Island communities and disaster resilience: Applying the EnRiCH community resilience framework.

OBJECTIVE: To explore the beliefs, attitudes, and perspectives of community resilience in St. Kitts and Nevis. DESIGN: Qualitative Interpretive Phenomenological Analysis using the EnRiCH Community Resilience Framework for High-Risk Populations (EnRiCH Framework) to identify factors that enhance or create barriers to community resilience to disasters in St. Kitts and Nevis. SAMPLE: Twenty-one key informants and 23 community informants provided insight into the history of disasters. RESULTS: Unique strengths and barriers that significantly influenced this high-risk population's adaptive capacity were identified. A discrepancy between the way disaster preparedness was perceived by government officials and the local population was noted. Cultural factors promoted connectedness and communication and created barriers to empowerment and collaboration. Innovative strategies were suggested that could enhance upstream leadership, downstream management, and resource management during disasters. CONCLUSIONS: Island communities represent a unique opportunity to examine risk reduction and vulnerability within the context of community and societal characteristics. This research addresses a significant gap in the literature on interventions that utilize a strengths-based approach to building adaptive capacity and resilience to disasters among at-risk populations. The EnRiCH Framework can be used to develop an approach to strengthen adaptive capacity and improve resilience to disasters.

The Emergency Nurses Association: 50 Years of Advocacy and Advancement.

To commemorate the 50th anniversary of the Emergency Nurses Association, this article describes the 3 most enduring and impactful policy initiatives in the organization's history. These initiatives were identified through a comprehensive review of the articles published in the Journal of Emergency Nursing as well as in other publications of the Emergency Nurses Association, including position statements and press releases. The top 3 policy issues throughout the Emergency Nurses Association's history were identified as provision of care for vulnerable populations, trauma and injury prevention, and patient quality and safety. The Emergency Nurses Association also worked hard to professionalize emergency nursing within the realms of nursing and emergency services during the first half of its history, and since then the Emergency Nurses Association has promoted issues related to the emergency nursing workforce and to ensuring a safe and sustainable environment in which nurses practice. This article includes critical constructs such as the professionalization of emergency nursing; advocating for vulnerable populations such as children, older adults, and people experiencing sexual violence or human trafficking; improvements in trauma care and injury prevention; promoting quality and safety through nursing certifications, efficient and accurate nurse triage, and disseminating best practices in evidence-based care; and supporting the nursing workforce by championing issues such as workplace violence, ED crowding, and healthy work environments.

Learning Together: Combining Undergraduate and Graduate Simulated Learning for Practicing Physical Assessment Skills.

The effectiveness of using undergraduate nursing students (UNS) as standardized patients for advanced practice nurses (APNs) was studied. First-semester UNS, as part of their health assessment course requirements, participated in APN students' practice and testing sessions as standardized patients for their health assessment course physical exam. Analysis of pre/post experience scores and open-ended questions demonstrated UNS perceived confidence increased in 15 of 21 areas and APN students' confidence increased in three areas. The collaborative examination process aided students in their learning of the process of the physical examination.

Partnership integration for rural health resource access.

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations. This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face. Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model's use through clinical and non-clinical disciplines and a community engagement framework is also described. Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey.

The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale-Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting.

Analyzing the Usability of the 5-Level Canadian Triage and Acuity Scale By Paramedics in the Prehospital Environment.

INTRODUCTION: ED crowding negatively affects throughput, quality of care, and outcomes. Paramedics do not have an evidence-based, feasible triage instrument to guide classification of patients. No studies have compared the Canadian Triage and Acuity Scale (CTAS) used by prehospital paramedics against the Emergency Severity Index (ESI) used by nurses in the emergency department. This study sought to determine if a relationship exists between paramedics' triage scores and emergency nurses' scores in the emergency department using 2 common 5-level triage instruments, as well as to determine whether either instrument correlates with patient admission. METHODS: CTAS scores determined by paramedics on arrival at the emergency department were compared with the initial ESI scores determined by emergency nurses. Both scores were compared with the patient's disposition status. Data analyses included descriptive statistics, χ(2) statistics, and hierarchical regression analysis. RESULTS: The analysis included 2,222 patients. There was a poor relationship between the CTAS and the ESI at the facility (P = .599, κ = -0.003). The final regression model explained 32.9% of the admission variance (P < .001). The model correctly predicted 61.5% of admissions, with an 82% accuracy rate for all other forms of disposition and an overall model prediction rate of 73.7%. DISCUSSION: Using the CTAS, paramedics can predict admission comparably with nurses using the ESI. However, both instruments showed weakness in over- and under-triage rates. Additional studies are indicated to better understand prehospital paramedic triage and its impact on throughput.

