate, healthy food options are available, and schools and municipal services are adequate

-Personal lifestyle behaviors contribute to social health conditions, such as addictions and obesity, while social behaviors contribute to others, such as gang membership, prostitution, sexual abuse, and deviant behavior

-The popular press has exposed many of these conditions

-Documentaries and reports have helped raise awareness about the effects of methamphetamine on entire communities, the abuse of opioid prescription painkillers, the obesity epidemic growing throughout the world, and the exploitation of children through human trafficking

Question 23

What are the global health concepts?

Answer 23

-Global burden of disease (GBD)

-Health for all and HiAP initiatives

-Primary health care (PHC) achievements

-Sustainable development goals (SDGs)

-Telehealth

-Women’s health

Question 24

What is the global burden of disease?

Answer 24

-When populations or societies experience disadvantages socially, economically, or environmentally, these differences are called health disparities

-The calculation of health disparities is the goal of a series of studies known as the global burden of disease (GBD)

-GBD is the measure for a population of disability-adjusted life years (DALY), which is an equation that adds the total years of life lost (YLL) due to diseases and premature mortality to the years lived with disability (YLD)

-The impact of public health interventions is calculated the same way, but using presumed years saved

-Data collection and data analysis are an important part of the C/PHN toolkit

-In addition to morbidity and mortality rates, one data tool used in global health helps to measure what it costs society when not everyone is healthy and helps answer the following questions
1. If a member of your family dies, what is the impact to your family?
2. What does it cost if you miss a month of work or school because of an illness?
3. What does it cost a country when adults have high rates of diabetes or depression, or when the greatest cause of disability in children age 5 to 14 years is from iron deficiency?

-The first GBD study was commissioned by the World Bank in 1990
1.It was unique for its time because it brought together economists and health experts to evaluate health as an economic investment
2. That same year, the World Health Organization (WHO) assumed responsibility for the GBD study which emphasized the impact of disability (morbidity) and death (mortality) rates
3. Since 2010, the IHME has repeated the study at regular intervals
4. Because the GBD studies attempt to assess all health conditions using the same methodology, comparison of one condition to another is now possible
5. We can also compare disease rates and trends over time and by location

-The 2017 GBD report published by the independent IMHE provided data for 195 countries and territories around the globe
1. Updated mortality and morbidity estimates covered 359 diseases and injuries and 80 new risk-outcome data pairs were added
2. GBD data were also used to generate projections of health into the future

-The information obtained from calculating the GBD informs decisions related to investments in health, research, human resource development, and physical infrastructure

Question 25

What is an example of the global burden of disease?

Answer 25

-For example, let’s say one community has a high rate of death from measles for children under 5 years of age, but after a measles vaccine campaign the next year, there are no deaths from measles

-When the DALYs are calculated from the year with measles, they are able to demonstrate the burden of measles on that community related to the lost lifetime productivity of the children who died

-Comparing DALYs to the year without measles demonstrates the impact of the vaccine

-Children who might have died did not die and are now counted among those in the community who are healthy

-Children who received the vaccine can become productive adults

-The GBD on the community is lessened with the vaccine

Question 26

What is the health for all: a primary health care initiative?

Answer 26

-In its earlier years after World War II, the focus of the WHO was on building hospitals and costly health establishments throughout the world
1. The thinking was that hospitals brought health to a region
2. However, many countries could not afford to build health care centers, nor could they afford to train large numbers of health professionals
3. Because of those emerging trends and, believing that a major change in thinking and practice was needed, many health leaders from throughout the world met in Alma-Ata, Kazakhstan, in 1978 at the International Conference on Primary Health Care

-They created a sweeping set of recommendations emphasizing the importance of PHC that became the Declaration of Alma-Ata or Health for All

-Section VI in the Declaration states that primary health care (PHC) “is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain… spirit (underscoring) self-reliance and self-determination”

-It was a lofty goal to implement PHC for all by the year 2000

-Each country was encouraged to develop goals for their specific population needs

-The United States responded by launching Healthy People in 1979 with the specific goal to reduce preventable death and injury

-Updated every decade since the first report, Healthy People 2030 represents the nation’s current health goals and objectives for the next decade

-Healthy People 2030 covers many objectives for health attainment while still including objectives for the prevention of death and injury

-Compared to the initial goals from 40 years ago, one can see the evolution in our understanding of how to best achieve health for all

-Health for All emphasized PHC that is affordable, culturally acceptable, appropriate, accessible, and delivered through partnerships between national health services and local communities

-Communities assumed responsibility for identifying their own priority health concerns, with planning and implementing PHC services that match their unique needs

-Common PHC services include health promotion, disease prevention, treatment, and rehabilitative care provided by health care workers who live in the same community

Question 27

What is health in all policies?

Answer 27

-In 2006, Health for All was expanded to HiAP as an essential component of PHC

-The idea of HiAP is that good health in any society requires policies across all sectors to actively support health

-This expanded approach requires policymakers to incorporate consideration of the health impact in policies for transportation, housing, employment, nutrition, water and sanitation, and education

-By acknowledging the impact that any policy has on health, optimal health is maintained for the community’s benefit

Question 28

What are the achievements of PHC?

Answer 28

-One example in the achievement of PHC is in Portugal with the extensions of comprehensive services to their full population

-In a classic example, Waddington reported how Portugal organized Family Health Units (FHU) across the country

-FHUs are designated groups of physicians, nurses, and staff who work to provide care to local patients and families and make decisions together with them about health needs

-Since the 1970s, Portugal’s infant mortality rate has dropped by 50% every 8 years to only 3 per 1,000 by 2006
1. Life expectancy jumped 9.2 years in one generation
2. Patients register for government-sponsored health services through their family physician, which guarantees each patient has a PHC medical home

-MD/RN salaries are based on FHU productivity and performance
1. However, continued improvement in life expectancy (81.3 years in 2014) has been tempered by ongoing health inequalities

-Since 2011, efforts at cost containment have included a greater focus on governance and regulation, health promotion, more reliance on generic drugs, and increased taxes and cost-sharing
1. The total health expenditures in 2014 totaled 9.5% of GDP, or about half the amount paid in the United States

-Many other nations are working toward Health for All by making health care a right for all citizens and expanding services to meet the needs of rural populations and high-risk groups

-Future action regarding PHC calls for strengthened collaboration among governmental agencies and NGOs in public and private sectors

-Only when PHC is accessible to all people will the world have a realistic chance of achieving all the goals set out in the Declaration of Alma-Ata

Question 29

What are the sustainable development goals?

Answer 29

-In 2000, during the Millennium Summit, the United Nations (UN) approved eight international health goals for the year 2015
1. These goals were named the Millennium Development Goals (MDGs), targeting health improvement, eradication of poverty and hunger, and achievement of universal education and gender equality
2. All UN member states and 22 international organizations committed to developing global partnerships
3. By combining resources, skills, and knowledge, these partnerships were assumed to facilitate goal achievement
4. Although some MDGs were accomplished before the 2015 deadline, progress between countries was uneven
5. Some countries found some of the goals were not appropriate for their populations

-Drawing on the experience from the MDGs, a revision and expansion was approved
1. The Sustainable Development Goals (SDGs) were launched as the future global development framework to be achieved by 2030

-The SDGs are a collection of 17 global goals and “are a call for action by all countries—poor, rich, and middle-income—to promote prosperity while protecting the planet”

-Interestingly, only goal 3, Good Health and Well-Being, is specifically devoted to health and wellness
1. However, because the goals are all interconnected in the spirit of HiAP, each one of the goals reflects an important health element

-Through the pledge to leave no one behind, the SDGs are looking for “life-changing zeros”: zero “poverty, hunger, AIDS, and discrimination against women and girls”

Question 30

What is telehealth?

Answer 30

-Long-distance provision of health care support and information via broadband and Internet devices

-Enables remote client and provider:
1. Contact
2. Care
3. Advice
4. Reminders
5. Education
6. Intervention
7. Monitoring

-Achieving these goals has been facilitated by the expansion of broadband and the Internet throughout the world

-Ministries of health are training community care workers in communication, observation, and technical skills for telehealth systems that link remote areas to academic health centers
1. For example, in Brazil’s Minas Gerais state, PHC centers in 608 municipalities, some in remote areas, are now connected through the country’s Telehealth Network (TN)
2. In the first 5 years of the TN, 6,000 health professionals were trained in its use
3. The system was shown to be cost-effective and simple to use
4. With access to specialist teleconsultations, users of the TN were able to prevent 81% of case referrals from leaving the local community
5. A 2016 evaluation study found that the network had expanded to include 88% of Minas Gerais state with 40 teleconsults occurring each day. User satisfaction with the services provided through the TN was reported at 95%, demonstrating that this telehealth service is successful and sustainable

-A feasibility study in India networked five rural health clinics with a large teaching hospital
1. Electrocardiographs (EKGs) were transmitted from portable EKG tablet devices using WiFi hotspots at the clinics
2. The 12-lead EKGs were transmitted as secure PDF files for cardiologists to read
3. Individuals and their local primary care providers now receive support and information from distant providers without traveling or being away from home

Question 31

What is women’s health?

