NR442 Community Health Week 6 With Answers (60 Solved Questions)

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WEEK 6 EDAPT NOTES NR 442, COMMUNITY HEALTHNURSING CARE DURING A DISASTERWhich terms are stages in the process of emergency management?The process of emergency management includes:PreparednessMitigation/PreventionResponseRecoveryPlanning/ContinuityTraining can span across stages, but usually is part of preparedness. Notification may be part ofany of the stages.Which populations are most likely to be at high risk during a disaster?All of these populations could be considered vulnerable. Retirement village residents mayinclude older adults with disabilities or medical needs and who may not be mobile. Prisoninmates are entirely dependent on staff for their needs. English language learners may notunderstand advisories or information about preparedness or evacuation. Families on aranch may attempt to save their livestock and may not evacuate if needed. Inner-city apartmentdwellers may lack transportation options and may struggle to obtain resources to deal with adisaster or evacuate.Nurses can participate in which stages of emergency management?Nurses can, and do, participate in all stages of emergency management.What is disaster?Have you experienced a disaster? To answer that question, you need to know the definition of adisaster. According to the International Federation of Red Cross and Red Crescent Societies(2021):“A disaster is a sudden, calamitous event that seriously disrupts the functioning of a communityor society and causes human, material, and economic or environmental losses that exceed thecommunity’s or society’s ability to cope using its own resources. Though often caused bynature, disasters can have human origins.” (Para. 1)Think about the elements of this definition. What is a community or a society? A communitycould mean a neighborhood, a workplace, a stadium, a city, a region, or what you define it to be.A community can be a permanent fixture or could be a temporary gathering or grouping ofpeople.The definition of a disaster event is just as variable. For example, disasters can include naturalor man-made events, and even a mix of both (think Hurricane Katrina, where the hurricane wasnatural, but the levee breach was man-made). Likewise, disasters can be acts of terrorism orwar and involve natural or man-made agents. More frequently, technology is a vector ofdisaster, with attacks on facility and government systems and power grids.

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What constitutes a disaster for one community might not be a problem in another. The key todetermining if an event is a disaster is if the event exceeds the community’s ability to cope usingits own resources. If a community can cope, the event might be an emergency but notnecessarily a disaster. For instance, if a tornado destroys a neighborhood in a large city, the citylikely has enough resources to manage this as an emergency event. However, suppose atornado destroys an area in a small town. In that case, the event may stretch their capabilities,requiring responders and resources from the surrounding region might be called to help, so thiswould be a disaster in this small town.Causes of disasters:You may ask why it matters what caused a disaster. Imagine you are ahospital emergency management coordinator. While planning for any disaster involves the samesteps, how you implement those steps may be very different depending on if the disaster isnatural or man-made, especially when planning prevention measures.Tornadoes:You are in a high-risk area for tornadoes. As the emergency managementcoordinator, you understand you cannot prevent a tornado. Your plan will includemeasures to lessen the damages caused by a tornado (mitigation) by working witharchitects and engineers on building design, ensuring an early warning system for staff andclients, and providing staff training on actions to take if a tornado is imminent.Power Grid Failure:A power grid failure in your facility would be life-threatening to manyclients and disrupt care for all. This man-made disaster can be prevented within the facilitywith the proper equipment, resources, and planning. You work with facilities managers toensure appropriate generators are in place and fuel to run the generators is available. Youcan also mitigate the effects of a grid outage by training staff on the use of emergencyoutlets.At-Risk (Vulnerable) PopulationsAre there some types of disasters that affect specific populations more? For example, thinkabout an at-risk population, such as older adults in a nursing home. Why are they at-risk(medical issues, cognitive deficiencies, immobility)? How would a disaster such as a flood orwildland fire affect them differently than a suburban neighborhood?Nursing Care ConsiderationsHow does the type of disaster impact nursing response? Some disasters are quick eventsand may impact clinical nursing (such as a tornado with multiple injuries). Others mayrequire the evacuation of large numbers of people into shelters (hurricane). A largeearthquake and tsunami might require an extended recovery period over the years,demanding much different nursing skills.