Risk screening for cardiovascular disease and diabetes in Latino migrant farmworkers: a role for the community health worker.

Diabetes and heart disease are two of the leading causes of death for Hispanics living in the United States (American Heart Association [AHA] in Circulation 123:e18-e209. doi: 10.1161/CIR.0b013e3182009701 , 2010). As the Hispanic population continues to grow, the need for low-cost, non-invasive methods to detect at risk populations for such diseases becomes more important. Once at risk individuals are detected, prevention strategies can be implemented. Studies have shown that Latino community health workers (CHWs) are effective educators, patient advocates and health promotion motivators for patients with known heart disease or diabetes. This pilot study examined the accuracy with which Latino CHWs could determine migrant farmworkers at risk for diabetes or cardiovascular disease (CVD) in rural Virginia. This quasi-experimental study supports the hypothesis that Latino CHWs can use non-invasive diabetes and CVD screening tools with similar accuracy as a registered nurse. The screening tools used were the American Diabetes Association's diabetes risk calculator and a non-laboratory screening tool for CVD risk designed by Gaziano et al. (Lancet 371:923-931, 2008). The terms Latino and Hispanic will be used interchangeably.

Gentle Massage Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous Leukemia.

OBJECTIVE: Cancer treatment is reported to be stressful, and patients diagnosed with hematologic cancers often exhibit higher levels of anxiety and emotional distress than individuals with other malignancies. Management of these symptoms in patients with hematologic cancer presents significant challenges, as many of them are in and out of the hospital while undergoing high dose chemotherapy. Oncology patients use complementary modalities such as therapeutic massage in an attempt to alleviate disease and treatment-related symptoms, including anxiety and emotional distress. In the current study, the feasibility of a novel massage intervention delivered over the continuum of care, as well as assessment of the immediate and cumulative effects of massage, was examined in patients with acute myelogenous leukemia. METHODS: A mixed-methods, unmasked, prospective, randomized study was conducted with two groups: a usual care alone control group and a massage therapy intervention plus usual care group. RESULTS: Significant improvements in levels of stress and health-related quality of life were observed in the massage therapy group versus the usual care alone group, after adjusting for anxiety level, including both immediate and cumulative effects of massage. CONCLUSIONS: While the findings of the current study regarding acceptability, feasibility, and potential efficacy of therapeutic massage as a complementary health-enhancing intervention in patients diagnosed with acute myelogenous leukemia are very promising, the relatively small size of the study sample limits generalizability.

From the trunk of a Volkswagen beetle: a mobile nursing clinic in Appalachia.

Access to health care has been a factor for patients living in isolated mountain regions. The Frontier Nursing service was a pioneer in reaching those patients living in the most remote regions of Appalachia. Geography, demographics, and culture present obstacles for rural residents and health care providers. This article identifies and describes the roles nurses and nurse practitioners played in caring for Appalachian families through a roving Health Wagon in the 1980s and 1990s in Southwest Virginia. Family nurse practitioner Sister Bernadette Kenny was instrumental in bringing care on wheels to rural residents living in the Appalachian mountainous region of southwest Virginia.

Description of healthcare needs at an episodic clinic in rural southwest Virginia.

INTRODUCTION: The objective of this study was to describe the population served at an episodic clinic in Southwest Virginia to better understand patient needs at a yearly episodic Remote Area Medical (RAM) clinic that provides free healthcare services. METHODS: The dataset was compiled retrospectively from 2834 medical records from RAM patients between 1 July 2006 and 31 July 2008. Information was de-identified and manually recorded from paper records. The data were analyzed using descriptive statistics and compared to pre-existing estimates from the region. FINDINGS: The number and type of services rendered at the RAM clinic each year varied greatly, and was dependent on the availability of staff and supplies. Diabetes, hypertension, and other prevalent diseases were reported, and an overwhelming majority (74%) of patients were overweight or obese. In 2008, 62% of patients were uninsured, 44% had no primary care physician, and a majority of patients were diagnosed with hypertension or poorly managed diabetes. CONCLUSIONS: Chronic diseases including obesity, hypertension, diabetes, and arthritis plague the Appalachian region. However, better knowledge of the medically underserved in this region can help address the patient's needs through RAM clinics and other accessible health clinics by increasing patient and physician awareness of available services, decreasing patient waiting time, and improving medical recordkeeping.

The role of procalcitonin in community-acquired pneumonia: a literature review.