Answer 31

-The WHO estimates that almost 295,000 women died in 2017 from complications of pregnancy and childbirth
1. Ninety-four percent of these deaths are in economically poor countries
2. Nigeria and India had an estimated 35% of all maternal deaths in 2017
3. Pregnant women living in rural areas and adolescent mothers face higher mortality rates

-The death of a mother profoundly impacts the well-being of the entire family

-Between 2000 and 2017, due to efforts to improve prenatal and delivery care, global rates of maternal mortality dropped by 38%

-Women’s health continues to be a major emphasis in Health for All

-Goals:
1. Eliminate health disparities affecting women globally
2. Decrease infant and maternal mortality
3. Improve prenatal and delivery care

-All populations we serve deserve respect for their personal choices, including our health care colleagues

Question 32

What are the global health trends?

Answer 32

-The overarching perspective of global health nursing is one planet of interdependent nations

-What happens in one country affects others in important ways
1. For example, air travel can transport health problems from any remote village halfway around the world to any major city within 36 hours
2. Detecting disease quickly has become more urgent for everyone’s health since the outbreak of SARS in 2003 and more recently the COVID-19 pandemic, caused by the novel coronavirus SARS-CoV2
3. By February 16, 2020 China had 51,174 cases and 1,666 deaths, but there were only 683 cases and 3 deaths outside of China
4. By October 2, 2020, the United States had 7,260,425 total cases and 207,302 deaths, with 302,093 new cases in the last 7 days

-Other global issues with an impact on population health include ongoing efforts to eradicate old diseases such as TB or malaria while maintaining ongoing efforts to improve basic health care services

-While we think of the CDC as a U.S. government agency, it also has a global focus that includes global health security and outbreak investigation

-Includes:
1. UN and WHO
2. Managing global diseases during epidemics and pandemics
3. Interdependence of nations during migration
4. Armed conflict, uprisings, wars, and humanitarian emergencies

Question 33

What is the UN?

Answer 33

-At the end of World War II after earlier attempts to form international agreements, the United Nations (UN) Charter was signed and ratified in 1945 by 50 countries who were “committed to maintaining international peace and security, developing friendly relations among nations and promoting social progress, better living standards and human rights”

-The UN today supports and manages several international funds, programs, and specialized agencies that focus on health

-Some of these existed before World War I, some were part of the League of Nations, and some were established more recently to meet emerging needs such as the Joint UN Programme on HIV/AIDS

Question 34

What is the purpose/mission of the World Health Organization (WHO)?

Answer 34

-Created in 1948

-Located in Geneva, Switzerland, the World Health Organization (WHO) is a specialized agency under the UN with the objective for “the attainment by all peoples of the highest possible level of health”

-Directs, coordinates authority on international health

-Improves global health

-As of 2020, there are 194 member states in the WHO divided into 6 geographical regions for the purposes of reporting, analysis, and administration

Question 35

What are nongovernmental organizations?

Answer 35

-Other organizations are also active in promoting health internationally but are not necessarily sponsored by governments

-Nongovernment organizations (NGOs) are often philanthropic and some are for profit

Question 36

What are examples of nongovernmental organizations (global health organizations)?

Answer 36

-World Health Organization

-United Nations International Children’s Emergency Fund (UNICEF)

-United Nations Educational, Scientific, and Cultural Organization (UNESCO)

-The World Bank (WB)

-Pan American Health Organization (PAHO)

-U.S. Agency for International Development (USAID)

-Centers for Disease Control and Prevention (CDC; including the Center for Global Health)

-Partners in Health

-Medecins Sans Frontiers (Doctors Without Borders)

-Bill and Melinda Gates Foundation

-International Council of Nurses (ICN)

Question 37

What is involved with managing global diseases during epidemics and pandemics?

Answer 37

-An example of the interdependency of all nations is the cooperation needed when epidemics or pandemics occur

-The WHO has led the way with developing an approach to respond to, coordinate, and assist all nations during such outbreaks
1. The Global Outbreak Alert and Response Network (GOARN) was established by WHO in 2000
2. GOARN initially responded to national outbreaks such as cholera and yellow fever
3. Today GOARN is made up of more than 600 partners, including public health institutions, government agencies, NGOs, and labs specializing in epidemiology

-Through GOARN, the WHO’s true impact was first realized with the coordination of the global response to the SARS epidemic in 2002 to 2003
1. From this response, the WHO established international networks and created standards for mutual assistance in anticipation of future threats

-The WHO Health Emergency Dashboard is an interactive web-based platform, refreshed every 15 minutes, that shares real-time information about global public health events and emergencies

-Includes:
1. International Health Regulations
2. Public Health Emergencies of International Concern
3. Global Health Security Agenda
4. Global Influenza Surveillance Network
5. One Health
6. Centers for Disease Control and Prevention
7. Examples of recent epidemics and pandemics

Question 38

What are international health regulations?

Answer 38

-In 2005, the International Health Regulations (IHR) of the WHO was accepted as a legally binding, international treaty between all member states

-The IHR require that all countries will independently perform the following
1. Detect: Make sure surveillance systems and laboratories can detect potential threats
2. Assess: Work together with other countries to make decisions in public health emergencies
3. Report: Report specific diseases, plus any potential international public health emergencies
4. Respond: Respond to public health events

-Each nation has committed to meeting these four obligations within their own borders and to the development of an internal public health strategy and implementation plan for addressing domestic public health emergencies

-Before public health events happen,
1. The IHR direct the WHO to provide tools, guidance, and training in support of any country

-During public health events,
1. The WHO offers decision support to affected areas for rapid assessment, critical information, and communications, and
2. GOARN coordinates sending teams with technical expertise upon request as needed

-According to the IHR reporting protocols, when there is a new reportable event, the affected nation first assesses the public health risk within 48 hours
1. If the event meets IHR reporting criteria, the country notifies the WHO within 24 hours
2. The WHO will then assess the event using the Emergency Response Framework (ERF)

-The ERF provides guidance for the level of response that is indicated
1. There are four response levels, from Ungraded (requiring no response or monitoring only) to Grade 3 requiring a major response across regions)

-The response needed is based on risk, as follows:
1. Very low or low risk event: The WHO team may simply monitor the event. Mitigation, preparedness, and readiness may be part of the low-risk response.
2. High or very high-risk event: The Incident Management System may be activated with an appropriately scaled response

Question 39

What are public health emergencies of international concern?

Answer 39

-Once Public Health Emergencies of International Concern (PHEIC) are declared, the WHO coordinates an active response with the reporting country and with other countries as indicated

-The response may include controlling borders as well as containing the source of the public health threat
1. These were the steps followed in 2016 by Brazil with the Zika virus outbreak and in 2019 with the novel, SARS-CoV2 outbreak in Wuhan, China

-Most epidemics or emergencies do not fulfill criteria to be considered a PHEIC
1. For example, WHO Emergency Committees (ECs) were not convened for the cholera outbreak in Haiti after the earthquake, for the use of chemical weapons in Syria, or following the Fukushima nuclear disaster in Japan

-Four critical diseases will always be considered extraordinary and require mandatory notification: smallpox, poliomyelitis due to wild-type poliovirus, human influenza due to a new subtype, and severe acute respiratory syndrome (SARS)

-Other conditions are potentially notifiable events according to IHR criteria, whether infectious disease, biological, radiological, or chemical events

Question 40

What is the global influenza surveillance network?

Answer 40

-Another important cooperative agency is the Global Influenza Surveillance and Response System (GISRS), a network of international laboratories established in 1952 by the WHO

-GISRS has emerged as a critical player coordinating worldwide efforts for surveillance and control of influenza

-Functions of GISRS include the following:
1. Maintaining physical presence in 144 National Influenza Centres (NICs), 6 WHO Collaborating Centres, 4 Essential Regulatory Laboratories, and 13 WHO H5 reference laboratories
2. Recommending the composition of twice yearly seasonal influenza vaccine, and aid in its development
3. Posting on an open access platform for the specific gene sequence of an influenza virus (reference viruses)
4.Providing open access to confirmed lab protocols for testing and disease confirmation
5. Developing test kits for shipping to requesting countries free of charge

Question 41

What is the global health security agenda?

Answer 41

-In 2014, the United States helped launch the Global Health Security Agenda (GHSA), an independent group of 67 countries, international organizations, nongovernmental organizations, and private sector companies who also have as their vision a world that is safe and secure from infectious diseases

-The GHSA 2024 target is for 100 countries to complete assessment, planning, and mobilization to minimize gaps in health care services

-Each country has agreed to demonstrate improvement in at least 5 of 11 technical areas according to measures within the WHO IHR Monitoring and Evaluation Framework

-Because of GHSA partnerships, when SARS-CoV2 became a PHEIC, there was more information readily available to all nations than in any previous outbreak

Question 42

What is one health?