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Which event is most likely to become a disaster?During the peak tourist season in a remote area, a large resort hotel fire would most likelybe a disaster.Remember, what constitutes a disaster for one community might not be a problem inanother. The key to determining if an event is a disaster is if the event “exceeds thecommunity’s ability to cope using its own resources.” Since the hotel is in a remote area,few resources are likely to help respond to the fire and potential injuries. If this happenedin Las Vegas, this might be another emergency response.One hundred acres of remote forest land burning would not likely be considered a disasterdue to the small size and remoteness. However, the impact of the fire might be different ifit burned, say, a cultural heritage site, but there is no indication of that here.A fast-moving tropical storm that makes landfall at low tide in a rural area may causelocalized flooding but is not likely a disaster. However, flooding might be an issue if thestorm was very slow-moving or stalls, thus raining over the area for an extended time. Ifthe storm strikes at high tide, storm surge might also be problematic.Losing power in one city block is most likely not a disaster, though it may be an emergencyduring a heatwave or if residents have power-dependent critical medical devices. However,this might be a disaster if it involved an unprepared hospital in a small town.Stages of emergency:PreparednessActions to promote readiness and responseMitigation/PreventionPrevent disasters, when possible, reduce risks and effects from hazardsResponseActions taken after a disaster occurs to save lives and reduce the damage toproperty and the environmentRecoveryBegins during response, help restore and resume normal operationsPlanning/ContinuityOccurs during all stages of emergency management, cyclical, continuousimprovement, and updates, helps to ensure all stages are successfulThe school nurse wants to help at-risk students and their families prepare for theupcoming hurricane season. Which is the most critical action for the nurse to take?The school nurse should provide information and resources for students and families tohelp them plan. Planning will help at-risk clients identify vulnerabilities they may needassistance with, such as lack of transportation for evacuation or funds for extra food andwater. Communities usually have pre-designated shelters or transportation options, which

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the family should locate before the hurricane strikes. They may also need to plan for extramedication or supplies for medical devices.Teaching a CPR course is a good idea, but that would not be the best to help with theupcoming hurricane season. Conducting a vulnerability analysis for a known hazard mightbe helpful, but planning considers several vulnerabilities and would have an immediateimpact on safety. Handing out gift cards might be a good idea for some clients but wouldhave a minimal effect compared to a plan.Prevention and mitigation:Mitigation is reducing the severity of a disaster or lessening the impact of a disaster andcan be accomplished through resources like theFirewise program for wildland fires,building sprinkler systems, tsunami walls, avalanche tunnels, and tornado shelters.Prevention is eliminating the threat of a disaster. These efforts could include flood zonelevee systems, forest thinning, zoning laws, and building codes. Watch thisshortexplanation of mitigation/prevention strategies.These two activities ideally occur before a disaster strikes, though at times, some mitigationactivities may occur after a disaster to keep the disaster from spreading or getting worse.Mitigation and prevention strategies build on what worked before or should work asidentified during the planning process. Use an evidence-based approach to find strategiesthat have worked well or adapting methods that were not successful. With mitigation andprevention, it is essential to understand what does not work so that time, money, andresources focus on ideas that are most likely to be successful.Self-actualizationMorality, creativity, spontaneity, lack of prejudice, acceptance of factsEsteemself-esteem, respect, achievement, confidenceLove/Belongingfriendship, family, intimacy, sense of connection with othersSafetysecurity of body, of employment, of resources, of moralty, of the family, of health, ofpropertyPhysiologicalair, food, water, shelter, clothing, sleep

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Which prevention activity is most appropriate for the nurse to take in a flood-pronecommunity?Prevention is eliminating the threat of a disaster—these activities include flood zonedesignations that move people from flood-prone areas to more appropriate housingoptions. Often, a disproportionately high number of at-risk populations live in these areas,so working with city leaders to find alternate affordable housing options is critical as thesefamilies may not otherwise have the resources to relocate.Mitigation reduces the severity of a disaster or lessens the impact of a disaster, includingevacuation, any lifesaving supplies, or shelter information.Response:The response is the most visible stage of disaster management and usually the shorteststage and most chaotic. Response to a disaster focuses on saving lives and includes effortsto reduce damage to property and the environment. The roles of nurses in disasterresponse can include treating victims or other responders or any other response function.The most important thing to remember about responding to a disaster is safety.Yourability to follow the emergency plan is vital when responding to your workplace as part oftheir disaster operations. First, of course, you need to know the emergency plan before adisaster strikes. Second, if you intend to respond to disasters outside your workplace, youmust plan and join a response group, such as a stateMedical Reserve Corps (MRC). Manyorganizations are involved in disaster response, but remember, you must start theserelationships before a disaster strikes.At-Risk (Vulnerable) PopulationsThink about disasters you have heard about on the news. What at-risk populations did theydiscuss, and why were they so vulnerable? Remember, disasters do not affect all peoplethe same. Some populations are more likely to experience the devastating effects of adisaster. Those populations that require the most care and resources during the disasterare often the most vulnerable to its outcomes.Nursing Care ConsiderationsDuring a disaster, nurses can fill roles or perform skills and actions outside their scope ofpractice or training. While we often take the stance of doing whatever it takes, specific legaland ethical issues need consideration. This issue brief by theAmerican Nurses Association(2017) provides some guidance on these issues and questions you should address.Recovery:Recovering from a disaster is said to begin during the response, with the intent to helprestore and resume normal operations of organizations and communities. However, this

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stage should start much earlier, during preparedness activities. Plans should be in place tobegin the recovery process, which can take weeks, months, or years, as soon as it is safe todo so.Once it is safe, begin efforts to ensure emergency services and infrastructure are in placeor repaired. First responders, power, roads, bridges, medical care, and communications willbe the priority. Hotels and restaurants will be needed operational to serve the resourcesand workforce necessary for recovery efforts. Grocery stores and home supply businesseswill be required as residents work to return to normal.The clinic nurse is concerned about the death of several clients due to carbonmonoxide poisoning after a recent two-week power outage due to a hurricane. Thenurse identifies several activities that might make a positive impact in thecommunity. Click to specify in which stage of disaster management the nurseimplements each activity. More than one stage may apply to each activity.Acquiring and handing out flyers for generator safety should ideally be a part ofpreparedness activities and should continue throughout the disaster stages. Recovery maynot seem like the appropriate time, but this may be the time (after a disaster or death hitsclose to home) when clients are most likely to listen to information.Accompanying a CERT to identify dangerous generator usage would happen during theresponse and recovery stages as clients are using generators. Therefore, if you are part ofthe CERT, you will want to participate and train well before a disaster.Advocating for changes in policy or law can last for years by changing how a communityprepares for action during a disaster.Planning and continuity:This stage of disaster management is cyclical to ensure components are still valid (such asan emergency operations plan), exercised (sand table or full-scale), and “lessons learned”incorporated after an event occurs. Planning helps to ensure the continuity of a business,organization, or community. Disaster planning, though complex, can start with the basics ofidentifying issues (risks, hazards, disasters, vulnerable populations), solutions (evacuation,mitigation, search and rescue, etc.), and resources available (police, fire, emergencymedical services [EMS], hospitals, buses, boats, helicopters).Plans for businesses and small organizations may be concrete, while plans for largeorganizations or government entities will be significant. Planning may include reciprocityagreements with other communities or other facilities in the case of hospitals or nursinghomes. BothFEMA andReady have a variety of planning tools for individuals, businesses,and organizations. Start with a plan for you and your family (use the Ready resources).Planners in emergency management utilize after-action reports to update emergencyoperations plans.The Texas Hospital Association has a great example of an after-actionreport from Hurricane Harvey.

