Disaster Nursing Lecture Notes PDF

NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 1...

NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 1 Materials: LESSON TITLE: I. Disaster Preparedness: Essentials of Disaster Planning Book, pen and notebook LEARNING OUTCOMES: Upon completion of this lesson, the nursing student can: 1. Classify the major types of disasters based on their unique characteristics. References: 2. Describe basic principles of disaster planning. Veenema, T.G. (2019) Disaster Nursing and 3. Differentiate risk assessment, hazard identification, and Emergency Preparedness for Chemical, vulnerability analysis. Biological, and Radiological Terrorism and other 4. Identify the core preparedness actions. Hazards 4th Edition SUBJECT ORIENTATION (10 minutes) The instructor will start by introducing herself to the class and the assigned subject, Disaster Nursing – Lecture. The course outline will be distributed and discussed accordingly. Listed below are the additional information vital in orientation: 1. Classroom rules and regulations. 2. The calendar of activities (major examinations). 3. Computation of grades specific for this subject. 4. Election for block officers. MAIN LESSON (35 minutes) The students will study and read their book about this lesson (Chapter 1 of the book): DISASTER: “a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts” (United Nations International Strategy for Disaster Reduction [UNISDR], 2017). DISASTER NURSING  The adaptation of professional nursing skills in recognizing & meeting the nursing physical & emotional needs resulting from a disaster.  “Nursing practiced in a situation where professional supplies, equipment, physical facilities & utilities are limited or not available”.  GOAL: To achieve the best possible level of health for the people & the community involved in the disaster. Nurses’ Roles in Disaster: 1. Determine magnitude of the event 2. Define health needs of the affected groups 3. Establish priorities & objectives 4. Identify actual & potential public health problems 5. Determine resources needed to respond to the needs identified 6. Collaborate with other professional disciplines, governmental & non-governmental agencies 7. Determine magnitude of the event 8. Define health needs of the affected groups HEALTH DISASTER: is a catastrophic event that results in casualties that overwhelm the healthcare resources in that community and may result in a sudden unanticipated surge of patients, a change in standards of care, and a need to allocate scarce resources. This document and the information thereon is the property of PHINMA 1 of 7 Education (Department of Nursing) TWO BROAD CATEGORIES OF DISASTER: 1. Natural 2. Man-made or anthropogenic NATURAL DISASTER Those caused by natural or environmental forces. WHO defines “natural disaster” as the “result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community” (Lechat, 1979). Natural disasters include earthquakes, floods, tornadoes, hurricanes, volcanic eruptions, ice storms, tsunamis, and other geological or meteorological phenomena. Natural disasters are the consequence of the intersection of a natural hazard and human activity. MAN-MADE OR ANTHROPOGENIC (Human Generated) Anthropogenic disasters are those in which the principal direct causes are identifiable human actions, deliberate or otherwise (Jha, 2010). Anthropogenic disasters include biological and biochemical terrorism, chemical spills, radiological (nuclear) events, fire, explosions, transportation accidents, armed conflicts, and acts of war. THREE CATEGORIES OF HUMAN-GENERATED DISASTERS: 1. Complex Emergencies 2. Technological disasters 3. Disasters that are not caused by natural hazards but occur in human settlements Complex human emergencies involve situations where populations suffer significant casualties as a result of war, civil strife, or other political conflict. Technological disasters, large numbers of people, property, community infrastructure, and economic welfare are directly and adversely affected by major industrial accidents, unplanned release of nuclear energy, and fires or explosions from hazardous substances such as fuel, chemicals, or nuclear materials. Natural and human-made disasters trigger each other and the distinctions between the two disaster types may be blurred. A natural and human-generated disaster may trigger a secondary disaster, the result of weaknesses in the human environment. An example of this is a chemical plant explosion following an earthquake. Disasters are frequently categorized based on their: 1. Onset 2. Impact 3. Duration For example: - Earthquakes and tornadoes are rapid-onset events—short durations but with a sudden impact on communities. - Hurricanes and volcanic eruptions have a sudden impact on a community; however, advanced warnings are issued enabling planners to implement evacuation and early response plans. - A bioterrorism attack may be sudden and unanticipated and have a rapid and prolonged impact on a community. - In contrast, droughts and famines have a more gradual onset or chronic genesis, the so- called creeping disasters and generally have a prolonged onset. Factors that influence Impact of a Disaster on a Community: 1. Nature of the event 2. Time of day and year 3. Health and age characteristics of the population affected 4. Availability of resources Classification of disasters in the field of disaster science: 1. Hazards (cause) is a potential threat to humans and their welfare (Smith & Petley, 2009) 2. Disasters 3. Risk-- is the actual exposure of something of human value and is often measured as the product of probability and loss (Smith & Petley, 2009). Classification of Disasters in hospital and other health care facilities: This document and the information thereon is the property of PHINMA 2 of 7 Education (Department of Nursing)  1. internal 2. external External disasters are those that do not affect the hospital infrastructure but tax hospital resources due to numbers of patients or types of injuries (Burstein, 2014). For example, a tornado that produced numerous injuries and deaths in a community would be considered an external disaster. Internal disasters cause disruption of normal hospital function due to injuries or deaths of hospital personnel or damage to the facility itself, as with a hospital fire, power failure, or chemical spill (Hendrickson & Horowitz, 2016). HEALTH EFFECTS OF DISASTERS: ▪ Disasters may cause premature deaths, illnesses, and injuries in the affected community, generally exceeding the capacity of the local healthcare system. ▪ Disasters may destroy the local healthcare infrastructure, which therefore will be unable to respond to the emergency. Disruption of routine health and mental healthcare services and prevention initiatives may lead to long-term consequences in health outcomes in terms of increased morbidity and mortality. ▪ Disasters may create environmental imbalances, increasing the risk of communicable diseases and environmental air, soil, and water hazards. ▪ Disasters may affect the psychological, emotional, and social well-being of the population in the affected community. Depending on the specific nature of the disaster, responses may be fear, anxiety, depression, widespread panic, terror, and exacerbation of preexisting mental health problems. Children, in particular, may be deeply affected by the impact of a disaster (Save the Children, 2017). ▪ Disasters may cause shortages of food and cause severe nutritional deficiencies. ▪ Disasters may cause large population movements (refugees) creating a burden on other healthcare systems and communities. Displaced populations and their host communities are at increased risk of communicable diseases and the health consequences of crowded living conditions (Lam, McCarthy, & Brennan, 2015). ▪ Disaster frameworks for response are increasingly shaped by globalization, changing world dynamics, social inequality, and sociodemographic trends (Tierney, 2012; WHO, 2016 2 Major Concerns about Role (Dr. Veenema) 1. Personal safety: “Nurses want to know that they’re safe & that their loved ones & patients are safe.” 2. Clinical competence: “They want to know they can deal with emergencies properly—even less common ones like massive radiation exposure or SARS outbreaks.” Nurses’ Roles in Disaster: 1. Determine magnitude of the event 2. Define health needs of the affected groups 3. Establish priorities & objectives 4. Identify actual & potential public health problems 5. Determine resources needed to respond to the needs identified 6. Collaborate with other professional disciplines, governmental & non-governmental agencies 7. Determine magnitude of the event 8. Define health needs of the affected groups THE DISASTER CONTINUUM – life cycle of a disaster management program. Three Major Phases 1. Preimpact (before) 2. Impact (during) 3. Postimpact (after) Basic phases or “life cycle” of a disaster management program: (PMPRR) 1. Preparedness refers to the proactive planning efforts designed to structure the disaster response prior to its occurrence. Disaster planning encompasses evaluating potential vulnerabilities (assessment of risk) and the propensity for a disaster to occur. Warning (also known as “forecasting”) refers to monitoring events to look for indicators that predict the location, timing, and magnitude of future disasters. This document and the information thereon is the property of PHINMA 3 of 7 Education (Department of Nursing)  2. Mitigation includes measures taken to reduce the harmful effects of a disaster by attempting to limit its impact on human health, community function, and economic infrastructure. These are all steps that are taken to lessen the impact of a disaster should one occur and can be considered as prevention measures. Prevention refers to a broad range of activities, such as attempts to prevent a disaster from occurring, and any actions taken to prevent further disease, disability, or loss of life. Mitigation usually requires a significant amount of forethought, planning, and implementation of measures before the incident occurs. 