Answer 42

-One Health is a coordinated approach, recognizing that PHEICs are increasingly related to the interconnectedness between humans, the health of animals, and our shared physical environment

-The One Health initiative cuts across all sectors of society from local, regional, national, and global levels

-It is especially crucial for low-resource emerging economies, but novel infectious diseases (e.g., Ebola, COVID-19) can impact many countries around the world

-The Food and Agricultural Organization of the U.N. uses a One Health interconnected approach with an established early warning monitoring system to alert for changes in zoonotic diseases, food safety, and agricultural production

-In the United States, the CDC uses One Health to gain an understanding about how diseases spread among people, animals, and the environment

-The foundation of One Health is three-fold: the multidisciplinary cooperation for communication, coordination of effort, and collaboration on activities at the animal–human–environment interface

Question 43

What is the centers for disease control and prevention?

Answer 43

-In the United States, the Centers for Disease Control and Prevention is the agency responsible for leading the federal response to an internal public health emergency

-Each state is also required to have a strategic plan outlining the response of each local health agency (LHA)

-When a local public health event or emergency occurs somewhere within the United States, the LHA reports upstream to the state who then reports to the CDC

-If the event has a potential international impact, the CDC evaluates the event according to the WHO IHR and reports the concern to the WHO, as indicated for monitoring or mobilization of international support

-The CDC also has an outward facing global mission supporting global health security and disease outbreak investigation throughout the world

-CDC scientists work collaboratively through 10 state-of-the-art global disease detection (GDD) Centers located in different regions of the world

-The expertise of the GDD centers evolved over the first four global epidemics of the 21st century

-The CDC plays a lead role in global health security when outbreaks occur anywhere

-CDC disease experts join with stakeholders to address more than 400 diseases and health threats

-Strengthening critical public health services globally protects Americans and saves lives worldwide

-The CDC also maintains an emergency surge staff of responders ready to be deployed as needed

-Partners in the CDC response effort include the following:
1. Foreign governments and ministries of health
2. Other U.S. government agencies
3. The WHO and other international organizations
4. Academic institutions
5. Foundations
6. Nongovernmental organizations (NGOs)
7. Faith-based organizations
8. Businesses and other private organizations

-The C/PHN may participate with One Health principles anywhere and everywhere

-The C/PHN’s response during an infectious disease epidemic or pandemic may include one or more areas of focus as described by the WHO:
1. Focus 1. Provide community education in support of an individual’s response, such as wearing masks in public, handwashing, and physical distancing
2. Focus 2. Explain evolving risk with communication to support life-saving actions using local data indicators
3. Focus 3. Facilitate access to timely treatment for persons who display symptoms and ensure protection of the health care workforce

Question 44

What are examples of recent epidemics and pandemics?

Answer 44

-SARS-CoV2 (COVID-19)

-Ebola

-Tuberculosis

-Malaria

-Global HIV/AIDS response

-Acute respiratory tract infections

Question 45

What is the interdependence of nations during migration?

Answer 45

-When hardships come, people would rather try to adapt and stay where they are, but if there is limited assistance from their government to remain, then people will leave

-Populations may relocate within their own countries or move across borders or oceans to find safety after natural disasters

-Climate change in today’s world, which causes more frequent and severe wildfires and rising oceans (from melting glacial ice), can result in population migration

-Population movement may also be in response to
1. Economic opportunities for workers and their families
2. A nation’s need to invite immigrants to offset low birthrates
3. Large migrations of people fleeing violence or armed conflict, or
4. Food insecurity

-In each case, the challenge is to ensure that human rights are met first, followed by the maintenance of environmental law and refugee or migration law

-In 2016, the UN adopted the Global Compact for Migration as a framework for international cooperation for orderly migration

-Unfortunately, the actual migration process has become quite political
1. As of 2020, there were no global agreements or policies to support either present migration humanitarian crises or the impact on environmental rights breaches

Question 46

What is involved with armed conflict, uprisings, wars, and humanitarian emergencies?

Answer 46

-An armed conflict is defined as major if the number of deaths has reached 1,000

-Increasingly, conflicts are internal rather than between nations

-Combatants seeking economic and political power often target the lives and livelihoods of civilians associated with opposing factions

-Armed conflicts and uprisings initially cause governments and agencies to place a high priority on injuries, but the ability to sustain routine health care is reduced as time goes on

-The health infrastructure itself becomes vulnerable during conflicts and uprisings as a consequence of political instability
1. Often, opposing factions raid hospitals and clinics

-During national conflicts, health services become disorganized with decreased resources from disrupted supply chains
1. Such actions have been repeated over the years as conflicts have emerged

-C/PHNs need to become aware of who is involved in an immediate local conflict and who is influencing the situation from abroad
1. Outside help is needed in these instances, and often, international help is available
2. Funding and sustaining health projects may depend ultimately on a variety of factors, not the least of which is providing care when the safety and survival of patients and nurses may also be threatened

-The CDC describes complex humanitarian emergencies as situations that affect civilian populations and distinguishes them from factors related to war or civil strife, shortage of necessities such as food, and the displacement of local populations

-During wars and other man-made disasters, infrastructures fail, and epidemics are almost inevitable

-As conflict wears on, the health care needs of the combatants often take priority over health care needs of civilians

-As communities and families are relocated, thousands of children may be injured, orphaned, or become at risk for disease

-Additionally, conflict disrupts food cultivation, harvest, and distribution, leaving populations at risk for malnutrition, which can lead to disease

-These circumstances can result in complex humanitarian emergencies, with increased mortality rates beyond what is expected under normal circumstances

Question 47

What are global health ethics?

Answer 47

-Certain ethical considerations guide global health even as basic ethical principles guide the delivery of health care

-Ethics of justice, equality, diversity, and inclusivity become even more important in an interconnected, multicultural world

Question 48

What are the clinical service learning for the C/PHN?

Answer 48

-Opportunities for participating in a global health activity may be offered for experiential learning

-C/PHNs should familiarize themselves with global health ethical considerations whether engaging with global communities to conduct research or deliver clinical care in the community

-Positive outcomes for the C/PHN from community and global health service learning include the following:
1. Increased awareness caring for patients who are economically and socially disadvantaged
2. Improved cultural awareness
3. Increased interest in public health and primary care career-related opportunities

-Communities who host C/PHN students also enjoy documented benefits. These include the following:
1. An influx of resources
2. Extra hands
3. Extra supplies and equipment

-The presence of well-trained health volunteers can lead to skills transfer within the community, either intentionally through education or more indirectly through observation

-Volunteers and host communities may develop a sense of solidarity

-Sometimes the host community may gain social capital with nearby communities because foreign health care providers have spent time with them

Question 49

What are the ethical considerations for the global health volunteer?

Answer 49

-The weight of authority

-The volunteer effect

-The burden of hosting

-Individual motivations
1. “Volunteer-centric” focused on the volunteer’s persona goals and interests
2. “Community-centric” focused on thee community’s beneficial outcomes

Question 50

What are the characteristics of natural disasters?

Answer 50

Caused by natural events, such as earthquakes and tsunamis

Question 51

What are characteristics of man-made disasters?

Answer 51

-Caused by human activity, such as mass shootings, the bombing of significant landmarks in major cities, or the riots in major cities after a sociopolitical event

-Other man-made disasters include nuclear reactor meltdowns, industrial accidents, oil spills, construction accidents, and air, train, bus, and subway crashes

-In fact, man-made disasters can and frequently do follow natural disasters, as occurred with the nuclear reactors in Japan following the earthquake and tsunami in 2011

Question 52

Who are persons impacted by disasters?

Answer 52

-Because disasters are so variable, there is no typical person impacted in a disaster, nor can anyone predict whether he or she will ever be impacted by a disaster

-Includes:
1. Directly impacted by disaster
2. Displaced persons
3. Refugee
4. Indirectly impacted by disaster

Question 53

Who are those directly impacted by disaster?

Answer 53

-Those who are directly impacted by disaster experience the event firsthand, whether fire, flooding, mass shooting, vehicular accident, or bombing

-They also constitute the dead and the survivors of the event; these survivors are likely to have health effects from their experience, even if they are without physical injuries directly caused by the event

-Some may be without shelter or food, and many experience serious psychological stress long after the event is over, such as victims of the Thomas Fire
1. This fire, California’s largest wildfire to date, was started by sparks from powerlines during a powerful wind, destroyed 1,063 structures, and burned 281,893 acres

Question 54

Who are displaced persons?

Answer 54

-Depending on the cause and characteristics of the disaster, some direct survivors may become displaced persons or refugees

-Displaced persons are forced to leave their homes to escape the effects of a disaster

-Usually, displacement is a temporary condition and involves movement within the person’s own country

-Returning displaced persons or refugees can place economic and social strains on the county of origin

-Along with needs for employment and shelter, these influx situations raise concerns, especially regarding early or forced marriages, child labor, and human trafficking

-Whether the displacement of refugee status is permanent or not, the lasting impact to both the country of origin and the host country is significant

Question 55

Who are refugee’s?

