Caring for those who care: the role of the occupational health nurse in disasters

Since the events of 9/11, health care facilities have devoted substantial resources to emergency preparedness, especially for a surge of patients in a large-scale incident. Hurricane Katrina reinforced the need for such surge planning. Due to the SARS experience in Toronto, health care professionals have had increased awareness of their "duty-to-care" responsibility. These caregivers make the decision, even when they themselves may be at risk, to continue to care for patients. However, little has been done about planning to care for these caregivers. Health care professionals can be deeply affected physically, emotionally, and spiritually when caring for patients in a large-scale incident. Emergency preparedness professionals must consider the needs of health care providers because providers must care for a large number of patients with limited resources under stressful conditions. It is the obligation and responsibility of each health care organization to care for these caregivers. However, when assigning responsibility for this task, it becomes evident this responsibility belongs to employee health nurses, "employee advocates," and organizational leaders.     

International Emergency Medicine and the Role for Academic Emergency Medicine

International emergency medicine continues to grow and expand. There are now more than 30 countries that recognize emergency medicine as a specialty. As the field continues to develop, many physicians are reaching across borders and working with their colleagues to improve patient care, education, and research. The future growth and success of the specialty are based on several key components. These include faculty development (because this is the key driver of education), research, and curriculum development. Each country knows what resources it has and how best to utilize them. Countries that are developing the specialty can seek consultation from successful countries and develop their academic and community practice of emergency medicine. There are many resources available to these countries, including distance learning and access to medical journals via the Internet; international exchanges by faculty, residents, and medical students; and physicians who are in fellowship training programs. International research efforts require more support and effort to be successful. This report discusses some of the advantages and hurdles to such research efforts. Physicians have a responsibility to help one another succeed. It is the hope of the authors that many more emergency physicians will lend their skills to further global development of the specialty.     

Continuity of care. Balancing care of elders between health care settings

Continuing care planning and balancing care of elders are crucial components of health care today. The most sweeping change that has come with the advent of prospective pricing for the acute care setting is in the financing of health care for the aged and disabled. Prospective pricing, which uses the diagnosis-related group system, is the method chosen by federal agencies to restrain Medicare costs. For almost two decades, the hospital has been the reservoir for the impaired elderly who could not be returned home or to the community without support services. The system now encourages shortened hospital stays. Continuing care planning is the key to balancing the care of the elder through the process of discharge planning. We must assure patients and families that their needs will be met in the community when the patient is discharged. Balancing care of elders between health care settings through discharge planning is identified in three simple words: A Complex Process. As health care professionals, we must be ready to accept this challenge.     

The hospitalized patient with arthritis

Patients hospitalized with arthritis require the expertise of nurses with a solid medical and surgical background, a base upon which approaches to rheumatic disease can be developed. The nurse should play a primary role in planning a realistic and integrated schedule for meeting the patient's pharmacotherapeutic and rehabilitation needs, in reinforcing physical medicine principles and programs, and in serving as a liaison between patient and physician, patient and other health care providers, patient and family, and patient and community. The nurse is pivotal in assuring that the comprehensive care and educational needs of the patient with arthritis are met, whether hospitalized or in an out-patient setting.     

Aftercare residential facility for ex-psychiatric patients--the Australian and American perspectives

The decline in the number of inpatients in psychiatric hospitals over the last decade has resulted in a strong demand for community based mental health services, and a search for alternative accommodation for ex-psychiatric patients. However, for any comprehensive planning for residential services for ex-psychiatric patients to be effective, there must be a recognition of the variety of patient needs and resources and the range of service models available. This paper attempts to review aftercare residential facilities in America and Australia, to identify the underlying care philosophy and to propose various supervision approaches.     

Characteristics of Medical Surge Capacity Demand for Sudden-impact Disasters

Objectives
To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters.
Methods
Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points.
Results
The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances.
Conclusions
As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses.     

Parish nursing: renewing a long tradition of caring.

Parish nurses are experienced registered nurses committed to helping people meet the health needs of their body, mind, and spirit. To fulfill this goal, parish nurses must be health educators and counselors, referral sources, facilitators, patient advocates, healthcare plan interpreters, and multitalented coordinators. The parish nurse uses the skill of nursing assessment of individual and congregational needs and matches the assessment findings to available resources. The parish nurse also advocates increased awareness of health-related issues that lead to earlier and more effective treatment and care. All ages benefit within a context of personal caring and attention offered by a parish nursing model that is often lacking from healthcare delivery systems. Congregations of all sizes, both urban and rural, have successfully started parish nurse programs. Parish nursing programs are a religious response to help bring wholeness and healing to the faith community. The purpose of this article is to explore parish nursing as it has evolved into a model of health care delivery contributing to the empowerment and health of both the individual and the community.     