3. Response phase is the actual implementation of the disaster plan. Disaster response, or emergency management, is the organization of activities used to address the event. Traditionally, the emergency management field has organized its activities in sectors, such as fire, police, hazardous materials management (hazmat), and emergency medical services. The response phase focuses primarily on emergency relief: saving lives, providing first aid, minimizing and restoring damaged systems such as communications and transportation, and providing care and basic life requirements to victims (food, water, and shelter). 4. Recovery actions focus on stabilizing and returning the community (or an organization) to normal (its preimpact or improved status). This can range from rebuilding damaged buildings and repairing infrastructure to relocating populations and instituting physical, behavioral, and mental health interventions. Rehabilitation and reconstruction involve numerous activities. Goal: “Build, Back, Better” 5. Evaluation is the phase of disaster planning and response that often receives the least attention. After a disaster, it is essential that evaluations be conducted to determine what worked, what did not work and what specific problems, issues and challenges were identified. DISASTER PLANNING Addressing the problems posed by various potential events. Participation by nurses in all phases of disaster planning is critical to ensure that nurses are aware of and prepared to deal with whatever these numerous other factors may turn out to be. Individuals and organizations responsible for disaster plans should consider all possible eventualities from the sanitation needs to the crowd, psychosocial needs of vulnerable populations, to evacuation procedure. Completion of the disaster planning process should result in the production of a comprehensive disaster or “emergency operations plan”. DISASTER PLAN- a formal plan of action of coordinating the responsive of health care agency staff in the event of a disaster. AIM: to provide prompt & effective medical care to the maximum possible in order to minimize morbidity and mortality. Objectives: To optimally prepare the staff and institutional resources for effective performance in disaster situation. To make the community aware of the sequential steps that could be taken at individual and organizational levels. Types of Disaster Planning: 1. Agent specific approach – focus their preparedness activities on the most likely threats to occur based on their geographic location (Hurricanes in Florida) 2. All -hazards approach- conceptual model for disaster preparedness that incorporates disaster management component that are consistent across all major events to maximize resources, expenditures and planning efforts. Nurses’ Roles in Disaster Planning: 1. Personal and professional preparedness 2. Make a personal and family preparedness. 3. Be aware of the disaster plan at the workplace and community. 4. Maintain certification in disaster training and CPR This document and the information thereon is the property of PHINMA 4 of 7 Education (Department of Nursing)  5. Participate in Mock disaster drills. Problems, Issues and Challenges in Disaster Planning: 1. Anticipate communication problems. 2. Address operational issues related to effective triages, transportation and evacuation. 3. Accommodate the management, security of and distribution of resources at the disaster sides. 4. Implement advanced warning systems and increase the effectiveness of warning messages 5. Enhance coordination of search and response efforts. 6. Effective triage of patients (prioritization for care and transport of patients). 7. Establish plans for the distribution of patients to hospitals in an equitable. 8. Patient identification and tracking. 9. Damage or destruction of the health care infrastructure. 10. Management of volunteers, donations and other large numbers of resources. 11. Organized improvisational response to the disruption of major systems. 12. Encountering overall resistance (apathy) to planning efforts. HAZARD IDENTIFICATION, VULNERABILITY ANALYSIS, AND RISK ASSESSMENT Methods for Data Collection for Disaster Planning: 1. Hazard identification is used to determine which events are most likely to affect a community and to make decisions about whom or what to protect. 2. Vulnerability analysis is used to determine who is most likely to be affected, the property most likely to be damaged or destroyed, and the capacity of the community to deal with the effects of the disaster. Data are collected regarding the susceptibility of individuals, property, and the environment to potential hazards in order to develop prevention strategies. A separate vulnerability analysis should be conducted for each identified hazard. 3. Risk assessment uses the results of the hazard identification and vulnerability analysis to determine the probability of a specified outcome from a given hazard that affects a community with known vulnerabilities and coping mechanisms (risk equals hazard times vulnerability). Disaster Planning and Public Health Preparedness: Six Domains: 1. Community resilience 2. Incident management 3. Information management 4. Countermeasure and mitigation 5. Surge management 6. Biosurveillance EVALUATING CAPACITY TO RESPOND Resource identification is an essential feature of disaster planning. A community’s capacity to withstand a disaster is directly related to the type and scope of resources available, the presence of adequate communication systems, the structural integrity of its buildings and utilities (e.g., water, electricity), and the size and sophistication of its healthcare system (Burstein, 2014; Cuny, 1998). Resources include both human and physical elements, such as organizations with specialized personnel and equipment. Disaster preparedness includes assembling lists of healthcare facilities; medical, nursing, and emergency responder groups; public works and other civic departments; and volunteer agencies, along with phone numbers and key contact personnel for each. CORE PREPAREDNESS ACTIVITIES 1. Prepare a theoretical foundation for disaster planning. This document and the information thereon is the property of PHINMA 5 of 7 Education (Department of Nursing)  2. Disaster planning is only as effective as the assumptions upon which it is based. 3. Core preparedness activities must go beyond the routine 4. Have a community needs assessment. 5. Identify leadership and command post. 6. Design a local response for the first 72 hours. 7. Identify and accommodate vulnerable populations. 8. Know about state and federal assistance. 9. Identify training and educational needs, resources, and personal protective equipment (PPE). 10. Plan for the early conduction of damage assessment. EVALUATION OF A DISASTER PLAN An essential step in disaster planning and preparedness is the evaluation of the disaster response plan for its effectiveness and completeness by key personnel involved in the response. The comprehension of people expected to execute the plan and their ability to perform duties must be assessed. The availability and functioning of any equipment called for by the disaster plan needs to be evaluated and reviewed on a systematic basis. Several methods may be used to exercise the disaster plan, the most comprehensive of which would be its full implementation in an actual disaster. Disaster drills may also provide an excellent means of testing plans for their completeness and effectiveness. Drills can be staged as large, full-scale exercises, using triaged victims and requiring vast resources of supplies and personnel, or they may be limited to a small segment of the disaster response, such as drills that assess the effectiveness of communications protocols or notification procedure. CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 10 minutes for this activity: Multiple Choice (For 1-5 items, please refer to the questions in the Rationalization Activity) RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS) The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss among their classmates for 10 minutes. 