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How often should facility leadership update their emergency operations plan?Disaster planning is ongoing and never-ending and donecontinuously.Yearly might be appropriate for a simple plan, but components usually change more often.Indeed, plans should be updated after a disaster to incorporate lessons learned, but thisshould not be the only time they are updated. For example, updating a city emergencyoperations plan may necessitate revising a facility plan independently of the city plan.Disaster exercise:Walkthroughusually, to discuss various scenarios or plan componentsoften in a workshop format where a variety of planners and responders talkthrough issuesfamiliarization of a planTabletopsmall teams of disaster management personnelvery interactive discussions, usually with a facilitator to unfold a scenariogood way to challenge plan components and identify issuesFunctionalsimulated event, small scale, hands onuseful for small teams or functional teams (testing K9 search and rescue forexample)common as training scenariosFull-scalereal-life simulated scenario of any type (all hazard)involve all resources (medical, fire, rescue, law enforcement, government, volunteerresources)can be expensive and requires a good deal of planning

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John is an emergency department nurse who has just been assigned to the hospital’semergency management committee. He has been asked to conduct an annual reviewof the emergency operations plan. John has never seen the plan and he asked severalmembers of the committee where to locate the plan. The committee chair (theemergency management director) tells him the plan is in a locked cabinet in hisoffice and they can retrieve it after the meeting.Which cues should concern John?John should be concerned that he has never seen the emergency operations plan; he hadto ask several people about the plan's location before discovering it in a locked cabinet.After reading the plan, John is concerned that the plan is only reviewed annually by oneperson.A good emergency operations plan should be readily accessible by those expected toexecute the plan and familiar to everyone in the facility. Emergency planning is acontinuous process of editing and revising as necessary, mainly after incidents occur, andshould involve various key stakeholders, such as the incident management team,emergency coordinator, unit representatives, and outside response personnel.Including John, an emergency department nurse on the hospital’s emergency managementcommittee, is not a concern as this is an appropriate use of his nursing skills.John understands which stage(s) of disaster management are dependent on a goodemergency operations plan?A good emergency operations plan is critical for all stages of disaster management:preparedness, mitigation/prevention, response, and recovery.Training is not a distinct disaster phase but part of preparedness. Clean-up is part of therecovery phase. An after-action review and report are usually done after a disaster andhelp inform needed changes in the disaster plan.John reviews the emergency operations plan and has several suggestions for thecommittee. Select the correct phase of disaster management for eachprocedure listed on the left.Arranging a series of walkthrough sessions of the emergency operations plan for allhospital personnel is a priority preparedness activity. While reaching out to communityleaders to determine what risks exist within communities might be an essentialpreparedness activity, this is usually part of a community plan and not a facility plan.Providing fire extinguisher training is a priority mitigation activity for a facility. Exit markingfollows applicable laws, and glow-in-the-dark paint is not required.Ensuring a 3-day supply of personal protective equipment is available is a priority responseactivity for the facility. While it is appropriate to buy color-coded vests, this should not by

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prioritized over the safety of facility personnel. Finally, contracting with a critical incidentstress debriefing (CISD) team for care after a disaster is an appropriate recovery activity forthe facility.John knows he needs to arrange a series of emergency operations plan walkthroughsessions for all hospital personnel as part of initial preparedness activities.What other preparedness activities are appropriate now?Preparedness activities are those actions to promote readiness and response, including:schedule training sessionsensure emergency radios are working and accessibleprepare a contact list of incident command staffInstalling new smoke detectors to replace those over ten years old is amitigation/prevention action designed to prevent disasters and, when possible, reducerisks and effects from hazards.Moving personal protective equipment carts to every room is a response activity, which areactions taken after a disaster to save lives and reduce the damage to property and theenvironment.Conduct an after-action review once disaster recovery actions are complete to incorporateknowledge gained and revised outcomes into the emergency operations plan.After conducting a series of emergency operations plan walkthrough sessions for allhospital personnel, John needs to understand if incident command personnel knowhow to activate the emergency operations plan, call in critical staff for any event (allhazard), open the emergency operations center, and utilize the emergency radiosystem. Which action is most appropriate for John to take next?A functional exercise should be the following action. These are small-scale simulatedevents useful for small teams and would be an excellent way to understand if the incidentcommand team can perform initial emergency operations.After completing a walkthrough discussion about scenarios or plan components, a tabletopis helpful for small teams, but it is usually a deep discussion with a facilitator. In addition, itdoes not allow for hands-on actions such as opening the emergency operations center orutilizing the emergency radio system. A full-scale exercise would involve all types ofhospital personnel and potentially outside responders and would be beyond the scopeneeded to test a portion of the plan.Planning a minor disaster and a press release would not be appropriate activities to solvethis problem.

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Having completed a functional exercise to determine if incident command personnelknow how to activate the emergency operations plan, John and the group conduct asmall after-action review to assess their readiness. Which findings indicate incidentcommand personnel are proficient in disaster management skills?The after-action team creates a process to add new personnel to the call list, indicating thatkeeping the plan updated is ongoing. Immediately accessing the emergency operationsplan and continuing to refer to it during the exercise demonstrate knowledge that the plancontains valuable information to help with all aspects of disaster management.Radios that are unused and found not charged are concerning and indicate a need formore training on proper use and maintenance of the equipment.A community health nurse is working with community leaders on disaster mitigationefforts. Which at-risk populations should the nurse be most concerned about?A 55 and over community may have many residents who are home-bound, have disabilitiesof some kind, or utilize power-dependent medical equipment.A Laotian immigrant community may have members who do not speak English and mayhave members who do not interact with others outside their community.Any prison population is completely dependent on facility personnel and so is vulnerable.Food pantry customers may not be able to prepare for a disaster by saving three days offood and water. They may also lack resources for evacuation or recovery if needed.Low-income housing residents may also lack resources to prepare for a disaster, evacuate,or recover.Suburban residents are not vulnerable just because they have long commute times.A community health nurse is working with community leaders on disaster mitigationefforts. The nurse has identified at-risk populations that may need assistance. Whatactivities can be used while working with vulnerable populations?Appropriate actions to take when working with vulnerable populations include:Asking community leaders what would be necessary.Meeting them where they are.Providing materials in the language they speak.While equality is essential, in this case, equity is more important. Therefore, mitigationefforts should focus on equal outcomes, and vulnerable populations may need more ordifferent resources to realize the same mitigation outcomes.Forcing community members to come to you is not appropriate as many cannot come toyou, and in many vulnerable populations, the trust of government officials may be low.

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DISATER RESPONSE AND RECOVERY:Which actions are part of disaster response?Disaster response includes those actions taken after a disaster occurs to save lives andreduce the damage to property and the environment.Which actions are part of disaster recovery?Recovery begins during response and are those actions to help restore and resume normaloperations.Which disaster response roles are appropriate for nurses?All of these roles are appropriate for a nurse. Nurses are well-suited to fill all types ofdisaster response roles.Incident CommanderIn charge of the organization’s on-scene response and appoint others to positionsas neededMaintain command until relieved by more appropriate incident commander or thenext operational period commanderAssess the situation and brief staff on current organization and activities; assigntasks; schedule planning meetingOrder warning of persons at risk or potentially at risk to take appropriate protectiveactionsNotify or verify internal teams, departments, public agencies, regulators, contractorsand suppliers have been notifiedDetermine the incident objectives and strategy; identify information needed orrequired by others; ensure planning/strategy meetings are held and attend asneededCoordinate activities with the emergency operations center (EOC); identify prioritiesand activitiesTerminate the response and demobilize resources when the situation has beenstabilizedSafetyIdentify and assess hazardous situations; prevent accidentsPrepare safety plan; ensure messages are communicatedStop unsafe acts; correct unsafe conditionsLiaisonPoint of contact with outside agencies and companies

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Monitors operations to identify inter-organizational problemsPublic InformationNotify spokespersons and Crisis Communications TeamDevelop information for use in media briefings and obtain incident command andmanagement approval for all news releasesArrange for tours, interviews and or briefingsOperationsManage all tactical operations during the incidentAssist in the development of the operations portion of the Incident Action PlanEnsure safe tactical operations for all responders (in conjunction with any assignedSafety Officer)Request additional resources to support tactical operationsMaintain close communication with the Incident CommanderPlanningConduct and facilitate planning meetingsSupervise preparation of the Incident Action PlanCoordinate with business continuity and senior management teamsAssemble information on alternative strategies and plansAssess current and potential impacts on people, property, environmentLogisticsProvides resources to stabilize the incident and support personnel, systems, andequipment:Workspace or facilities for incident management staffTransportationCommunications equipmentFood, water, shelter and medical care for respondersProvides updates on resources (availability, response time, deployment)Finance/Administration:Manages all financial aspects of the incidentCreate accounts for claims and costs; coordinates with LogisticsTracks worker time and costs for materials and suppliesDocuments claims for damage, liability and injuries

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Provides oversight of financial expenditures, new leases, contracts and assistanceagreements to comply with corporate governanceWhich positions are part of the incident command system (ICS) command andgeneral staff?ICS command and general staff include the following:Incident CommanderSafety OfficerLiaison OfficerPublic Information OfficerOperations Section ChiefPlanning Section ChiefLogistics Section ChiefFinance Section ChiefTransportation and food are units/resources located with the logistics section but are notpart of the command and general staff.Scenario 1:As an emergency nurse, you are working in your emergency department whena disaster involving a large number of injuries occurs. You access the emergency responseplan and activate the incident command team (ICT), which opens the facility emergencyoperations center (EOC). The ICT coordinates with the disaster ICT to manage the flow ofinjured to the facility, potential decontamination operations, and the need for otherresources. The ICT also calls in additional staff and activates the plan for obtainingadditional equipment. The ICT continues operations for two days until all injured have beenmoved through the emergency department into appropriate care and all departmentsresume normal operations.Scenario 2:A nurse interested in helping her community takes American Red Cross sheltertraining. A major flood occurs and she is activated to respond to the designated shelterlocation and assist in setting up (or standing up) the shelter site. She starts receivingdisplaced residents who were evacuated by boat from their homes. As she checks theevacuees into the shelter, she assesses for injuries and medical needs. The next day shereturns and notices there are many more evacuees in the shelter and they have lots ofquestions about what comes next. Some are distraught because their homes were floodedand there are lots of emotions. They are asking for places to charge their phones so theycan communicate with family members. The shelter is open for several days and evacueesare needing basic supplies, such as food, personal hygiene products, and prescriptionmedications.Scenario 3:A nurse joins a federal disaster medical assistance team (DMAT) to help

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communities in need during a variety of incidents and disasters. The DMAT is deployed to acoastal city after a major hurricane. The nurse, who keeps deployment bags ready to go,heads to the airport and flies to meet the rest of the team. They are bussed to the disasterlocation of a hospital to assist in returning the heavily damaged facility to a functionalstatus. The nurse helps assemble a tent field hospital in the parking lot and beginsreceiving residents who have been injured or are experiencing other medical issues. TheDMAT uses equipment that was trucked in with the field hospital, all in crates and boxeswhich they unpack and use to form an operational medical facility. Once the field hospitalis up and running, the nurse is assigned to work with logistical personnel in creating atemporary emergency department on the second floor of the facility to serve the residentsuntil the destroyed first-floor emergency department can be repaired.Question:Helen is a unit charge nurse who is called in to help with receiving those injured froma building collapse. She is asked to monitor for hazardous situations in theemergency department, which she understands is the role of the safety officer. Shenotices that personal protective equipment is running low and so she coordinateswith the logistics section chief to restock the supply.Responding safety:The most important part of responding safely starts with you and your family. Here aresome questions you should ask before responding to a disaster:Are you well? If you are sick or injured, do not respond to a disaster.Can you meet the physical or emotional demands? Disasters can be challengingenvironments.Do you have serious medical conditions that cannot be managed well in a disasterenvironment? If so, find a way to help without needing to deploy to the disaster site.There are a variety of options with response organizations.Do you have enough prescribed medications? You may not be able to fillprescriptions.Do you know where you are going, and can you get there? Do you need extra fuel?None may be available in the disaster zone and roads may be impassable.Do not put yourself in danger! If you need assistance or resources, those resources orpersonnel cannot be utilized for disaster needs. It is a good idea to talk to others who haveresponded to a disaster in your role to get an idea of the experience and lessons learned.Disaster response organizations will have training to help you understand therequirements.

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