Rehabilitation and the geriatric patient

The true challenge in the care of the elderly is to keep people at home, in the community, with a high degree of functional ability. This is beneficial to the individual and, from a financial point of view, to the community and public. Maintenance and restoration of function are best accomplished within a framework that considers the psychosocial and developmental needs of the geriatric patient and in a setting specifically intended for the geriatric rehabilitation patient. Unlike the rehabilitation process in younger age groups, which is often dramatic, successful work with geriatric patients is likely to be subtle, but it will result in a return to the community and allow patients to experience a higher level of satisfaction (both emotional and functional) at the end of their lives. The needs of this population are many, and the health care provider must consider disease, physiologic changes associated with aging, and developmental needs when planning and implementing care. Initial research has pointed to the efficacy of geriatric rehabilitation programs; this would seem to indicate a need for a true specialization in geriatrics within the field of rehabilitation.     

Research directions in emergency medicine

The goal of emergency medicine is to improve health while preventing and treating disease and illness in patients seeking emergency medical care. Improvements in emergency medical care and the delivery of this care can be achieved through credible and meaningful research efforts. Improved delivery of emergency medical care through research requires careful planning and the wise use of limited resources. To achieve this goal, emergency medicine must provide appropriate training of young investigators and attract support for their work. Promotion of multidisciplinary research teams will help the specialty fulfill its goals. The result will be the improvement of emergency medical care which will benefit not only the patients emergency physicians serve but also, ultimately, the nation's health.     

Research Directions in Emergency Medicine*

The goal of EM is to improve health while preventing and managing disease and illness in patients seeking emergency medical care. Improvements in emergency medical care and the delivery of this care can be achieved through credible and meaningful research efforts. Improved delivery of emergency medical care through research requires careful planning and the wise use of limited resources. To achieve this goal, EM must provide appropriate training of young investigators and attract support for their work. Promotion of multidisciplinary research teams will help the specialty fulfill its goals. The result will be the improvement of emergency medical care, which will benefit not only the patients whom EPs serve, but also, ultimately, the nation's health.     

Discharge planning and follow-up care: the asphyxiated infant.

Discharge planning and follow-up care of the asphyxiated infant is a complex process. Models of discharge planning, team member responsibilities, and teaching responsibilities are components of hospital discharge plans. Special care needs of these infants may include vision, hearing, immunizations, seizures, medications, and feeding. Families and health care professionals need to be familiar with programs providing financial resources for care of the infant such as private insurance, prepaid health care, Medicaid, Medical Needy program, Children with Special Health Care Needs (CSHCN), federal legislation mandating education and services for high-risk infants (PL 99-142 and PL 99-457) and intervention programs. Families returning to Newborn Follow-up programs become acquainted with a variety of professionals and types of neonatal and infant assessments. Providing teaching materials and information regarding special health problems, services and outcome, as it becomes known, is the responsibility of the extended health care team of nurses, physicians, home health services, psychologists, and therapists.     

The Business of Emergency Medicine: A Nonclinical Curriculum Proposal for Emergency Medicine Residency Programs

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.     

A Collaborative Communitywide Health Fair: The Process and Impacts on the Community

The purpose of this article is to describe the process of conducting a collaborative communitywide health fair, and the impacts of such health intervention programs on community members. A community health fair addresses the health access needs of underserved populations. The success or effectiveness of such community-based programs requires systematic approach to assessment, planning, implementation, and evaluation. The PRECEDE?PROCEED model was used as the guiding framework. The health fair described in this article was coordinated by nurses and drew resources from multiple health providers and organizations. The fair provided opportunities for vulnerable populations to access and utilize appropriate and comprehensive health services, resources and education.     

Observation Medicine in Emergency Medicine Residency Programs

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.     

Role of physician for promoting the involvement of other health personnel and auxiliaries in implementing programmes of fertility regulation and family.