1. It is a catastrophic event that results in casualties that overwhelm the healthcare resources in that community and may result in a sudden unanticipated surge of patients, a change in standards of care, and a need to allocate scarce resources? a. Disaster b. Health Disaster c. Pandemic d. Natural disaster ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2. It is a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts a. Disaster b. Health Disaster c. Pandemic d. Natural disaster ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3. Which of the following is not a category in determining disasters? This document and the information thereon is the property of PHINMA 6 of 7 Education (Department of Nursing)  a. Man-made b. Natural c. Anthropogenic d. Supernatural ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4. This is a potential threat to humans and their welfare a. Risk b. Disaster c. Hazard d. Warning ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5. It is used to determine which events are most likely to affect a community and to make decisions about whom or what to protect as the basis of establishing measures for prevention, mitigation, and response. a. Hazard Identification b. Vulnerability analysis c. Risk Assessment d. Disaster Planning ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ LESSON WRAP-UP (5 minutes) Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track how much work they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet. You are done with the session! Let’s track your progress. AL Activity: Minute Paper Instruction: 1. Reserve a few minutes at the end of class session. Leave enough time to ask the questions, to allow students to respond, and to collect their responses. 2. Pass out slips of paper on index cards for students to write on. You may also ask students to bring out and write on a half sheet of paper instead. 3. Collect the responses as or before students leave. One way is to station yourself at the door and collecting “minute papers” as student file out. 4. Respond to students’ feedback during the next class meeting or as soon as possible. 1) What was the most useful or the most meaningful thing you have learned this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2) What question(s) do you have as we end this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA 7 of 7 Education (Department of Nursing)  NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 2 Materials: LESSON TITLE: I. Disaster Preparedness: Leadership and Book, pen and notebook Coordination in Disaster Healthcare System: DRRM in the Philippine Perspective References: LEARNING OUTCOMES: Veenema, T.G. (2019) Disaster Nursing and Emergency Preparedness for Chemical, Upon completion of this lesson, the nursing student can: Biological, and Radiological Terrorism and other Hazards 4th Edition 1. Describe DRRM. 2. Familiarize the goals of NDDRM. 3. Describe the Incident management system and its http://www.ndrrmc.gov.ph/attachments/artic elements and their relationships with the Health Sector. 4. Discuss the various types of command structures; Incident le/3031/NDRP_Consequence_Management_f Command Post, Emergency Operations Center, or_Terrorism_related_Incidents.pdf Emergency Coordination Center. 5. Identify the command structures that could be applicable to the Health Sector. https://www.slideshare.net/irpex/disaster-risk- 6. Discuss the role of the HEM (Health Emergency reduction-and-management-28415360 Management) developing incident command system integrating health component. LESSON PREVIEW/REVIEW (5 minutes) Instruction: Differentiate Natural Disasters from Anthropogenic Disasters and give an example for each. MAIN LESSON (30 minutes) DISASTER RISK REDUCTION and MANAGEMENT (DRRM) It is a systematic process of using administrative decisions, organization and operational skills and capacities to implement strategies, policies and improved coping capacities of the society and community in order to lessen the adverse impacts of hazards and the possibility of a disaster. 2 ASSUMPTIONS: disaster risk is endemic & it is within the power of the state to reduce disaster risk (Source: IRR of RA10121) DRRMC ORGANIZATIONAL NETWORK ❖ National Disaster Risk Reduction & Management Council ❖ 12 Regional Disaster Risk Reduction & Management Councils ❖ 80 Provincial Disaster Risk Reduction and Management Councils ❖ 122 City Disaster Risk Reduction and Management Councils ❖ 1,512 Municipal Disaster Risk Reduction and Management Councils ❖ 42,026 Barangay Disaster Risk Reduction and Management Committees This document and the information thereon is the property of PHINMA 1 of 7 Education (Department of Nursing) THE NATIONAL DISASTER RISK REDUCTION MANAGEMENT COUNCIL (NDRRMC) The National Disaster Risk Reduction and Management Council (NDRRMC), formerly known as the National Disaster Coordinating Council (NDCC), is a working group of various government, non-government, civil sector and private sector organizations of the Government of the Republic of the Philippines established by Republic Act 10121 of 2010. THE NATIONAL DISASTER RESPONSE PLAN The NDRP is the Government of the Philippines’ “multi-hazard” response plan. Emergency management as defined in the NDRRM Act of 2010 (RA10121), is the organization and management of resources to address all aspects or phases of the emergency, mitigation of, preparedness for, response to and recovery from a disaster or emergency The NDRP is also built on the following understanding: All government agencies and instrumentalities have their own respective Disaster Preparedness Plans for Terrorism related incidents; All Local Government Units (LGUs) have prepared their Contingency Plans for Terrorism related incidents and implemented their Local Disaster Risk Reduction and Management Plans (LDRRMPs) within the DRRM Framework of Prevention/Mitigation, Preparedness, programs and activities that are directly connected to response like prepositioning of key assets and resources; and The Cluster Approach System and Incident Command System in response operations have been cascaded to all levels of government both national and local. National Disaster Risk Reduction and Management Plan 2011-2028. The NDRRMP sets down the expected outcomes, outputs, key activities, indicators, lead agencies, implementing partners and timelines under each of the four distinct yet mutually reinforcing thematic areas. The goals of each thematic area lead to the attainment of the country’s overall DRRM vision, as graphically shown below. This document and the information thereon is the property of PHINMA 2 of 7 Education (Department of Nursing) The NDDRMP goals are to be achieved by 2028 through 14 objectives, 24 outcomes, 56 outputs, and 93 activities. The 24 outcomes, with their respective overall responsible agencies, are summarized below. COORDINATION AND EMERGENCY AND DISASTER Challenges in Managing Emergencies related to Coordination and Communication No identifiable leader or incident manager No basic organizational structure for chain of command and span of control No common terminology No unified communications system No system for allocating resources Lack of integration, due to competition Lack or loss of resources, due to failures in planning and lack of resource allocation Lack of planning, due to absence of commitment failures in risk and crisis communications INCIDENT MANAGEMENT SYSTEM (IMS) ❑ Is a standardized, all hazards incident management concept. ❑ It can be composed of several levels ICP (INCIDENT COMMAND POST) EOC (EMERGENCY OPERATIONS CENTER) ECC (EMERGENCY COORDINATION CENTER) ❑ Allows its users to adopt an integrated organization structure to match the complexities and demands of single or multiple incidents without hindered by jurisdictional boundaries Emergency Response Management Systems: Core Principles Based on an all-hazards approach Modular, scalable or adaptable organization This document and the information thereon is the property of PHINMA 3 of 7 Education (Department of Nursing)  Support for joint engagement of multiple institutions / organizations in management decisions Clear lines of accountability and authority Clearly defined roles and responsibilities, consistent with normal roles and supported by training Clearly articulated procedures for activation, escalation, and demobilization of emergency capacities. Common functional groupings and consistent terminology Integrated with stakeholder agencies Mechanisms for the involvement of all stakeholders and users of the EOC in its design, operational planning and evaluation. Provision of capacity to manage public communications opportunities as part of the response to emergencies Core Components of the System integrated communications modular organization unified command structure manageable span of control consolidated incident action plans comprehensive resource management pre-designated incident facilities The essence of the system 5 functions (in many countries) 1. Incident management (manager who coordinates) 2. Operations 3. Planning 4. Logistics 5. Administration and finance Management: provides overall direction of the response through the