Community-acquired pneumonia (CAP) is a significant clinical and public health problem. Recently, attention has been paid to the potential for procalcitonin (PCT) both to differentiate the diagnosis and to indicate the prognosis of pneumonia. The purpose of this literature review was to evaluate the eligibility of PCT for defining typical bacterial infections and for predicting severity and mortality in trials for CAP. The literature review suggests that PCT has the ability to supplement clinical information to determine whether or not the cause of the infection is likely to be bacterial. In addition, PCT seems to be superior to the most prevalent inflammatory biomarker C-reactive protein and also demonstrates a significant correlation between the current clinical scoring systems and actual mortality.

Use of complementary and alternative healthcare practices among persons served by a remote area medical clinic.

Remote rural communities are often without adequate healthcare resources. To address the need in one area of Appalachia, an annual medical clinic is held to provide free healthcare services to residents of Appalachia. The Appalachian culture has a number of unique features that influence the healthcare practices of persons living in this region. Cultural values and beliefs about health and the use of complementary and alternative therapies among those attending the remote rural clinic are described, with faith healing, including prayer, and family-taught remedies being the most commonly used complementary and alternative medicine modalities.

Differential access to quality rural healthcare: professional and policy challenges.

Using a national dataset, the influence of the community and individual provider characteristics on the availability of healthcare resources in rural areas was evaluated. Disparities continue to exist in the availability of providers including organizational types of providers such as Community Health Centers and Community Mental Health Centers. A lower percentage of nonmetropolitan counties have such centers, and more rural counties within the general grouping of nonmetropolitan counties have fewer of these organizational resources. A case study on the Southwestern region of Virginia is presented to highlight the impact on health outcomes and an innovative community response to the lack of availability of needed healthcare services.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications: Part III--Mental health and psychosocial effects.

BACKGROUND: In 2001, the mountain town of San Sebastian, El Salvador experienced a series of earthquakes that affected the livelihood of its people. METHODS: A convenience sample of 100 households of 594 inhabitants of San Sebastian and the surrounding rural farming areas was completed. One study participant for each household was evaluated for mental health and psychosocial changes after the earthquakes. The participant's questionnaire was used to investigate the relationship between physical health, access to health care, housing, food and water, and the occurrence of negative mental health markers six months after the disasters. RESULTS: Findings indicate that the majority (67%) of respondents experienced 6 or more mental health complaints. Risk factors associated with multiple negative mental health symptoms included change in household income and loss of job, a new illness or a new injury in the household, reliance on healthcare services since the earthquake, and managing a chronic illness. CONCLUSION: Findings indicate a need for rapid, acute mental health screening with at-risk groups and the need to educate the entire community regarding what medical and mental health treatments are available to reduce barriers to treatment and increase public awareness.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications--part II.

Results reported in Part I of the Earthquakes in El Salvador series (see Disaster Management & Response 2003;1:105-9) indicated clinically relevant findings. The findings indicated a need for greater public health action within all five categories reviewed: healthcare, access to healthcare, housing, food, water and sanitation. Significant results between urban and rural communities indicated a need for broader community aid, public health and sanitation services to rural areas. Faster and more efficient disaster management and care services throughout the San Sebastian community were also necessary modifications.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications, part I.

INTRODUCTION: This is the first article in a series that evaluates the health concerns of people living in a Salvadoran rural community after major earthquakes. Part I reviews the background, methods, and results of post-earthquake conditions with regards to healthcare, access to healthcare, housing, food, water and sanitation. Part II reviews the implications of these results and recommendations for improvements within the community. Part III investigates the psychosocial and mental health consequences of the earthquakes and provides suggestions for improved mental health awareness, assessment, and intervention. BACKGROUND: El Salvador experienced 2 major earthquakes in January and February 2001. This study evaluates the effects of the earthquakes on the health practices in the rural town of San Sebastian. METHODS: The research was conducted with use of a convenience sample survey of subjects affected by the earthquakes. The sample included 594 people within 100 households. The 32-question survey assessed post-earthquake conditions in the areas of health care and access to care, housing, food and water, and sanitation. RESULTS: Communicable diseases affected a number of family members. After the earthquakes, 38% of households reported new injuries, and 79% reported acute exacerbations of chronic illness. Rural inhabitants were 30% more likely to have an uninhabitable home than were urban inhabitants. Concerns included safe housing, water purification, and waste elimination. CONCLUSION: The findings indicate a need for greater public health awareness and community action to adapt living conditions after a disaster and prevent the spread of communicable disease.