Answer 55

-Depending on the cause and characteristics of the disaster, some direct survivors may become displaced persons or refugees

-The term refugee is reserved for people who are forced to leave their homeland because of war or persecution

-Returning displaced persons or refugees can place economic and social strains on the county of origin

-Along with needs for employment and shelter, these influx situations raise concerns, especially regarding early or forced marriages, child labor, and human trafficking

-Whether the displacement of refugee status is permanent or not, the lasting impact to both the country of origin and the host country is significant

Question 56

Who are those indirectly impacted by disaster?

Answer 56

-Those who are indirectly impacted by disaster are the relatives and friends of persons directly impacted by the disaster

-These supporters often undergo extreme anguish while trying to locate loved ones or accommodate their emergency needs

-If bodies cannot be found or are unidentifiable, the supporting persons experience even greater anguish and may not be able to accept that a loved one did not survive

-Family members of those killed on 9/11 in New York City worked with architects to develop a memorial that meets the expectations of most of those indirectly impacted by the attack and honors their loved ones
1. This effort, along with the Flight 93 National Memorial in Shanksville, PA, and the Pentagon Memorial, helps with the long healing process of the supporters and serves as a reminder of the impact that day had on each of our lives

Question 57

What are the factors contributing to disasters?

Answer 57

It is useful to apply the host, agent, and environment model (epidemiological triad) to understand the factors contributing to disasters, because manipulation of these factors can be instrumental in planning strategies to prevent or prepare for disasters

Question 58

What are host factors?

Answer 58

-The host is the human being who experiences the disaster

-Host factors that contribute to the likelihood of experiencing a disaster include age, general health, mobility, psychological factors, and socioeconomic factors

-For instance, older residents of a mobile home community may be unable to evacuate independently in response to a tornado warning if they can no longer drive

-Residents of a low-income apartment complex in a large city may be aware that their building is not compliant with city fire codes but avoid alerting authorities for fear of the complex being closed and being homeless due to their inability to afford new, safe housing

Question 59

What are agent factors?

Answer 59

-The agent is the natural or technologic element that causes the disaster

-For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs

Question 60

What are environmental factors?

Answer 60

-Environmental factors are those that could potentially contribute to or mitigate a disaster

-Common environmental factors include a community’s level of preparedness; the presence of industries that produce harmful chemicals or radiation; the presence of flood-prone rivers, lakes, or streams; above-average amount of rainfall or snowfall; above- or below-average high or low temperatures; proximity to fault lines, coastal waters, or volcanoes; and the presence or absence of political unrest

Question 61

What are the agencies and organizations for disaster management?

Answer 61

-In 1803 the United States first recognized the need to prepare for emergencies through law and dedicated organizations
1. The first law was written as a direct response to a major disaster, the Portsmouth, New Hampshire fire of 1803, which swept through the seaport town

-The majority of subsequent legislation was in response to specific crises and created many different agencies to respond to those disasters

-The one constant was that the response of the federal government to disasters remained more reactive than proactive and was ad hoc in nature, only becoming coordinated with the establishment of the Federal Emergency Management Agency (FEMA) in 1979 and the passage of the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988

-In response to World War II and the specter of all-out nuclear war with the Soviet Union, the United States created Civil Defense, a series of programs and agencies designed to protect the population from “counter-value” nuclear strikes and increase the survivability of a nuclear war

-The U.S. Department of Health, Education, and Welfare (USDHEW), predecessor to the U.S. Department of Health and Human Services, created the Handbook for Civil Defense Emergency Planning in Welfare Institutions, which was a guide to protect individuals and help staff prepare for fallout from a nuclear event
1. Significant in this handbook was the attention given to family responsibilities and the likelihood that staff, including nurses, would choose family responsibilities over professional responsibilities

-To help alleviate the problems associated with absenteeism as a result of the nurses’ conflicting responsibilities, the handbook recommended:
1. Reminding staff of their responsibility as public servants,
2. Providing shelter for families within the institution,
3. Planning for getting families to the shelter,
4. Planning for families to assist the staff during a crisis

-Under the 1950 version for the United States Civil Defense Plan, health services were to remain under the control of existing health agencies to avoid unnecessary duplication of services and would be subject to the rules and regulations of civil defense

-The U.S. Public Health Service (USPHS) was responsible for providing staffing for civil defense offices and would work for the state health officer who would have the lead
1. The roles have been in continual transition since that time, but the basic principles remain the same

-Public health has become recognized as a critical component of emergency planning, preparedness, and response

-National public health response requires coordination with state and local authorities, to include nongovernmental agencies

-President George W. Bush sought to consolidate the roles and responsibilities of agencies and organizations involved in disaster response and to align them with emergency support functions

-The Department of Homeland Security (DHS) was organized in 2002 and incorporates many of the nation’s security, protection, and emergency response activities into a single federal department

-The DHS includes other widely known agencies, including the Transportation Security Administration, U.S. Customs and Border Protection, U.S. Immigration and Customs Enforcement, U.S. Citizenship and Immigration Services, U.S. Coast Guard, and U.S. Secret Service

Question 62

What is the American Red Cross?

Answer 62

-Among disaster-relief organizations, perhaps none is as famous as the Red Cross, which is referred to as the American Red Cross in the United States and the Red Crescent Societies in Islamic countries

-The American Red Cross was founded in 1881 by Clara Barton and was chartered by the U.S
Congress in 1905

-It is authorized to provide disaster assistance free of charge across the country through its more than half a million volunteers and staff

-The duties assumed by the Red Cross in the event of a disaster are to provide shelter, food, basic health and mental health services, and distribution of emergency supplies

Question 63

What is the Federal Emergency Management Agency (FEMA)?

Answer 63

-In 2003, FEMA, along with parts of 23 agencies, became part of the DHS

-FEMA, established in 1979, is the federal agency responsible for assessing and responding to disaster events in the United States and provides training and guidance in all phases of disaster management

-FEMA provides oversight of the National Incident Management System (NIMS), developed to allow responders from different jurisdictions and disciplines to work more cohesively and proactively in response to natural disasters, emergencies, and terrorist acts

Question 64

What are the WHO’s emergency relief operations?

Answer 64

N/a

Question 65

What is the Pan American Health Organization?

Answer 65

N/a

Question 66

What is the National Incident Command System (ICS)?

Answer 66

-NIMS is the National Incident Command System (ICS), meaning that it takes a unified approach to incident management, incorporates standard command and management structures, and emphasizes preparedness, mutual aid, and resource management

-Nurses and other health care professionals must understand this system and are encouraged to take courses dealing with the ICS

-The most important courses for a nurse are
1. IS-100 Introduction to the Incident Command System
2. IS-200.C Basic Incident Command System for Initial Response
3. IS-700 Introduction to the NIMS, and
4. IS-800.b Introduction to the National Response Framework

Question 67

What is the Department of Health and Human Services (DHHS)?

Answer 67

-The Department of Health and Human Services (DHHS) is the lead federal agency for public health and medical services during a public health or medical disaster

-Supplemental services are provided to state, local, and territorial governments and may include Disaster Medical Assistance Teams (DMAT), USPHS officers, epidemiological personnel from the CDC, and veterinary support to name a few

-Various international nongovernmental organizations, religious groups, and other volunteer agencies provide needed emergency care

-Examples of international nongovernmental organizations:
1. Doctors Without Borders: provide emergency aid and medical care
2. The International Medical Corps: founded in 1984; provides emergency relief to those struck by conflict, disaster, disease no matter where they are; work to help recover and rebuild and gain some skills and tools needed for self-reliance
3. Operation Blessing: nonprofit, humanitarian organization in U.S. and globally

Question 68

How does the military provide assistance in disasters?

Answer 68

-Governments often send their military personnel and equipment in response to international disasters

-However, political agendas may prevent aid typically accepted by countries experiencing catastrophe to reach the impacted communities

-Fortunately, the USPHS Commissioned Corps was allowed to provide aid for the 2008 tsunami and earthquake survivors in Indonesia and Haiti

-The USPHS has also worked collaboratively with the U.S. Navy to provide nursing and other medical care on combined humanitarian missions to South America and the South Pacific, and was sent to Africa to assist with the Ebola crisis

Question 69

What are the phases of disaster management?

Answer 69

In developing strategies to address the problem of disasters, it is helpful for the C/PHN to consider each of the four phases of disaster management: preventive/mitigation, preparedness, response, and recovery and become familiar with the language typically used in disaster preparedness

Question 70

What is the prevention or mitigation phase?

Answer 70

-Activities during this phase are focused on preventing future emergencies or minimizing their effects

-The shaping of public policies and plans that either modify the causes of disasters or mitigate their effects on people, property, and infrastructure are critical activities during this phase

-Mitigation activities take place before and after disaster emergencies

-To reduce our vulnerability to disasters, the United States has strengthened its disaster management activities over the past decade and continues to do so today
1. The screening process at airports and shipping ports includes advanced imaging technology scanning and random hand-carried luggage or canine searches preboarding
2. Nonpassengers cannot go beyond the security entrance area, and photographic identification is required at two or more points before boarding

-Although globally we have experienced a pandemic and much will be learned from it, the Global Health Security has steps in place designed to help decrease the risk of pandemics
1. These steps include surveillance systems that detect possible threats, laboratories to identify the agent, a workforce for follow-up and containment, and emergency management systems to coordinate the activities
2. To prevent possible contamination by Covid-19, individuals are advised to wash hands for 20 seconds, to wear a face mask when going out in public, and to maintain a 6 ft distance between each other

Question 71

What is the preparedness phase?

Answer 71

-Disaster preparedness involves improving community and individual reaction and responses, so that the effects of a disaster are minimized

-Disaster preparedness includes plans for communication, evacuation, rescue, victim care, and recovery

-Preparedness may be hazard-specific or a general all-hazard approach
1. For example, the Centers on Medicare and Medicaid Services (CMS) recommends that an “all-hazards approach” be taken by health care agencies when taking into consideration their location and disasters common to that area

-For instance, although plans may differ in states at higher risk of earthquakes from those in tornado alley, the preparedness plans apply to numerous disasters
1. Communities must ensure that warning systems are tested routinely to ensure appropriate notifications to the residents of a tornado or hurricane, or any other potential threat
2. The Office of the Assistant Secretary for Preparedness and Response oversees the Strategic National Stockpile (SNS), which contains doses of vaccines, medical countermeasures, and needed medical supplies stored around the country in various strategic locations
3. The CDC reports that the SNS contains enough medications and medical supplies to manage a large public health emergency and protect the American public
4. Examples of preparedness include duck, cover, and hold during an earthquake and run, hide, or fight for an active shooter incident

-Nurses have a role in preparedness as well

-Leaving one’s home to assist in a disaster is difficult, especially if one, or one’s family, is not prepared
1. Therefore, nurses need to be prepared with an individual and family plan and supplies that could possibly be needed

-Enrolling in disaster classes or/and registering with a disaster agency such as the Red Cross, reinforces professional preparedness

-On a community level, nurses can enhance preparedness by participating in community drills often held by public health agencies

-Preparedness activities take place before an emergency occurs
1. We cannot provide adequate disaster relief until we are prepared on all three levels

Question 72

What is the response phase?

Answer 72

-The response phase begins immediately after the onset of the disastrous event and during the emergency

-Response is putting your preparedness plans into action immediately, with the goals of saving lives and preventing further injury or damage to property

-Activities during the response phase include rescue, triage, on-site stabilization, transportation of injured, and treatment at local hospitals and clinics

-Disaster triage differs from triage done in the emergency departments

-START, the most commonly used technique in the United States, consists of triaging individuals in 30 to 60 seconds during a mass casualty
1. The four categories consist of the walking wounded/minor (green tag), delayed (yellow), immediate (red), and deceased (black)
2. These categories are based on ambulation, respirations, perfusion, and mental status

-Response also requires recovery, identification, and refrigeration of deceased remains, until notification of family members is possible

-Persons trained in mortuary services are an essential part of any emergency planning and response effort
1. The mortuary teams includes pastoral personnel to ensure that remains are always treated with respect and in accordance with religious traditions

-Supportive care, including food, water, and shelter for survivors and relief workers, is a critical element of the total disaster response

-Veterinary response teams are essential to address the acute and long-term needs of the animals impacted by the disaster
1. Many shelters will not accept pets, causing confusion and delays in sheltering displaced persons

-Individuals with chronic health conditions and/or mental illness may need specific interventions in recovery from a disaster

-Those with serious mental illness such as bipolar disorder and schizophrenia are less likely to be prepared for disasters than the general population
1. Although these disorders are not caused by disasters, the effects of the disaster can cause higher hospitalizations and higher levels of avoidance behavior
2. C/PHNs need to be aware of support agencies for this population because their needs may increase due to lack of support systems and poor coping skills

-In recent years, it has become clear that all of us need to be have a plan in place so that we recover as quickly as possible if a disaster arises

-Individuals on medications need at least a 3-day supply of medications
1. Special diet foods may be hard to locate during a disaster; therefore, advise patients to eat healthy as much as possible if their special diet foods are unavailable during a disaster

-Be prepared for possible power outages

-The Emergency Prescription Assistance Program helps to replace medications and equipment that is lost due to a disaster

-Knowledge of the community assists the C/PHN in ensuring all populations have services needed, with special attention paid to those who are most vulnerable

Question 73

What is the recovery phase?

Answer 73

-During the recovery phase, the community joins together to repair, rebuild, or relocate damaged homes and businesses, and restore health, social, and economic vitality to the community

-There will be many opportunities during this phase to enhance prevention and increase preparedness, thus reducing future vulnerabilities

-Both survivors and relief workers may experience psychological trauma and should be offered mental health services to support their recovery

-The traumatic emotional scars may last a lifetime

-The Substance Abuse Mental Health Services Administration (SAMHSA) offers guides and a disaster kit for managing stress in crisis for both professionals and victims

-Recovery activities take place after an emergency, and may extend over a period of months or even years

-During the recovery phase, special attention should be given to the needs of children who are approximately 25% of the population in the United States and even higher in other countries

-The CDC has resources in English and Spanish to assist children that have experienced disasters
1. One example is the coloring book Coping After a Disaster

Question 74

What is the role of the community/public health nurse?

Answer 74

-The C/PHN has a pivotal role in preventing, preparing for, responding to, and supporting recovery from a disaster

-After a thorough community assessment for risk factors, the C/PHN may initiate the formation of a multidisciplinary task force to address disaster prevention and preparedness in the community

Question 75

What is involved in preventing disasters?

Answer 75

Disaster prevention may be considered on three levels:
-Primary
-Secondary
-Tertiary

Question 76

What is primary prevention for disasters?

Answer 76

-Primary prevention of a disaster means keeping the disaster from ever happening by taking actions that completely eliminate its occurrence—or, if that is not possible, to minimize damage through primary prevention

-Primary prevention includes providing and participating in training sessions on prevention of disaster risk factors, knowing high-risk groups through community assessments, and working with community partners

-Primary prevention of disasters can be practiced in all settings in the workplace and home—with defined processes to reduce safety hazards and in the community, to monitor risk factors, reduce pollution, and encourage nonviolent conflict resolution

-Primary disaster prevention efforts should include awareness of a community’s physical, psychosocial, cultural, economic, and spiritual stance

-The C/PHN educates people at home, at work, at school, or in a faith community, and has a unique opportunity to be aware of the community perspective about safety and security focused on preventing a disaster

-There are many prevention actions the C/PHN can initiate. These prevention actions can include the following:
1. Completing a community assessment, including the residents with special needs and those in high-risk categories
2. Collaborating with community leaders to provide general community prevention and preparation education activities
3. For instance, working with community partners C/PHNs promote policies that better prepare vulnerable populations
4. These relationships are built on trust and a common goal of serving the population
5. C/PHNs work closely with these community partners acting in a leadership role to ensure populations are assessed and have the services needed if a disaster occurs
6. The second aspect of primary disaster prevention is anticipatory guidance
7. Disaster drills and other anticipatory exercises help the community and relief workers experience some of the feelings of chaos and stress associated with a disaster before one occurs
8. It is much easier to do this when energy and intellectual processes are at a high level of functioning
9. The C/PHN has a role in community collaborative disaster drills through committee membership, organization of drills at the place of employment, or activism at the grassroots level to assist in holding community-wide disaster drills on a regular basis

Question 77

What is secondary prevention for disasters?

Answer 77

-Secondary disaster prevention focuses on the earliest possible detection and treatment

-After a disaster, the local health department’s C/PHNs work with the American Red Cross to coordinate and provide emergency assistance

-Secondary prevention corresponds to immediate and effective response

-Agencies who provided early evacuation, identified shelters for special-needs patients outside the high-risk area, implemented volunteer cascading communication systems, and conducted pre-event mock evacuation plans and included volunteers in their disaster plan were most successful with their response efforts

-Recommendations to improve responses include identification of patients who may be reluctant to evacuate, the provision of adequate security at special-needs shelters, and, most importantly, practice drills

-Many local communities have developed preparedness programs to inform, prepare, and ensure residents are ready for any type of man-made or natural disaster, such as the City of New Orleans’s NOLA READY

Question 78

What is tertiary prevention for disasters?

Answer 78

-Tertiary disaster prevention involves reducing the amount and degree of disability or damage resulting from a disaster

-This level involves rehabilitative work and can help a community recover and reduce the risk of further disasters

-Since 9/11, the American Psychiatric Nurses Association has provided access to many resources for nurses dealing with traumatic events

-The Office of the Assistant Secretary for Preparedness and Response offers a three-module series on compassion fatigue and secondary trauma for health care providers

Question 79

What is involved with preparing for disasters?

Answer 79

-Disaster planning is essential for a community, business, and hospitals

-Details of preparation and management by all involved, including community leaders, health and safety professionals, and lay people must be considered

-Despite many disaster drills and numerous iterations of disaster plans before Hurricane Katrina, some hospitals in New Orleans were better prepared for terrorism events than for the hurricanes and flooding that were not uncommon to that geographic area

-C/PHNs can be very instrumental in disaster preparedness and must ensure they have their own family disaster preparation plan in place

Question 80

What is involved with nurses’ personal preparation for disasters and available training?

Answer 80

-Nurses are ready, willing, and well positioned to respond to disasters; however, nurses receive minimal disaster-focused instruction as part of their formal education

-Due to the reality that a disaster can occur at any time, it becomes all the more urgent for nurses to be well prepared through valid and low-cost education in disaster management

-American Nurses Association (ANA) has educational opportunities for nurses on disaster preparedness
1. Position Statement Background Information: Registered Nurses’ Rights and Responsibilities Related to Work Release During a Disaster
2. Position Statement Background Information: Work Release During a Disaster—Guidelines for Employers

-When we are a prepared profession, we can cope and help our communities recover from disasters better, faster, and stronger

-Other educational opportunities include:
1. HHS Guidance for Mass Decontamination: Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities
2. A Nurse’s Duty to Respond in a Disaster: Unresolved issues of legal, ethical, and professional considerations of disaster medical response remain a challenge, and could hamper the ability of nurses to respond
**A concerted effort to solving these problems is needed, with nurses and stakeholders at the national, state, and local levels
3. IOM Report on Establishing Crisis Standards of Care to use in Disaster Situations

-The American Nurses Association also offers the National Healthcare Disaster Certification (NHDP-BC)
1. Nurses are able to take the certification exam once certain requirements are met

-Personal preparedness means that the nurse has read and understands workplace and community disaster plans and has developed a disaster plan for his or her own family

-The prepared nurse should also have participated in disaster drills, have documented up-to-date vaccinations, be a certified basic life support (BLS) provider, and be able to provide basic first aid

-Nurses preparing to work in disaster areas as “spontaneous volunteers” should have copies of their nursing license and driver’s license, durable clothing, and basic equipment, such as stethoscopes, flashlights, and cellular phones to facilitate appropriate task assignments during the disaster response

-To increase understanding of and the ability to work within an emergency situation, every nurse should become familiar with the National Incident Management System (NIMS)
1. The NIMS is “a systematic, proactive approach to guide all levels of government, NGOs, and the private sector to work together to prevent, protect against, mitigate, respond to, and recover from the effects of incidents”
2. In essence, NIMS provides a framework for management of incidents in support of the national preparedness system

-In addition to the FEMA courses, other options include the following
1. CDC Emergency Preparedness and Response Training and Education
2. Federal Emergency Management Agency (FEMA)
3. Public Health Foundation
4. National Institutes of Health—Radiation Emergency Medical Management
5. University of Minnesota, School of Public Health

Question 81

What is involved with the assessment for risk factors and disaster history?

Answer 81

-The C/PHN is uniquely qualified to perform a community assessment for risk factors that may contribute to disasters

-In addition, the nurse should review the disaster history and preparedness plans of the community
1. Have earthquakes, tornadoes, hurricanes, floods, blizzards, riots, or other disasters occurred in the past?
2. If so, what (if any) were the warning signs?
3. Were they heeded?
4. Were people warned in time?
5. Did evacuation efforts remove all people in danger?
6. What were the community’s on-site responses, and how effective were they?
7. What programs were put in place to rehabilitate the community?

-Community health assessment tool may assist with identifying critical needs of the community

Question 82

What is involved with establishing authority, communication, and transportation?

Answer 82

-In addition to assessing for preparedness, the effective disaster plan follows the NIMS model and establishes a clear chain of authority, develops lines of communication, and delineates routes of transport

-Establishing a clear and flexible chain of authority is critical for successful implementation of a disaster plan
1. Usually, the chain is hierarchical, with, for example, the community’s governmental head (e.g., mayor) initiating the plan, alerting the media to broadcast warnings, authorizing the police to begin evacuations, and so on
2. Within each level of the organization, the hierarchy continues
**For example, at the local hospital, the hospital administrator may be responsible for alerting nurse managers to call in additional personnel
3. Flexibility is essential, because key authority figures may themselves be survivors of the disaster
**If the home of the chief of police is destroyed in an earthquake, his or her second-in-command must have equal knowledge of the community’s disaster plan and be able to step in without delay

-Effective communication is often a point of breakdown for communities attempting to cope with major disasters

-After the terrorist attacks in Oklahoma City and New York City, phone lines were damaged and cellular sites were overwhelmed, making communication difficult
1. Communication was possible only through handheld radios or by way of couriers on foot

-At times of heightened chaos and stress, as well as after physical damage to communication facilities and equipment, misinformation and misinterpretation can flourish, leading to delayed treatment and increased loss of life

-Again, clarity and flexibility are the watchwords for establishing lines of communication
1. How will warnings be communicated?
2. What backups are available if the normal communication systems are destroyed in the disaster?
3. How will communication between relief workers at the disaster site, hospital personnel, police, and governmental authorities be maintained?
4. What role will local media play, both in keeping information flowing to the outside world and in broadcasting needs for assistance and supplies?
5. Significant forms of communication have developed since the 9/11 terrorist attacks
**Social media has become a critical method of communicating important health and safety information to the public since the 2001 terrorist attacks
**Social media and disaster communication leaderships have collaborated and formed a partnership to disseminate information as quickly as possible
6. How will friends and family members be informed of the whereabouts or health status of loved ones?
7. The CDC offers Crisis and Emergency Risk Communication (CERC) to ensure the correct messages by the correct authorities are communicated during emergencies

-The CDC Sample Single Overriding Communications Objective (SOCO) is an effective template to disseminate information concisely and quickly to the media during a disaster

-Closed or inefficient routes of transportation can also increase injury and loss of life
1. For example, if a single, narrow mountainous road is the only means of transporting firefighters to or evacuating residents from the scene of a forest fire, then disaster planners should propose widening the road or clearing a second road

-Disaster planners must also consider what routes emergency vehicles will take when transporting disaster survivors to local and outlying hospitals or health care workers to the disaster site
1. What if the chosen routes are inaccessible because of floodwaters, advancing fires, mountain slides, avalanches, or building rubble?
2. Are alternative routes designated?
3. Also, how will people move about after the disaster?
**For example, after the Japanese earthquake and tsunami in 2011, Nakanishi, Matsuo, and Black examined planning methodologies and future hypothetical disaster scenarios to help answer these types of questions

Question 83

What is involved with mobilizing, warning, and evacuating?

Answer 83

-In many natural disasters, local weather service personnel, public works officials, police officers, or firefighters have the earliest information indicating an increasing potential for a disaster

-These officials typically have a plan in place for providing community authorities with specific data indicating increased risk

-They may also advise the mayor’s office or other community leaders of their recommendations for warning or evacuating the public

-Additionally, they may recommend actions the community can take to mitigate damage, such as spraying rooftops in the path of fires, sandbagging the banks of rising rivers, or imposing a curfew in times of civil unrest

-Disaster plans must specify the means of communicating warnings to the public, as well as the precise information that should be included in warnings

-Planners should never assume that all citizens can be reached by radio or television or that broadcast systems will be unaffected by the disaster
1. Broadcast media may indeed be a primary means of communicating warnings, but alternative strategies, such as social media or police and volunteers canvassing neighborhoods, should be considered

-Social media options such as Facebook, Twitter, and blogs are reliable methods used by news stations and public health agencies that must not be ignored
1. Over 20 million tweets were sent by utilities after Hurricane Sandy, and Google’s Web application, Person Finder, was especially helpful during the Boston Marathon bombings

-In multilingual communities, messages should be broadcast in multiple languages

-Not only homes but also businesses must be informed

-Information that should be communicated includes the nature of the disaster; the exact geographic region affected, including street names if appropriate; and the actions citizens should take to protect themselves and their property

-A study on the use of GPS devices in a simulated mass casualty found the devices useful in tracking patient locations throughout the drill
1. Technology improves tracking of injuries and fatalities

-An evacuation plan is an essential component of the total disaster plan
1. The plan should include notification of the police, local military personnel, or voluntary citizens’ groups of the need to evacuate people, as well as methods of notifying and transporting the evacuees
2. A plan should also be made for responding to citizens who refuse to evacuate

-For example, will police authorities forcibly remove an elderly citizen from his home to a shelter?
1. Will evacuation plans include household pets?
2. If farms or ranches are in the path of fires or floods, will animals be evacuated? How?
3. Who will do this and where will they be taken/sheltered?

Question 84

What is involved with responding to disasters?

Answer 84

-At the disaster site, police, firefighters, nurses, and other relief workers develop a coordinated response to rescue, triage, and treat disaster survivors

-One of the first obligations of relief workers is to remove survivors from danger

Question 85

What is involved with rescue?

Answer 85

-The job of rescue typically belongs to firefighters and urban search and rescue teams that have personnel with special training in search and rescue

-Depending on the disaster agent, protective gear, heavy equipment, and special vehicles may be needed, and dogs trained to locate dead bodies may be brought in

-Sometimes, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in triage and treatment of survivors during this time

-However, the C/PHN’s population-based approaches, as well as knowledge of community resources and particularly vulnerable aggregates are needed during this response phase

-Rescue workers face the logistically and psychologically difficult task of determining when to cease rescue efforts

-Some factors to consider include increasing danger to rescue workers, diminishing numbers of survivors, and diminishing possibilities for survival
1. For example, after a plane crash on a snowy mountain, rescue efforts may cease if it is deemed that anyone who might have survived the crash would subsequently have died of exposure

Question 86

What is involved with triage?

Answer 86

-Knowing the prinicples and practices of triage allows the responding C/PHN to provide the most effectvie nursing skills

-Triage is the process of sorting multiple casualties in the event of a war or major disaster
1. It is required when the number of casualties exceeds immediate treatment resources

-The goal of triage is to effect the greatest amount of good for the greatest number of people

-The most common method of triage used by first responders at a mass-casualty incident in the United States is the simple triage and rapid treatment (START) for adults and JumpSTART for pediatric patients
1. START and JumpSTART are forms of triage used to sort victims into four categories (immediate, delayed, minor, or morgue/deceased) and are consistent with international triage system

-Prioritization of treatment may be very different in a mass-casualty event as opposed to an average day in a hospital emergency department

-Under normal circumstances, a person presenting to a hospital emergency department with a myocardial infarction and showing no pulse or respirations would receive immediate treatment and have a chance of recovery
-At a disaster site, a person without a pulse or respirations would most likely be placed in the nonsalvageable category

-The term mass casualty refers to a number of persons impacted that is greater than that which can be managed safely with the available community resources, such as rescue vehicles and emergency facilities to serve disaster survivors while also meeting the needs of the rest of the community

-In mass-casualty occurrences, the broader community will need to become involved, including requests for rescue vehicles, firefighters, and police officers from neighboring towns, and/or the use of neighboring hospitals
1. Depending on the magnitude of the mass casualty, state and federal resources may also be needed

-This adds another layer of disaster management coordination that must be considered

-Based on the disasters of 2017, FEMA is revising the National Response Framework to improve relationships with the private sector and to improve their readiness outside the continental United States to name a few of the new revisions

-C/PHNs should acquaint themselves with the phases of disaster a community experiences

-According the Substance Abuse and Mental Health Services Administration (SAMHSA) there are six phases of disasters
1. Phase 1: Predisaster phase—fear and uncertainty
2. Phase 2: Impact phase—range of intense emotional reactions
3. Phase 3: Heroic phase—high level of activity with a low level of productivity
4. Phase 4: Honeymoon phase—dramatic shift in emotion
5. Phase 5: Disillusionment phase—realize the limits of disaster assistance
6. Phase 6: Reconstruction phase—overall feeling of recovery

Question 87

What is involved with immediate treatment and support?

Answer 87

-Disaster nurses provide treatment on-site at emergency treatment stations, at mobile field hospitals, in shelters, and at local hospitals and clinics

-In addition to direct nursing care, on-site interventions might include arranging for transport once survivors are stabilized, and managing the procurement, distribution, and replenishment of all supplies

-The nurse may also manage provision or distribution of food and beverages, including infant formulas and rehydration fluids, and arrange for adequate, accessible, and safe sanitation facilities at the treatment location

-Finally, the nurse often may also arrange for psychological and spiritual care of survivors of disasters

-Some survivors who seem physically uninjured may, in fact, be suffering from major injuries but be unable to relate their symptoms to a relief worker because of shock or anxiety
1. For instance, a father pulling debris away from his collapsed house after a tornado may be so worried about a missing child that he does not realize that he has a broken arm

-Other survivors may be so emotionally traumatized by the disaster that they act out, disrupting efforts to assist them and other survivors and possibly engaging in dangerous activities
1. These survivors must be assessed for head trauma and internal injuries, because their behavior may have a physiological cause

Question 88

What is involved with the care of bodies and notification of families?

Answer 88

-Identification and safe transport of the dead to a morgue or holding facility is crucial, especially if a contagion is feared, though this is rare in mass-casualty situations

-Toe tags make documentation visible and accessible

-Records of deaths must be accurately documented and maintained, and family members should be notified of their loved ones’ deaths as quickly and compassionately as possible

-If feasible, a representative from each of the area’s faith communities should be available to assist families awaiting news of missing loved ones

-A family’s recovery from loss is often delayed when notification of their relative is not possible because the recovered bodies are badly damaged or not found

Question 89

What is involved with supporting recovery from disasters?

Answer 89

-Disasters do not suddenly end when the rubble is cleared and the survivors’ wounds are healed

-Rather, recovery is a long, complex process often including long-term medical treatment, physical rehabilitation, financial restitution, case management, and psychological and spiritual support

Question 90

What is involved with long-term treatment?

Answer 90

-Long-term treatment may be required for many survivors of disasters, straining the local rehabilitative care facilities and resources

-Children who are survivors may have to deal with lifelong disabilities or scars from their ordeal, and families may be without adequate financial support for their child’s medical care

-Elderly citizens who had been in excellent health but who sustained serious injuries in the disaster might suddenly find that they can no longer live independently and must move to a long-term care facility

-After floods, landslides, fires, or earthquakes, extensive property damage may cause some residents or businesses to relocate rather than rebuild on land they now deem to be disaster prone

-A disaster that creates numerous persons impacted in a small community may alter the entire social fabric of that community permanently

Question 91

What is involved with long-term support?

Answer 91

-Immediately after a disaster, some survivors may be unable to concentrate on anything beyond fulfilling their immediate needs and those of their family

-Disaster survivors may need funding to repair or rebuild their homes or to reopen businesses, such as stores, restaurants, childcare facilities, and other services needed by the community

-Insurance settlements, FEMA funding, and private donations may assist in financing community rehabilitation

-Psychological support is often required after a disaster, both for survivors and for relief workers

-Some individuals may experience posttraumatic stress disorder (PTSD)

-Many survivors, especially elderly persons displaced from their homes, may quietly lose their will to live and drift into apathy and malaise

-Depression and anxiety are positively correlated in the elderly following earthquakes

-While, some individuals may question their faith after a disaster, a systemic review found religion and spirituality may assist with coping and coming to terms with the disaster

-These survivors in spiritual distress often require not only empathetic listening but also long-term skilled spiritual counseling. In assessing a community’s citizens for counseling needs after a disaster, the PHN should not forget to include children

-Often, children do not have words to express their feelings or fears and may act out in ways adults find difficult to understand, unless age-appropriate psychological intervention is provided

-Medical responders to disasters are at risk of depression and PTSD with nurses being a greater risk than physicians
1. Risk factors included inadequate social support, inadequate coping skills, and insufficient training

-Long-term support must be considered when assessing a community and planning for disasters

-Each community may be unique in their needs, and each disaster requires a unique array of services and planning

-Many communities may be efficient in providing services in quick response to a disaster; however, they often do not factor in the long-term needs and provide the structure and support needed by the community residents

Question 92

What is involved with the need for self-care?

Answer 92

-Self-care, including stress education for all relief workers after a disaster, is a common practice and actively encouraged in many communities

-Proponents report that stress education helps to reduce anxiety and put the situation into proper perspective

-Critical incident stress debriefing (CISD) provides relief workers with professional debriefing that consists of phases followed by individual sessions and support services as needed

-CISD is generally provided between 24 and 72 hours after the disaster event

-Proponents of CISD claim that it typically produces positive effects by:
1. Accelerating the healing process
2. Equipping participants with positive coping mechanisms
3. Clearing up misconceptions and misunderstandings
4. Restoring or reinforcing group cohesiveness
5. Promoting a healthy, supportive work atmosphere
6. Identifying individuals who require more extensive psychological assistance

-A CISD addresses all components of the human response to trauma, including physiologic effects, emotions, and cognition

-The research on CISD has been mixed, but Mitchell reports that if the personnel providing the intervention are well trained and follow acceptable CISD practice standards, the outcomes are more positive

-Self-care comes in many forms and is part of a prescription for emotional healing after a traumatic event
1. Self-care is for everyone touched by trauma including the rescue workers

-Trauma-informed care acknowledges the impact of various types of trauma on the individual’s lifetime potential for health problems and “engaging in health-risk behaviors”

-Both relief workers and recent trauma victims can benefit from this approach, which seeks to limit secondary traumatic stress by promoting empowerment and collaboration, as well as providing safety and choice

-Earlier life experiences, such as abuse and neglect or systemic bias, may exacerbate experiences with traumatic events

Question 93

What are the psychological consequences of disasters?

Answer 93

-More research is needed in the monitoring of long term psychological effects and the evaluation of interventions following disasters

-Awareness of your perceptions and how your actions are viewed are essential in dealing with trauma victims

-Fitzgerald & Hurst identify the prevalence of implicit bias even in health care providers
1. Their review of literature indicates that health care professionals exhibit the same amount of implicit bias as the general public and that diagnosis and treatment may be affected
2. In addition, trauma victims during a crisis may have previous trauma experiences related to power inequities, preventing a willingness to seek care or comply with medical instructions
3. Trauma-informed care requires the C/PHN to ask permission and be supportive
4. As health professionals, C/PHNs must be aware of their biases and prejudices

-Survivors of natural disasters experience a significant increase rate of psychological distress, PTSD, and depression

-The C/PHN and community mental health nurses, through education, screening, assessment, and referral, have an important role in the primary, secondary, and tertiary prevention of psychological disturbances due to a disaster

Question 94

What is primary prevention related to psychological consequences?

Answer 94

-Although a disaster, by its very nature, is often unforeseen, people’s ability to cope with the disaster can be determined in part by their previous experiences and resources available

-Behavioral health is essential for overall health and wellness especially in the face of a disaster

-Due to the uncertainty of when a disaster might occur, it is imperative to fortify personal and external resources before one happens
1. Interventions should include strengthening of cognitive, psychosocial, psychological, physical, and emotional domains of the individual and the community
2. During these times, lessons learned from primary health education and interventions may help with the survival and recovery phases
3. Consideration must be given to the life stages of the survivors

-The American Psychological Association describes resilience as a process of behaviors, thoughts, and actions
1. The building of competency or resilience is an important primary prevention strategy, since a competent person or community can make informed decisions based on availability of resources and problem-solving skills
2. Community disaster training must include information on resiliency and resources to support individual and community resilience

-C/PHNs can contribute to primary prevention in the face of disaster by advocating for improving the social structure and economic conditions of the community, including housing, work, schools, child care, and recreational areas

-It is also important for the C/PHN to advocate for the resources necessary for the community to meet both the physical and psychological challenges of a disaster

Question 95

What is secondary prevention related to psychological consequences?

Answer 95

-Survivors of disasters often feel anxious and overwhelmed and may be in mental health crisis, where the usual coping mechanisms are no longer effective in the face of the overwhelming disaster

-Crisis intervention is a secondary prevention intervention that the trained C/PHN can employ to minimize the stress and psychological consequences of the disaster

-Crisis intervention is a short-term intervention with the goal of alleviating negative effects of a disrupting, unexpected event such as disasters

-The phases of crisis interventions are closely related to the nursing process: assessment, planning of interventions, implementing the interventions, and evaluation and future planning

Question 96

What is tertiary prevention related to psychological consequences?

Answer 96

-People who have experienced or witnessed a disaster and have been unable to adequately cope with its consequences can develop acute stress disorder or the long-term effects of PTSD

-According to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), text revision, both acute stress disorder and PTSD can occur after any traumatic event to which a person responds with intense fear, helplessness, or horror

-Posttraumatic stress disorder (PTSD), an anxiety disorder, occurs in some people after a traumatic event such as a disaster, crime, combat, or an accident

-It is important for the C/PHN to be aware of the symptoms of stress-related disorders and make referrals to the available mental health professionals

Question 97

What is terrorism?

Answer 97

Unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives

Question 98

What is involved with bioterrorism and nuclear warfare?

Answer 98

-Three major countries operated offensive bioweapons programs in recent years: the United Kingdom until 1957, the United States until 1969, and the former Soviet Union until 1990

-Iraq started its bioweapons program in 1985 and continued to develop weapons until 2003

-Bioweapons include mustard gas, sarin, and VX gas, as well as anthrax

-Terrorists typically use biologic or chemical agents, explosives, or incendiary devices to deliver the agents to their targets

-A terrorist attack using nuclear weapons or destruction of a nuclear plant would cause multiple and prolonged deaths with extensive damage and negative effects for decades

Question 99

What is involved with chemical warfare?

Answer 99

-Chemical warfare involves the use of chemicals such as explosives, nerve agents, blister agents, choking agents, and incapacitating or riot-control agents to cause confusion, debilitation, death, and destruction

-Terrorists in the Middle East, willing to murder others and knowing they will be committing suicide, strap bombs to their bodies and detonate the explosives in or near targets

-Others plant explosives at large outdoor events like the 2013 Boston Marathon or crash vehicles loaded with explosives into crowds of people or into a building

-The aircraft used on September 11, 2001, were incendiary devices because they were carrying thousands of tons of jet fuel

-The success of the mission depended on the surprise of the attack, severe damage to recognizable buildings, and the deaths of many people

Question 100

What is involved with biological warfare?

Answer 100

-Biologic warfare involves using biologic agents to cause multiple illnesses and deaths

-Biologic agents are graded as category A, B, or C by the CDC

-There are over 180 pathogens that have been used or studied as possible biologic warfare

-Typical biologic agents are anthrax, botulinum, bubonic plague, Ebola, and smallpox
1. These agents could be used to contaminate food, water, or air
2. Deliberate food and water contamination remains the easiest way to distribute biologic agents for the purpose of terrorism

-The United States is very concerned about the possibility of biologic warfare or bioterrorism

-The anthrax infections and deaths that occurred after September 11, 2001, added to these concerns
1. It was years before the government investigation led to a scientist at Fort Detrick as the cause of this terroristic act
2. Although charges were never filed because of the individual’s suicide, the FBI believes that he was solely responsible for this act of domestic terrorism

-Regardless of the source of terrorism, the outcomes are the same: fear, death, and destruction

Question 101

What is a traumatic brain injury?

Answer 101

-Characteristic injury of the Iraq and Afghanistan wars

-Most common causes: blast, object hitting head, falls

-Associated with: depression, PTSD, suicidal ideation

Question 102

What is important to assess in veterans?

Answer 102

-PHNs should be aware of the needs of veterans, especially during disasters, terrorist attacks, and other traumatic events that may bring these past experiences to the forefront again

-It is also important to ask patients if they have military experience during the initial assessment
1. This information may impact the planned interventions

-C/PHNs should be aware of services available to veterans and treatments that are effective

Question 103

What are the factors contributing to terrorism?

Answer 103

-International terrorism
1. Anti-American sentiment
2. Anti-Western sentiment

-Domestic terrorism: extremist views
1. Social
2. Environmental
3. Racial
4. Political
5. Religious

Question 104

What is primary prevention applied to terrorism?

Answer 104

-C/PHNs are in ideal situations within communities to participate in surveillance

-They must look and listen within their communities for antigroup sentiments, for example, antireligion, antigay, or antiethnic feelings, and appropriately report any untoward activities accordingly

-Nurses should be alert to signs of possible terrorist activity and develop the basic knowledge and skills to plan and respond to disasters including acts of terrorism

-The National Prevention Framework, produced by Homeland Security, provides guidelines to prevent or stop an act of terrorism
1. Pre- and postdisaster preparation to include critical, specific nursing competencies and evidence-based practices are strongly recommended by many hospitals and health care organizations for all health care personnel

-The American Nurses Association has developed policies, resources, and educational opportunities for nurses on disaster preparedness acknowledging the importance of nurse preparation before a critical event

-The American Nurses Credentialing Center (ANCC) offers a certification in National Healthcare Disaster

Question 105

What is secondary and tertiary prevention applied to terrorism?

Answer 105

-Although prevention of terrorist incidents is primarily the responsibility of the Department of Defense, the DHS, and public health and law enforcement agencies, C/PHNs must be ready to handle the secondary and tertiary effects of such attacks

-Knowledge of the lethal and incapacitating chemical, biological, and radiological weapons potentially used by terrorists is important

-Realizing that terrorist attacks may result in large numbers of casualties, the C/PHN must be prepared to act quickly, safely, and competently, and to access information and effectively use resources rapidly

-Formulating, updating, and following a disaster plan is one of the most effective community-based strategies to minimize injury and mortality from terrorism
1. However, a recent systematic review discovered that nurses were unprepared to manage a disaster and did not feel confident

-Most C/PHNs will not be on the front line of uncovering or immediately responding to terrorist activities; however, their skills will be needed with groups, families, or individuals who experience a terrorist-related event

-C/PHNs provide direct care to survivors, help survivors with coping, or provide guidance to those who want to do something to help

-After experiencing a traumatic event such as a terrorist attack, people do not know how to cope; they are warned to expect more attacks and to be vigilant

-The terror we are fighting is often our own
1. This is a new experience for most people, and assistance from the C/PHN can help them cope effectively

-C/PHNs can make major differences in grassroots efforts to bring about change, on a day-to-day basis
1. For example, providing information on foods to avoid and nonmedical treatment options such as support groups, hypnosis, and biofeedback are a few examples of how nurses can assist with coping mechanisms
2. Community resilience is the goal of the interventions