establishment of objectives for the system. This functional area usually includes other activities that are critical to providing adequate management: – Public Information manages information released to media and public; – Safety assesses hazardous and unsafe conditions and develops measures to ensure responder safety; and – Liaison provides coordination with agencies outside the response system. For the purposes of this discussion, the terms Operations: achieves management’s objectives through directed strategies and developed tactics. Logistics: supports management and operations with personnel, supplies, communications equipment, and facilities. Plans/Information: supports management and operations with information processing and the documentation of prospective plans of actions (also known as action plans, or APs). Critical components include: Administration/Finance: supports management and operations through tracking of such issues as reimbursement and regulatory compliance. Incident Management System (IMS) The IMS (or Incident Command System) refers to the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure and designed to aid in the management of resources during incident response. The MCM Management System emphasizes management rather than command because no inherent “line authority” exists in a multidisciplinary response by which assets can be commanded. Levels of command Level 1: using emergency response plans of the hospitals; developing operational plans to respond to a crisis Level 2: information sharing; systems: mutual aid Level 3: there are several command and coordination mechanisms: at the site (Incident Command Post); the Emergency Operations Centre (EOC) at the local authority level (multi-sectoral). Depending upon the organization of the country (it size; level of development, resources available) the EOC can be at District level or even at Provincial level Level 4: in some countries level 3 is assumed by level 4 in this diagram. The notion of Emergency Coordination Centre is important when the size of the incident justify the activation of national (or provincial in some countries) plans. In some This document and the information thereon is the property of PHINMA 4 of 7 Education (Department of Nursing) particular circumstances the national level has not only a coordination function but also a “managerial function of the response” (it can be in the case of a pandemic; for managing the international donations, etc.) Incident Command Post (ICP) Site tactical resources directly applied to address emergency problems responders may come from one agency, or many the on-site response is directed by one agency by jurisdiction or agreement operates from an ad-hoc site command post utilizes standard functions Advise incoming units of what’s going on. What does it contain? Be part of solution, not the problem. May have to wait for special resources to arrive. Does a problem still exist? Do not rush to a scene. Gather info before entering a scene. Is the area safe to be in? If not, make it safe with your capabilities or wait for trained resource to arrive Expect chaos & confusion Careless heroics can injure or kill you First priority is personal safety, then team safety, then by standers safety and last is patient safety EOP (Emergency Operation Center) requires much preparatory work, especially a plan describing the core elements: The plan usually is composed of: purpose of the plan concept of operations, management structure, roles of personnel and how the components work together Activation procedures and levels, and who has authority Escalation and de-escalation plan Call-out list and notification procedures Checklists of the roles and responsibilities of EOC functions Checklists of standard operating procedures floor plan, with inventory and locations of equipment and supplies Electronic information management processes (including a layout plan of phone, fax, data lines, cables, switches and outlets) Communication resources and procedures, especially mobile phones and radios Public information and warning processes Procedures for engaging levels of government and/or a superior authority/ jurisdiction Standard forms and instructions for documenting EOC activities Maps of the area of the event Guidelines for worker care and safety agency and position responsible for maintaining and updating the plan Training and exercise schedule to ensure staff and procedures are up-to-date. Role of Health Emergency Manager in IMS Protect response personnel and resources Minimize loss of life, disability and suffering Protect public health Protect civil infrastructure Protect environmental and economic assets, including property Reduce economic losses Risk Communication - purposeful exchange of information about the existence, nature and form severity or acceptability of health risks between policymakers, health care providers and the public/media aimed at changing behavior and inducing action to minimize/reduce risks. - The process of bringing together various stakeholders to come to a common understanding aboutthe risks, their acceptability, and actions needed to reduce the risks Risk Communication Activities Pre Crisis Crisis Post Crisis This document and the information thereon is the property of PHINMA 5 of 7 Education (Department of Nursing)  ◼ Development of a ◼ Implementation of the ◼ Impact/summative evaluation communication plan communication plan ◼ Documentation of lessons ◼ Fostering alliances/ ◼ Process evaluation/monitoring learned networking ◼ Impact evaluation of ◼ Revision of plans ◼ Formative evaluation of the immediate effects Plan ◼ Networking/advocacy ◼ Revision of plan based on monitoring results Nurses’ Responsibility in Risk Communication Identifying/ verifying sources of information Protecting patients’ rights to privacy and confidentiality Advocating for the public’s right to know Following institution’s chain of command or flow of communication Supporting institution’s official statements about public health risk and safety CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 10 minutes for this activity: Multiple Choice 1. It is a systematic approach to identifying, assessing and implementing strategies and plans that aims to reduce, the probability of a hazard event. a. Disaster risk reduction management b. Rehabilitation and recovery c. Disaster prevention d. Nursing process ANSWER: ________ RATIO:______________________________________________________________________________________ ________________________________________________________________________________________ 2. The leading agency for Disaster Prevention and Mitigation. a. DOST b. DILG c. DOH d. DSWD ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ 3. It is the Government of the Philippines’ “multi-hazard” response plan. a. National Disaster Response Plan (NDRP) b. National Disaster Risk Reduction Management Council (NDRRMC) c. Philippine National Red Cross d. Philippine Disaster Plan (PDP) ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ 4. It is the lead agency of Response. A. DILG B. DSWD C. DOH D. NEDA ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ This document and the information thereon is the property of PHINMA 6 of 7 Education (Department of Nursing)  5. It is a purposeful exchange of information about the existence, nature and severity or acceptability of health risk between policymakers, health care providers AND THE MEDIA. a. Emergency response b. Incident Action Plan c. Incident management system d. Risk Communication ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ 3. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ ____________________________________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT: 3-2-1 Instructions: 1. As an exit ticket at the end of the class period 2. After the lesson, have each student record three things he or she learned from the lesson. 3. Next, have them record two things that they found interesting and that they’d like to learn more about. 4. Then, have students record one question they still have about the material. 5. Review the students’ responses. You can use this information to help develop future lessons and 6. determine if some of the material needs to be taught again. Three things you learned: 1. ______________________________________ 2 ______________________________________ 3. ______________________________________ Two things that you’d like to learn more about: 1. ______________________________________ 2. ______________________________________ One question you still have: 1. ______________________________________ This document and the information thereon is the property of PHINMA 7 of 7 Education (Department of Nursing)  NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 3 LESSON TITLE: I. Disaster Preparedness: Understanding Materials: the Psychosocial Impact of Disasters Book, pen and notebook LEARNING OUTCOMES: Upon completion of this lesson, the nursing student can: 1. Identify the psychosocial effects likely to occur in various types of disasters. References: 2. Identify the elements of a community impact and resource assessment. Veenema, T.G. (2019) Disaster Nursing and 3. Describe the normal reactions of children and adults to Emergency Preparedness for Chemical, disaster. Biological, and Radiological Terrorism and other 4. Formulate strategies that helpers can use to assist children Hazards 4th Edition and their families in the immediate aftermath of a disaster. 