The magnitude of the task of providing basic health care for all the people of India necessitates reorientation of the entire health delivery system. Family welfare programs must be integrated into the comprehensive health care system. There must be a shift from the present institutionalized curative care programs to community-based comprehensive care which emphasizes preventive, promotive, and rehabilitative aspects of health care. In addition, the current health hierarchical system must give way to a health team approach. This can be facilitated if nursing personnel are given greater responsibilities in the health care system. Physicians must take the responsibility of training other members of the health care team, especially in family planning areas. Nurses can identify eligible cases, refer cases to proper services, actively participate in aspects of the family planning program, provide follow-up and educative services, and act in administrative roles. There is a current shortage of nursing personnel in India because salaries are low, working conditions are poor, facilities are inadequate, social security is lacking, and they are asked to perform many nonnursing duties. Recommendations to remedy these inadequacies are offered.     

An Open,Interoperable, and Scalable Prehospital Information Technology Network Architecture

Abstract

Some of the most intractable challenges in prehospital medicine include response time optimization, inefficiencies at the emergency medical services (EMS)–emergency department (ED) interface, and the ability to correlate field interventions with patient outcomes. Information technology (IT) can address these and other concerns by ensuring that system and patient information is received when and where it is needed, is fully integrated with prior and subsequent patient information, and is securely archived. Some EMS agencies have begun adopting information technologies, such as wireless transmission of 12-lead electrocardiograms, but few agencies have developed a comprehensive plan for management of their prehospital information and integration with other electronic medical records. This perspective article highlights the challenges and limitations of integrating IT elements without a strategic plan, and proposes an open, interoperable, and scalable prehospital information technology (PHIT) architecture. The two core components of this PHIT architecture are 1) routers with broadband network connectivity to share data between ambulance devices and EMS system information services and 2) an electronic patient care report to organize and archive all electronic prehospital data. To successfully implement this comprehensive PHIT architecture, data and technology requirements must be based on best available evidence, and the system must adhere to health data standards as well as privacy and security regulations. Recent federal legislation prioritizing health information technology may position federal agencies to help design and fund PHIT architectures.     

When Disaster Happens: Emergency Preparedness for Nurse Practitioners

Catastrophic events, including both natural and man-made disasters, usually create surge capacity needs for health care systems; subsequently, the ability to meet such capacity requires thoughtful preparation. While it is true that disastrous emergencies may not be prevented or controlled, it is vital for citizens to be prepared at multiple levels, including individuals, families, health care employees, and community organizations at-large, in order to mount a successful response to the event. Nurse practitioners, by virtue of their advanced biopsychosocial education, as well as their inherent role of community-based practice and collaboration, are uniquely situated to directly contribute toward these efforts.     

Emergency Department Surge Capacity: Recommendations of the Australasian Surge Strategy Working Group

For more than a decade, emergency medicine (EM) organizations have produced guidelines, training, and leadership for disaster management. However, to date there have been limited guidelines for emergency physicians (EPs) needing to provide a rapid response to a surge in demand. The aim of this project was to identify strategies that may guide surge management in the emergency department (ED). A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations and identified underlying assumptions from disaster epidemiology and clinical practice. The group then characterized surge strategies from their corpus of experience; examined them through available relevant published literature; and collated these within domains of space, staff, supplies, and system operations. These recommendations detail 22 potential actions available to an EP working in the context of surge, along with detailed guidance on surge recognition, triage, patient flow through the ED, and clinical goals and practices. The article also identifies areas that merit future research, including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies, and measurement of strategy impacts on throughput, cost, and quality of care.     

Needs assessment and staff education to effect long-term change in emergency medicine in rural Nepal

Medical work in developing countries is challenging and rewarding. To make a lasting impact on the local community, a health care worker must be willing to listen to the needs of the people. The long-term impact of a needs assessment and staff education on emergency medicine at a rural hospital in Nepal is presented. The Scheer Memorial Hospital is a 102-bed non-governmental, not-for-profit hospital in Banepa, Nepal. Nepalese and ex-patriot health care professionals staff the hospital. Medical supplies are obtained from local manufacturers or as donations from foreign organizations. The hospital waives fees for those who cannot afford care. Two academic emergency physicians with expertise in international health undertook a needs assessment to assist in planning for long-term health care goals related to emergency medicine. The assessment focused on health care planning and education of the local health care staff. Based on interviews and objective assessments, a plan was developed and implemented to address 4 key areas: physical plant, equipment, staff training and essential tasks. Sustainable positive change was accomplished by acknowledging local customs and standards of care, meeting the needs of local health care staff and using available resources.