Disasters and development: Part 2: understanding and exploiting disaster-development linkages

Disasters can impede the effectiveness of development resource allocation. The damage sustained from an event can be classified into four categories: (1) Loss of resources; (2) Interruption of programs and switching of crucial resources to other, shorter-term needs; (3) Negative impacts upon investment climates; and/or (4) Disruption of the non-formal sector (local businesses). Disasters have a particularly destructive economic impact in areas in which there are few alternatives for assets that are destroyed or in areas in which the resources already are at critical levels. Development processes can both increase and/or decrease the vulnerability of a society to hazards. There are dearly established linkages between poverty, marginalization, over-population, and vulnerability. To a large extent, vulnerability derives from poverty. The poor are more likely to live in vulnerable areas (slopes prone to landslides, flood plains, marginal agricultural land), have difficulty accessing education and information, have fewer assets to invest in resources to reduce vulnerability, and are more prone to become malnourished and have chronic illnesses that predispose them to injury and death. Development may be associated with the production of new hazards accepted by a society because the perceived benefits of the development project far exceed the relative risk associated with the project. Therefore, risk assessments must be part of any program planning and evaluation. Training and education are of critical importance in preventing increased vulnerability as a result of development strategies. Development also can progress in a manner that will result in mitigation of the impacts of an event on a given society (increase absorbing capacity and/or buffering capacity, elimination of hazards or the risk of them producing a disaster). Such mitigation measures can be either structural or nonstructural. There exists a wide range of options for incorporating mitigation measures in development projects. Two case studies provide exercises that incorporate the concepts provided in this discussion: (1) The 1985 earthquake in Mexico City; and (2) Agricultural development in northern Sudan.     

What have we learned? Capacity building for health responses in disasters

This is a synthesis of the presentations and discussions pertaining to Capacity Building for Health Responses in Disasters of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04-06 May 2005. The topics discussed included: (1) Specific goals; (2) Main focal areas, including available training programs, country-specific training programs, targeted technical assistance for training programs, certified training programs, and ensuring that funding is available for training; (3) What has been achieved in building capacity; (4) Challenges; (5) Where capacity building is needed; and (6) Conclusions and recommendations.     

Disasters and development: Part I. Relationships between disasters and development

This module introduces a paradigm for understanding the disaster/development interface. Specifically, the module asserts that disasters and development are linked closely in that disasters can both destroy development initiatives and create development opportunities, and that development schemes can both increase and decrease vulnerability. The module consists of four parts: Part One introduces these concepts and discusses how disasters can vary from one type of hazard to another, as well as from one type of economic condition to another. Part Two develops the paradigm in depth, and provides case examples to amplify the points made in the text. Part Three describes and discusses different methods and tools for analyzing decisions for potential investment of resources, and should enhance the reader's capacity to analyze the mitigational benefits of development alternatives in both the pre- and post-disaster context. Part Four conceptualizes the role of UN agencies, NGOs, and the affected communities in promoting development based on the concepts discussed in the module. This training module, Disasters and Development, initially was designed to introduce this aspect of disaster management to an audience of UN organization professionals who form disaster management teams, as well as to government counterpart agencies, non-governmental organizations (NGOs), and donors. The educational process has been designed to increase the audience's awareness of the nature and management of disasters, in order to lead to better performance in disaster preparedness and response. The content has been written by experts in the field of disaster management and in general follows the UNDP/UNDRO Disaster Management Manual and its principles, procedures, and terminology.     

Disaster nursing and primary school teachers' disaster-related healthcare knowledge and skills

The World Bank has ranked Taiwan as the 5th highest risk country in the world in terms of full-spectrum disaster risk. With volatile social, economic, and geologic environments and the real threat of typhoons, earthquakes, and nuclear disasters, the government has made a public appeal to raise awareness and reduce the impact of disasters. Disasters not only devastate property and the ecology, but also cause striking and long-lasting impacts on life and health. Thus, healthcare preparation and capabilities are critical to reducing their impact. Relevant disaster studies indicate children as a particularly vulnerable group during a disaster due to elevated risks of physical injury, infectious disease, malnutrition, and post-traumatic stress disorder. Primary school teachers are frontline educators, responders, and rehabilitators, respectively, prior to, during, and after disasters. The disaster prevention project implemented by the Taiwan Ministry of Education provides national guidelines for disaster prevention and education. However, within these guidelines, the focus of elementary school disaster prevention education is on disaster prevention and mitigation. Little guidance or focus has been given to disaster nursing response protocols necessary to handle issues such as post-disaster infectious diseases, chronic disease management, and psychological health and rehabilitation. Disaster nursing can strengthen the disaster healthcare response capabilities of school teachers, school nurses, and children as well as facilitate effective cooperation among communities, disaster relief institutes, and schools. Disaster nursing can also provide healthcare knowledge essential to increase disaster awareness, preparation, response, and rehabilitation. Implementing proper disaster nursing response protocols in Taiwan's education system is critical to enhancing disaster preparedness in Taiwan.     

Protecting new health facilities from natural hazards: guidelines for the promotion of disaster mitigation

The health sector is particularly vulnerable to naturally occurring events. The vulnerability of the health infrastructure (hospitals and clinics) is of particular concern. Not only are such facilities vulnerable structurally, but their ability to continue to provide essential functions may be severely compromised, thus leaving the stricken population without essential services. This paper summarizes a more detailed document, Guidelines for Vulnerability Reduction in the Design of New Health Facilities published by the Pan-American Health Organization (PAHO)/ World Health Organization (WHO). The current document summarizes these Guidelines emphasizing how they may be used, by whom, and for what purpose. Potential users of the Guidelines include, but are not limited to: (1) initiators of health facility construction projects; (2) executors and supervisors of health facility construction projects; and (3) financing bodies in charge of funding health facility construction projects. The Guidelines include: (1) implications of natural phenomena upon the health infrastructure; (2) guidelines for vulnerability reduction for incorporation into development project cycles; (3) definitive phases and stages within the phases for development projects including: (I) Projects Assessment (needs assessment; assessment of options, the preliminary project); (II) Investment (project design, construction); and (III) Operational Activities (operations and maintenance). In addition, investment in damage reduction measures, policies and regulations, training and education, and the role of international organizations in the promotion and funding of mitigation strategies are addressed.     

Partnership between CTSI and Business Schools Can Promote Best Practices for Core Facilities and Resources

Biomedical research enterprises require a large number of core facilities and resources to supply the infrastructure necessary for translational research. Maintaining the financial viability and promoting efficiency in an academic environment can be particularly challenging for medical schools and universities. The Indiana Clinical and Translational Sciences Institute sought to improve core and service programs through a partnership with the Indiana University Kelley School of Business. The program paired teams of Masters of Business Administration students with cores and programs that self‐identified the need for assistance in project management, financial management, marketing, or resource efficiency. The projects were developed by CTSI project managers and business school faculty using service‐learning principles to ensure learning for students who also received course credit for their participation. With three years of experience, the program demonstrates a successful partnership that improves clinical research infrastructure by promoting business best practices and providing a valued learning experience for business students.     

Development, Implementation, and Process Evaluation of a Regional Palliative Care Quality Improvement Project

The delivery of optimal palliative care requires an integrated and coordinated approach of many health care providers across the continuum of care. In response to identified gaps in the region, the Palliative Care Integration Project (PCIP) was developed to improve continuity and decrease variability of care to palliative patients with cancer. The infrastructure for the project included multi-institutional and multisectoral representation on the Steering Committee and on the Development, Implementation and Evaluation Working Groups. After review of the literature, five Collaborative Care Plans and Symptom Management Guidelines were developed and integrated with validated assessment tools (Edmonton Symptom Assessment System and Palliative Performance Scale). These project resources were implemented in the community, the palliative care unit, and the cancer center. Surveys were completed by frontline health professionals (defined as health professionals providing direct care), and two independent focus groups were conducted to capture information regarding: 1) the development of the project and 2) the processes of implementation and usefulness of the different components of the project. Over 90 individuals from more than 30 organizations were involved in the development, implementation, and evaluation of the PCIP. Approximately 600 regulated health professionals and allied health professionals who provided direct care, and over 200 family physicians and medical residents, received education/training on the use of the PCIP resources. Despite unanticipated challenges, frontline health professionals reported that the PCIP added value to their practice, particularly in the community sector. The PCIP showed that a network in which each organization had ownership and where no organization lost its autonomy, was an effective way to improve integration and coordination of care delivery.     

Learning from experience: Using action research to discover consumer needs in post‐seclusion debriefing

Approximately 16% of consumers are secluded during an inpatient admission. Despite the harmful psychological consequences resulting from the use of physical force, restraint, control, and temporary sequestration of therapeutic communication, there is little evidence of nursing practices to support consumers who are secluded. This paper will outline the findings from an action research project examining post‐seclusion debriefing practice. A series of focus groups was undertaken with mental health nurses (MHN) and consumer consultants (CC) to investigate current practice, identify consumer/clinician preferences, and scope future practice possibilities. The findings suggest that CC need assistance in dealing with the negative feelings evoked by seclusion. MHN use a range of approaches for debriefing; however, these sometimes do not meet consumer preferences. MHN focus on explaining why seclusion happened and how to avoid it. While mitigation is a critical issue, CC want more emotional support from debriefing. MHN saw the possibility of using the debriefing to support consumers' transit from seclusion to high‐dependency status and then to low‐dependency status. Opinions raised regarding the potential for CC to have a role in debriefing were divided. The findings will be used to inform the development of a consumer debriefing training program for MHN and CC.     

OSHA's voluntary protection programs. The benefits to occupational health nurses and their companies

The Voluntary Protection Programs (VPP) consist of three different programs: Star, Merit, and Demonstration. Each is designed with different criteria to allow the opportunity for a wide range of safety and health programs to be recognized. To be accepted into the Star program it is necessary to have statistics that indicate the program is effective and to have the following six elements incorporated into a comprehensive safety and health program: management commitment; established methods of worksite analysis; established methods of hazard prevention and control; quality safety and health training; employee participation; and annual self evaluation. Because occupational health nurses have daily experience and formal training in hazard prevention and control, safety and health training, and employee health, they are invaluable resources in the VPP application process and in the maintenance of Star level protection. Decreased workers' compensation costs, decreased injury rates, and development of a positive attitude toward OSHA are benefits of the VPP for management, employees, and OSHA.     

How to talk to the media: televised coverage of public health issues in a disaster

Public health officials often are critical of the way television news covers disasters, while broadcast journalists complain of a lack of cooperation from the public health sector during disaster coverage. This article summarizes the issues discussed in a session on Televised Coverage of Disasters, presented in April 1999 at the UCLA Conference on Public Health and Disasters in Los Angeles. Public health officials were asked to "talk back to their television sets" in a dialog with television journalists. Concerns included: 1) the lack of balance in television coverage that is dominated by sensational images that may frighten rather than inform the public; 2) the potential for psychological damage to viewers when frightening images are shown repeatedly in the days and weeks of the disaster; and 3) the perception that TV reporters place too much emphasis on crime, property damage, and loss of life, giving relatively low priority to disaster preparedness and to public health issues in the aftermath of a disaster. Options for improving communication between television journalists and public health professionals also are discussed.     

Hospital antibiotic management in Belgium – results of the ABS maturity survey of the ABS International group

BACKGROUND: While debate about optimal organization for hospital antibiotic stewardship programs is ongoing, limited information is available about the implementation of such programs in acute-care institutions. The ABS International project conducted a survey on the implementation and characteristics of hospital antibiotic management programs in several European countries. This paper summarizes the results for Belgium, where a federal program for developing multidisciplinary antibiotic management teams was started in 2002. METHODS: The survey was conducted in April and May 2007. A questionnaire with 39 items to be scored from 0 (absent) to 5 (fully available) was sent to medical directors and chairs of drugs and therapeutics committees in all acute-care hospitals to measure five dimensions of hospital antibiotic management. The results were analyzed by calculating the mean scores for the various items and topics. MAIN FINDINGS: Of 120 questionnaires sent, 46 (38%) were completed and returned in time for analysis. The three regions of the country were well represented by the respondents. The mean country maturity score of 3.75 (range 2.15-4.90) indicated that a well developed antibiotic management system was in place in most hospitals. Over 90% of hospitals had key structural resources and tools available for effective stewardship programs. Performance items that scored high were those related to microbiological diagnostics and surveillance of bacterial resistance (4.41), surveillance of antibiotic consumption (4.16) and organization of antibiotic guidance and support by trained antibiotic management officers (3.81). Items that scored lower were professional development of personnel (3.43) and co-ordination with outside healthcare providers (2.95). Hospitals with several years of funding for their antibiotic officer showed higher scores for antibiotic management but not for diagnostics. CONCLUSIONS: Antibiotic stewardship programs are well developed in Belgian hospitals, particularly in those which first qualified for federal support. Extension of funding and technical assistance should help all hospitals to catch up with excellence standards, provided that adequate support is given to laboratory services and advanced training of professional specialists.     

Nurses under threat: a comparison of content of 28 aggression management programs

Staff who work in the health service are now recognized as a high-risk group for assault in the workplace. Recently, professional and industrial organizations have begun to suggest appropriate curricula for training staff in aggression management. However, there is currently a plethora of aggression management training programs (AMP) available, varying both in content and in duration. In this paper, 28 programs were evaluated against 13 major content areas derived from the recommendations made from key professional and industrial organizations, and what may be today considered appropriate/ideal content areas for AMP. Information on programs available in English was sought via standard databases, the Internet, program providers, and through networking with colleagues and professional organizations. The majority of the programs reviewed covered personal safety issues for staff and patients, together with legal issues. The use of restraint, pharmacological management of aggression and seclusion were features of programs specifically addressing the needs of health care staff in mental health settings. Most programs appeared not to address the psychological and organizational costs associated with aggression in the workplace. This is surprising since the literature suggests that the effects of violence are wide and varied, including increased absenteeism and sick leave, property damage, decreased productivity, security costs, litigation, workers' compensation, reduced job satisfaction together with recruitment and retention issues. Also, few programs were based on a systematic evaluation of their outcomes. Suggestions for program development and their teaching are discussed.     

Emergency Supply Policy of Cryopreserved RBC and PLT: The Czech Republic Concept

Supply of blood for urgent substitution is a strategic logistical problem for the military medical services across the world. The limited shelf life of blood- derived bioproductsin the liquid state and the need for special transport and use conditions, apart from donor and donations availability are among the causes for concern. To solve these problems many national health-care authorities implemented the national emergency blood crisis policy, to get a large amount of blood at any time at any place in the case of disaster, terrorist attack or war. The civil therapeutic problems in immunohematolgy cases can also be solved by stocks of fresh and cryopreserved homologous or autologous blood for patients with rare RBCs antigens or HLA / HPA platelet refractoriness with no chance to use common blood. The short shelf life of fresh platelets limits their efficient inventory management and availability during a massive transfusion protocol. Building an inventory of frozen blood components can mitigate the risk of insufficient availability. Since the beginning of the century in the Czech Republic, used, like other countries, the use of of cryopreserved blood-derived bioproducts has become the current method used to overcome the shortages of a timely supply. The Military University Hospital, Prague, and its bank of cryopreserved blood have been operating under this policy since 2006. There is currently a stock of frozen RBCs for military reserve, for a national blood crisis and, also, a stock of rare RBC units. For crisis management there are also stored, frozen PLTs, which are used in the treatment of heavily bleeding polytrauma patients. Both the containment and research development mitigation policy programs are in place for civil / military emergency situations. Even pathogen reduced frozen PLTs and frozen RBCs were successfully investigated for clinical use if demands arose. Currently, it is possible to meet operational demand while reducing the number of resupply transports and loss of products due to expiration. A lesson has been learned from the current containment, reseach and mitigation programs of efficient blood supply management with cryopreserved blood and blood derived bioproducts.     

Medical student disaster medicine education: the development of an educational resource

Background

Disaster medicine education is an enormous challenge, but indispensable for disaster preparedness.

Aims

We aimed to develop and implement a disaster medicine curriculum for medical student education that can serve as a peer-reviewed, structured educational guide and resource. Additionally, the process of designing, approving and implementing such a curriculum is presented.

Methods

The six-step approach to curriculum development for medical education was used as a formal process instrument. Recognized experts from professional and governmental bodies involved in disaster health care provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development.

Results

The final course consisted of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training.

Conclusions

The curriculum offers medical disaster education in a reasonable time frame, interdisciplinary format, and multi-experiential course. It can serve as a template for basic medical student disaster education. Because of its comprehensive but flexible structure, it should also be helpful for other health-care professional student disaster education programs.     

Knowledge of and attitudes toward assisting patients with dementia during mealtime among nursing staff in acute care settings: A cross-sectional study

BackgroundMealtime difficulties are exacerbated in acute care settings, which further complicate health issues in people with dementia (PWD). Understanding staff knowledge and attitudes is crucial for providing better care for PWD in nursing home settings. However, little is known about the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.AimTo explore the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.MethodsWe conducted a cross-sectional study between August and December 2020 at three acute care hospitals in Illawarra region, New South Wales, Australia. Surveys were distributed to nursing staff including registered nurses, enrolled nurses, and nurse assistants, who worked in geriatric wards. Medical practitioners and casual staff were excluded from the survey. Demographics, knowledge, attitudes, and intentions toward mealtime assistance of PWD were included in the survey.FindingsA higher level of knowledge in mealtime assistance of PWD was found to be associated with positive attitudes toward mealtime assistance of PWD (r = 0.464, p < 0.001). No differences were found between educational levels and knowledge and attitudes of mealtime assistance for PWD.DiscussionThe need for mealtime assistance training to enhance knowledge of and attitudes toward assisting PWD during mealtimes is highlighted and needs more attention. Future studies could consider including a simulation training program and adopting a mealtime engagement scale to provide training and assess changes in nursing staff knowledge of and attitudes toward mealtime assistance for PWD in acute care settings.ConclusionsThe study findings can inform future research in raising awareness of the need for and developing mealtime assistance training programs for nursing staff in acute care settings.     

Pressure area management: a static-led approach

An increase in expenditure and inappropriate use of pressure-relieving equipment, along with high-prevalence figures, initiated the evaluation of current practice of pressure damage prevention in an acute general hospital. This evaluation started with the organization of a project group, who (after a baseline audit) identified and procured the resources required to introduce and manage an effective pressure damage prevention programme. The investment in high-quality static mattresses for all patients including those who are at high risk of developing pressure damage was based on available clinical evidence. This investment meant a reduction in the amount of dynamic systems needed as many of those patients are at high risk of pressure damage, and are now successfully managed on a static system. The development of a local policy including documentation facilitated regular reassessment of risk level based on a risk assessment tool and clinical rationale. This static-led approach has reduced not only costs but also improved the appropriate allocation of pressure-relieving/reducing equipment. The approach has also simplified the choice of equipment for staff who were previously expected to match patients' needs with varying levels of dynamic mattress efficiency. This article highlights the action taken from the initial identification of a specific need through to the effective implementation, management and monitoring of this innovative practice.     

A task-based approach to defining the role of the nurse practitioner: the views of UK acute and primary sector nurses

There exists within the United Kingdom considerable confusion relating to the definition and occupational boundaries of the nurse practitioner (NP). In consequence, the clinical practice and training of the NP remain unregulated, unstandardized and heavily dependent on local forces. Such a situation is regrettable, particularly in view of the potential value the nurse practitioner has for health care provision and also for influencing national policy decisions. It is conceivable that one reason for the current failure to reach agreement over the role definition of the nurse practitioner relates to the fact that their essential job functions depend upon the context in which the nurse practitioner operates, with primary-based practice differing from acute sector service delivery in sufficient critical ways as to make a generic, inclusive definition impossible. To investigate the veracity of this view, two cohorts of United Kingdom nurses were sampled, one of which worked within the acute sector (n = 49) and the other in the community (n = 420). These groups were surveyed using a unique training needs analysis instrument that had been developed along formal psychometric principles. Both groups perceived advanced clinical activities, including examination and diagnosis, and a range of research activities to be central to the role of the nurse practitioner. The primary sample, however, reported business and management activities as essential tasks, while the acute sector nurses regarded high levels of communication skills, autonomy and risk management to be more important. The implications of the similarities and differences between the two data sets are discussed with reference to different clinical domains.     

‘You don't know what you don't know’: The essential role of management exposure,understanding and commitment in peer workforce development

The peer workforce has increased significantly in recent years; however, structured development and support for the roles are lacking. This paper explores the role of executive and senior management understanding in the employment of peer roles. In‐depth, semi‐structured interviews and one focus group were conducted with 29 participants from a range of nongovernment and public mental health services within Queensland, Australia. Findings of this study suggest management exposure to and understanding of peer work are essential to the development of an effective peer workforce. Exposure and understanding of peer roles reportedly led to greater acceptance and commitment from management. This commitment inspired action in the form of; enhanced support including advocacy/championing, increased development of roles and influenced culture within the organization to be more accepting of peer work. There was a perception that developing an ‘accepting’ organizational culture supported the integrity and expansion of peer roles including designated ‘peer management’ positions. Development of peer management positions is suggested as an effective means of improving the impact of peer perspectives, advocating for peer work and providing ongoing and timely supervision. Recommendations include the need for training and information for management on the unique function, purpose and value of peer roles; and the development of networks, including mentoring opportunities, for organizations with limited experience to gain support and advice from those with greater experience developing peer roles.