5. Discuss the impact of disaster trauma on first responders and helpers. 6. Describe community reactions to a large-scale disaster. 7. Describe the manifestations of normal grief and mourning. LESSON PREVIEW/REVIEW (5 minutes) Instruction: what are the five phases of disaster management? 1. 4. 2. 5. 3. MAIN LESSON (40 minutes) Disaster Preparedness: Understanding the Psychosocial Impact of Disasters Disasters, by their very nature, are stressful, life-altering experiences, and living through such an experience can cause serious psychological effects and social disruption. Disasters affect every aspect of the life of an individual, family, and community. Depending on the nature and scope of the disaster, the degree of disruption can range from mild anxiety and family dysfunction (e.g., marital discord or parent–child relational problems) to separation anxiety, posttraumatic stress disorder (PTSD), engagement in high-risk behaviors, addictive behaviors, severe depression, and even suicidality While there are common mental health effects across different types of disasters, each disaster is unique and many factors can determine a given disaster’s effect on survivors. Natural disasters, such as floods, hurricanes, forest fires, and tornadoes most often result in property loss and dislocation. When physical injury and loss of life are minimal, the incidence of psychiatric sequelae may be reduced The mental health effects of any type of disaster, mass violence, or terror attack are well documented in the literature to be related to the intensity of exposure to the event. Documented potential indicators of mental health problems following the event are: sustaining personal injury, death of a loved one due to the disaster, disaster-related displacement, relocation, and loss of property and personal finances (Neria & Shultz, 2012). BIOTERRORISM AND TOXIC EXPOSURES “bioterrorism is an act of human malice intended to injure and kill civilians and is associated with higher rate of psychiatric morbidity than are ‘Acts of God’” This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 8 Common psychological reactions to bioterrorism Horror, anger, or panic Magical thinking about microbes and viruses Fear of invisible agents or fear of contagion Attribution of arousal symptoms to infection Anger at terrorists, the government, or both Scapegoating, loss of faith in social institutions Paranoia, social isolation, or demoralization The following are recommended interventions to minimize the potential psychological and social consequences of suspected or actual biological exposures: 1. Provide information on the believed likelihood of such an attack and of possible impact. 2. Communicate what the individual risk is. 3. Clarify that negative health behaviors, which may increase during time of stress (i.e., smoking, unhealthy eating, excessive drinking), constitute a greater health hazard than the hazards likely to stem from bioterrorism. 4. Emphasize that the only necessary action against terrorism on the individual level is increased vigilance of suspicious actions, which should be reported to authorities. 5. Clearly communicate the meaning of different levels of warning systems when such warnings are issued 6. When issuing a warning, specify the type of threat, the type of place threatened, and indicate specific actions to be taken. 7. Make the public aware of steps being taken to prevent bioterrorism without inundating people with unnecessary information. 8. Provide the public with follow-up information after periods of heightened alert. NORMAL REACTIONS TO ABNORMAL EVENTS Normal reactions to stress and bereavement can and do vary— sometimes even among members of the same family. Factors that affect expressions of stress and bereavement include age, gender, ethnicity, religious background, personality traits, coping skills, and previous experience with loss, especially traumatic loss. Stress symptoms can occur due to secondary exposure, meaning that those experiencing distress need not have been present at the site of the disaster but may have witnessed it secondhand either via media coverage or through retelling of the event by a person who was present. As these reactions can be quite startling and overwhelming to those who have not experienced them before, it is helpful for survivors to hear that their experiences are entirely normal, given the tremendous stress to which they have been exposed. COMMON REACTIONS OF DISASTER SURVIVORS Emotional Shock, feeling numb Cognitive Fear Confusion Grief, sadness Indecisiveness Anger Worry Guilt, shame Shortened attention span Feelings of helplessness Trouble concentrating Interpersonal Physical Distrust Tension, edginess Conflict Fatigue, insomnia Withdrawal Body aches, pain, nausea Work or school problems Startling easily Irritability Racing heartbeat Loss of intimacy Change in appetite Feeling rejected or abandoned Change in sex drive This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 8 SPECIAL NEEDS POPULATION Certain populations affected by disasters may be more vulnerable and therefore require special consideration both in disaster planning and response. In particular, women, older people, children and young people, people with disabilities, and people marginalized by ethnicity are more vulnerable (Sim & Cui, 2015). 1. Children and Youth - while most children are resilient, many children do experience some significant degree of distress. Poverty and parents with mental health challenges put children at higher risk for long-term impairments (McLaughlin et al., 2009). 2. Older Adults - Older adults are particularly vulnerable to loss. Factors such as age and disability affect vulnerability to a disaster. Both of these vulnerability traits are apparent in the elderly population. They are often lacking in social supports, may be financially disadvantaged, and are traditionally reluctant to accept offers of help. Older adults are also more likely to have preexisting medical conditions that may be exacerbated, either directly because of the emotional and psychological stress, or because of disruptions to their care, such as loss of medications or needed medical equipment, changes in primary care providers, lack of continuity of care, or lack of consistency in self-care routines due to relocation. 3. The Seriously Mentally Ill - According to Austin and Godleski (1999), the most psychologically vulnerable people are those with a prior history of psychiatric disturbances. Although previous psychiatric history does not significantly raise the risk of PTSD, exacerbations of preexisting chronic mental disorders, such as bipolar and depressive disorders, are often increased in the aftermath of a disaster. Those with a chronic mental illness are particularly susceptible to the effects of severe stress, as they may be marginally stable and may lack adequate social support to buffer the effects of the terror, bereavement, or dislocation. 4. Cultural and Ethnic Groups - Sensitivity to the cultural and ethnic needs of survivors and the bereaved is key not only in understanding reactions to stress and grief but also in implementing effective interventions. Mental health outreach teams need to include bilingual, multicultural staff and translators who are able to interact effectively with survivors and the bereaved. 5. Disaster Relief Personnel - The list of those vulnerable to the psychosocial impact of a disaster does not end with the survivors and the bereaved. Often victims can include emergency personnel: police officers, firefighters, military personnel, Red Cross mass care and shelter workers, cleanup and sanitation crews, the press corps, body handlers, funeral directors, staff at receiving hospitals, and crisis counselors. COMMON STRESS REACTIONS BY DISASTER WORKERS Psychological Behavioral Denial Change in activity level Anxiety and fear Decreased efficiency and effectiveness Worry about the safety of self or others Difficulty communicating Anger Outbursts of anger, frequent arguments, irritability Irritability and restlessness Inability to rest or “let down” Sadness, moodiness, grief, depression Change in eating habits Distressing dreams Change in sleeping patterns Guilt or “survivor guilt” Change in patterns of intimacy, sexuality Feeling overwhelmed, hopeless Change in job performance Feeling isolated, lost, or abandoned Apathy Periods of crying Increased use of alcohol, tobacco, and drugs Social withdrawal/silence Vigilance about safety of environment Avoidance of activities/places that trigger memories This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 8 Cognitive Physical Memory problems Increased heart/respiratory rate/blood pressure Disorientation Upset stomach, nausea, diarrhea Confusion Change in appetite, change in weight Slowness of thinking and comprehension Sweating or chills Difficulty calculating, prioritizing Tremor (hands/lips) Poor concentration Muscle twitching Limited attention span “Muffled” hearing Loss of objectivity Tunnel vision Unable to stop thinking about disaster Feeling uncoordinated Blaming Proneness to accidents Headaches Muscle soreness, lower back pain “Lump” in the throat Exaggerated startle reaction Fatigue Menstrual cycle changes Change in sexual desire Decreased resistance to infection COMMUNITY REACTIONS AND RESPONSES It is important to understand common responses and needs after a disaster, regardless of the type of disaster. It is important to recognize: 1. Everyone who sees or experiences a disaster is affected by it in some way. 2. It is normal to feel anxious about your own safety and that of your family and close friends. 3. Profound sadness, grief, and anger are normal reactions to an abnormal event. 4. Acknowledging your feelings helps you recover. 5. Focusing on your strengths and abilities helps you heal. 6. Accepting help from community programs and resources is healthy. 7. Everyone has different needs and different ways of coping. 8. It is common to want to strike back at people who have caused great pain. Large-group preventive techniques for children have been used for some time in California during the aftermath of community-wide trauma (Eth, 1992). This type of school-based intervention occurs as soon after the event as possible, and follows three phases: 1. Preconsultation—identifying the need; preparing the intervention with school authorities 2. Consultation in class—introduction, open discussion (fantasy), focused discussion (fact), free drawing task, drawing or story exploration, reassurance and redirection, recap, sharing of common themes, and return to school activities 3. Postconsultation—follow-up with school personnel and triage/referrals, as needed MOURNING, MILESTONES, AND ANNIVERSARIES The normal process of mourning is often facilitated by the use of rituals, such as funerals, memorials, and events marking key time intervals, such as anniversaries. It is important to include the community in the services, as well as the immediate family members. Community-wide ceremonies can serve to mobilize the supportive network of friends, neighbors, and caring citizens and provide a sense of belonging, remembrance, and letting go. Websites and social media groups link the bereaved and can also provide special support during important anniversaries or milestones. Ceremonies or memorials in schools should be developmentally appropriate and involve students in the planning process. Websites and pages to be created in the aftermath of a disaster serve as a place for people, both directly and indirectly impacted, to express their condolences and offer support. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 8  The phases of the mourning process have much in common with the emotional phases of disaster recovery, and Worden (1982) has identified specific tasks that need to be accomplished at each phase of mourning for successful resolution: - Period of shock, or “numbness.” The task is to accept the reality of the loss (as opposed to denying the reality of the loss). - Reality, or “yearning,” and “disorganization and despair.” The tasks are to accept the pain of grief (as opposed to not feeling the pain of the loss) and to adjust to an environment in which the deceased is missing (as opposed to not adapting to the loss). - Recovery, or “reorganized behavior.” The task is to reinvest in new relationships (as opposed to not loving). NORMAL MANIFESTATIONS OF GRIEF Feelings Behaviors Sadness Sleep disturbance Anger Appetite disturbance Guilt and self-reproach Absentmindedness Anxiety Social withdrawal Loneliness Avoiding reminders (of deceased) Fatigue Dreams of deceased Helplessness Searching, calling out Shock (most often after sudden death) Restless overactivity Yearning (for the deceased person) Crying Treasuring objects Emancipation Visiting places/carrying objects of remembrance Relief Numbness Thoughts Disbelief Physical Sensations Confusion Hollowness in stomach Preoccupation Tightness in chest Sense of presence Tightness in throat Hallucination Oversensitivity to noise Sense of depersonalization/derealization Breathlessness, shortness of breath Weakness in muscles Lack of energy Dry mouth This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 8 CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 10 minutes for this activity: Multiple Choice 1. It is an act of human malice intended to injure and kill civilians and is associated with higher rate of psychiatric morbidity than are ‘Acts of God’” a. Disaster b. Bioterrorism c. Calamity d. Natural disaster ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2. They are considered to be more vulnerable and therefore require special consideration both in disaster planning and response? a. Special needs population b. Older people c. Children and youth d. Ethnic people ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3. Who are considered to belong in those who have special needs population? a. Children and youth b. Older people c. Cultural and ethnic people d. All of the above ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4. A disaster survivor started to have trouble sleeping at night days after the disaster. What could be the explanation for this? a. It is a normal reaction. b. It is not a normal reaction to the situation c. Her sleep deprivation is caused by overstimulation d. She was just not tired. ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5. Which of the following may facilitate the process of mourning for the bereaved? a. Telling them to move on b. Acting as if nothing happened c. Facilitate rituals, ceremonies, or memorials d. Give them all the space they can have ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 7 RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 3. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: Minute Paper 1) What was the most useful or the most meaningful thing you have learned this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2) What question(s) do you have as we end this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 7  NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 4 Materials: LESSON TITLE: I. Disaster Preparedness: Legal and Ethical Issue in Disaster Response Book, pen and notebook LEARNING OUTCOMES: Upon completion of this lesson, the nursing student can: 1. Understand the sources of ethical and legal obligations for References: nurses and nurse administrators. 2. Discover that legal and ethical obligations may be similar, Veenema, T.G. (2019) Disaster Nursing and or may change, in the event of a bioterrorist attack or other Emergency Preparedness for Chemical, public health crisis. Biological, and Radiological Terrorism and other 3. Explore and identify personal beliefs about disaster Hazards 4th Edition response and consider the impact they may have on professional values. 4. Be familiar with major legal and ethical issues related to nurses’ responses in a disaster. LESSON PREVIEW/REVIEW (5 minutes) Instruction: Give examples of common reactions of disaster survivors and explain MAIN LESSON (40 minutes) The students will study and read their book about this lesson (Chapter 1 of the book): LEGAL AND ETHICAL ISSUE IN DISASTER RESPONSE Law – are the rules and regulations under which nurses must carry out their professional duties—can come from many different sources. What most people commonly think of as “law” are what lawyers call “statutes.” All of these sources of law can affect nurses in many different ways. For example, laws may require them to do some affirmative act, such as report new cases of certain diseases to the local or state health department. There may be criminal penalties for those who fail to comply with these requirements. Laws may also give the authority to certain governmental officers to require nurses to either do or refrain from doing something in a particular circumstance. Law can also create certain responsibilities for nurses, such as laws that impose civil liability for the failure to provide professionally adequate care. Civil liability is when an individual may be required to pay monetary damages to another individual, or in some cases to the government, for failure to comply with a legal obligation. Good Samaritan law – is a law that the nurses and other healthcare provider from liabilities for their good deeds during a sudden emergency, but not always during a disaster. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 7 RELATIONSHIP BETWEEN ETHICAL AND LEGAL OBLIGATIONS Ethics – refers to the examination of what it means to live a moral life. Morality – encompasses the norms people adopt to direct right and wrong conduct Nurses’ ethical obligations come from many different sources, but one formal source is the professional code of ethics. The ANA Code of Ethics for Nurses proscribes the ethical obligations of nurses, and expresses the profession’s commitment to society (ANA, 2015). Studying the potential issues in advance is key to this preparation. LAW AND ETHICS Typical disaster-related issues that challenge traditional legal and ethical thinking include the privacy issues of reporting diseases of epidemic or pandemic proportions, maintaining confidentiality, and issues surrounding a potential quarantine. Mandatory vaccination, treatment refusal, resource allocation, and duty to treat also legally and ethically challenge nurses working in disaster situations. It is important for nurses to think about ethical and legal issues in advance of disasters because sometimes it is the fear of handling these ethical issues that keep healthcare providers from offering their services during disasters. Public health events quickly transform resource-rich environments into settings of austerity and as a consequence produce unique and challenging ethical and legal issues. Healthcare providers are often conflicted between their moral duty to serve disaster victims and their moral duty to safeguard their own health, as well as their family’s and even their pet’s health (Rutkow et al., 2017). Research studies reveal that healthcare providers are more likely to respond to disasters with appropriate knowledge, sense of role importance, and trust in their organizations (Connor, 2014). Dilemma - is a circumstance in which a person finds himself or herself choosing between two or more actions he or she is morally required to perform, but the actions are actually incompatible with one another SPECIFIC ETHICAL AND LEGAL ISSUES Privacy Issue Case Example: An outbreak of an infectious disease leads public health officials to believe that a bioterrorist attack has occurred. To avoid panic of the public, however, the officials have made no public announcement of their suspicions. They have requested, however, that nurses be on the alert for new cases of the infectious disease and to report them immediately, along with certain information about the patient. A nurse asks her supervisor if she can legally make such reports. Reporting of Diseases Nurses should already be aware of the reporting requirements of the state and local governments in the areas where they currently practice. In the event of a public health crisis resulting from a terrorist attack, nurses will need to keep current on any additional reporting requirements that may be imposed by state and local health authorities. If the reporting is anonymous, then there is not concern for confidentiality of the individual. Where the reporting requires the naming of a particular individual, however, this raises both legal and ethical concerns surrounding the privacy and confidentiality of medical information, which will be discussed in the next section. Disclosure of Health Information When health information contains information that would identify the individual, issues are raised concerning both privacy and confidentiality. Frequently, these two terms are used interchangeably, but there are technical distinctions between the two. Privacy - is an individual’s claim to limit access by others to some aspect of his or her life Confidentiality - is a type of privacy aimed at preserving a special relationship of trust, such as the relationship between medical care provider and patient. Examples: A person who gains access to a patient’s electronic medical record without authorization violates patient privacy but does not violate confidentiality (Beauchamp & Childress, 2013). A nurse who discloses to a neighbor or colleague that a particular patient told her or him about past drug abuse violates confidentiality. Generally, disclosure of health information could not be made without the consent of the individual. Five exceptions are: This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 7  1. Disclosure directly to the individual 2. Disclosure to the individual’s immediate family members or representative 3. Disclosure to appropriate federal agencies or authorities pursuant to federal law 4. Disclosure pursuant to a court order to avert a clear danger to an individual or the public’s health 5. Disclosure to identify a deceased individual or to determine the manner or cause of death. Quarantine, Isolation, and Civil Commitment Quarantine - is usually considered to be the restriction of the activities of a healthy person who has been exposed to a communicable disease, usually for the period of time necessary for the disease to reveal itself through physical symptoms Isolation - is usually defined to mean the separation of a person known to have a communicable disease for the period of time in which the disease remains communicable. Civil commitment - is often associated today with proceedings in the mental health system to forcibly confine persons who are mentally ill and a danger either to themselves or to others. More broadly in public health, civil commitment “is the confinement (usually in a hospital or other specially designated institution) for the purposes of care and treatment”. Vaccination Under their police powers, states have the governmental authority to require citizens to be vaccinated against disease. The U.S. Supreme Court, early in the last century, upheld the authority of states to compel vaccination, even when an individual refused to comply with the mandatory vaccination laws (Jacobson v. Massachusetts, 1905). All states currently have laws that require school children to obtain vaccinations against certain diseases, such as measles, rubella, and polio, before attending school. In a public health crisis, however, the question may arise whether the state (or local) government could require an individual to be vaccinated against an infectious agent released into the general population. The state or local government must have the authority to do so. This may arise from a specific grant of authority by the state legislature to mandate vaccinations in the wake of a public health crisis, or the authority may be found in more general grants of authority given specific governmental agencies to protect the public’s health. Treatment for Disease The U.S. Supreme Court affirmed the right of adults to select the course of treatment for their disease, including the right of adults to refuse treatment. This right is not absolute, however. For example, when children are involved, the courts have consistently upheld the power of the state to step in and require treatment, even in the face of religious objections by the parents to medical treatment (Prince v. Massachusetts, 1944). Screening and Testing Case Example: Because public health officials suspect a “stealth” bioterror attack, they request that hospitals secretly test all of their new patients for the suspected contagious disease. The patient is to be notified only if he or she tests positively for the disease, and he or she will be offered standard medical treatment. Reports are to go directly to public health officials. Can a nurse legally or ethically participate in such a program? Screening and testing are two related, yet distinct, public health tools. “Testing” usually refers to a medical procedure to test whether an individual has a disease. “Screening,” on the other hand, might be thought of as testing all the members of a particular population. Although this distinction is important to public health officials, public health laws often use the terms interchangeably or make no sharp distinction between the two. Professional Licensing Case Example: In the immediate aftermath of the release of a biological agent in a large city, the city’s health professionals are overwhelmed with the number of people they must treat. Nurses from a nearby city, which is in another state, offer to help. In addition, it is proposed that nurses carry out duties normally performed solely by physicians. Can nurses without a current state license “help out” in a public health crisis? Can nurses perform duties and procedures normally outside the scope of their field? All states require licenses in order for an individual to engage in the practice of nursing. Most states, in addition, recognize different types of nurses such as professional nurses, licensed practical nurses, and nurse practitioners. Nurse licensing laws have two effects. The first is to limit the geographical area in which a nurse may practice to the state in which he or she holds a license. The second is to define the scope of practice. State statutes make illegal the practice This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 7 of nursing within the state by one not licensed to practice in the state , including the practice by an individual licensed to practice in another state. Resource Allocation Despite preparation, a bioterrorist attack or a disaster involving a large number of casualties or casualties in excess of personnel and resources will challenge providers to justly allocate resources. In this case, resources might be medical supplies, antibiotics, antitoxins, pain medications, vaccines, and/or personnel. One aspect of justice in healthcare is the concept of “distributive justice.” Distributive justice involves such issues as the fair and equitable allocation of scarce resources. Triage - is one mechanism for allocating scarce resources in emergency situations. “Triage” is a French word meaning “to sort.” Emergency room and military personnel use triage to prioritize treatments of wounded persons. For example, in the military, the practice of triage is to sort the wounded into three groups—the walking wounded, the seriously wounded, and the fatally wounded. The walking and seriously wounded receive immediate attention, the walking wounded so that they may be returned to fight in battle, the seriously wounded to save their lives. Those deemed fatally wounded are given narcotics to be kept comfortable, but their wounds are not treated. In emergency departments and at disaster sites, the wounded are also sorted into categories according to medical need and medical utility. Treated first (triage level 1) are those people who have major injuries and will die without immediate help; second are those whose treatment can be delayed without immediate danger (triage level 2). The third group treated is those with minor injuries (triage level 3), and the last group is those for whom treatment will not be effective. In emergency rooms, treatment for those with minor injuries tends to be delayed because the order of treatment is based only on medical need and medical utility. Professional Liability All healthcare professionals, including nurses, are subject to civil liability for providing substandard healthcare. Malpractice liability is generally a matter of state law, although the law of malpractice liability is very similar in all of the states. A nurse may be held liable, that is, have to pay monetary damages, for providing professional care that is below the standard followed by the profession. Absent special legislation, liability for medical professionals continues, even when they are performing medical care in an emergency situation Some states have enacted special legislation, often called “Good Samaritan” laws, which may provide immunity from civil liability for persons when they render care in emergency situations. It is important for nurses to know the Good Samaritan laws in their own states in order to avoid being held liable for negligence for intending to perform a good deed during an emergency or disaster. A nurse can be held liable for negligence if he or she deviates from the accepted standard of care, resulting in injury. Provision of Adequate Care Case Example: The local television news carries a story that a rash of human-to-human transmission cases of avian flu has occurred in the region, resulting in five deaths to date. Nurses and other staff begin calling in “sick.” When contacted by supervisors, the nurses admit they are afraid to come in to work because of fears of a possible pandemic and the danger of spreading flu to their families (as healthcare workers they received vaccinations, but their families were not similarly protected). What legal recourse does a hospital have if staff refuse to work during a public health crisis? What liability does the institution face if it operates in the absence of adequate staff? What ethical issues does calling in sick raise for the nurse and the institution? The relationship between nurses and hospitals legally is the same as between any other employer and employee. Aside from the exceptions discussed in the following, the relationship is viewed as an “at-will contract.” This means that the hospital can set the terms and conditions of employment and is free to dismiss an employee for any reason (except as this right is modified by state or federal statutes, e.g., laws against racial discrimination). Likewise, the employee, here the nurse, is free to leave the employment to go elsewhere for any reason, and technically without even giving notice, although custom usually prevails here This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 7 In dealing with staffing requirements during a public health crisis, nurses and nurse administrators will need to seek advice about the exact legal nature of the relationship between the nurses and the hospital or other employing agency. Employee policies regarding hours of work and refusals to work should be reviewed, and this is particularly critical if there is a contract (either individual or a collective union contract) governing the conditions of employment. In addition, legal advice will be needed concerning any state requirements about mandatory work and the hours of employment. A second legal issue surrounding staffing is liability for failing to maintain adequate nursing staff during a public health crisis. Generally, all hospitals may be held civilly liable if they fail to maintain adequate staffing and an individual is injured as a result of the inadequate staffing (Pozgar, 1999, p. 265). There is no hard-and-fast standard as to what constitutes adequate staffing, and the courts are likely to allow hospitals a large degree of discretion in determining whether staffing is adequate, particularly in the event of a public health crisis. Nonetheless, if at some point sufficient numbers of nursing staff fail to report for work, administrators will need to consider whether the staffing is so insufficient that the quality of care will suffer. CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 10 minutes for this activity: Multiple Choice 1. This refers to the examination of what it means to live a moral life. a. Law b. Morality c. Ethics d. Confidentiality ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2. These are the rules and regulations under which nurses must carry out their professional duties a. Law b. Morality c. Ethics d. Confidentiality ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3. It encompasses the norms people adopt to direct right and wrong conduct? a. Law b. Morality c. Ethics d. Confidentiality ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4. This is usually considered to be the restriction of the activities of a healthy person who has been exposed to a communicable disease? a. Isolation b. Quarantine c. Screening d. Vaccination ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 7  RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5. A nurse told the physician about the patient’s infidelity to his wife. The nurse violated the patient’s a. Civil liability b. Nurse-patient contract c. Privacy d. Confidentiality ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 3. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT: 3-2-1 Instructions: 1. As an exit ticket at the end of the class period 2. After the lesson, have each student record three things he or she learned from the lesson. 3. Next, have them record two things that they found interesting and that they’d like to learn more about. 4. Then, have students record one question they still have about the material. 5. Review the students’ responses. You can use this information to help develop future lessons and determine if some of the material needs to be taught again. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 7 Three things you learned: 1. ______________________________________ 2 ______________________________________ 3. ______________________________________ Two things that you’d like to learn more about: 1. ______________________________________ 2. ______________________________________ One question you still have: 1. ______________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 8  NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session #5 Materials: Book, pen and notebook LESSON TITLE: Principles of Emergency Care LEARNING OUTCOMES: References: Upon completion of this lesson, the nursing student can: Veenema, T.G. (2019) Disaster Nursing and Emergency Preparedness for Chemical, 1. Familiarize the common terms used in emergency care Biological, and Radiological Terrorism and other 2. Understand the basic principles in emergency care Hazards 4th Edition 3. Identify the aims of emergency care 4. Be able to intervene in an emergency situation https://www.makrosafe.co.za/blog/principles- of-emergency-care LESSON PREVIEW/REVIEW (5 minutes) Instruction: Differentiate quarantine, isolation and civil commitment. MAIN LESSON (40 minutes) Common Terms Used in Emergency Care Trauma :Intentional or unintentional wounds/injuries on the human body from particular mechanical mechanism that exceeds the body’s ability to protect itself from injury Emergency Management: traditionally refers to care given to patients with urgent and critical needs Triage: process of assessing patients to determine management priorities. First Aid: an immediate or emergency treatment given to a person who has been injured before complete medical and surgical treatment can be secured. BLS: level of medical care which is used for patient with illness or injury until full medical care can be given. ACLS: Set of clinical interventions for the urgent treatment of cardiac arrest and often life threatening medical emergencies as well as the knowledge and skills to deploy those interventions. Defibrillation: Restoration of normal rhythm to the heart in ventricular or atrial fibrillation Disaster: Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions a