Public Health Nursing Surge: Trail Guide, Curriculum and Preliminary Evaluation

1. Public Health Nursing Surge: Trail Guide, Curriculum and Preliminary Evaluation Deanna Gordon, Barbara Polivka and Sharon Stanley

2. The Beginning The design team came together under the auspices of the Ohio Public Health Leadership Institute. Members were: Sharon Stanley, Team Leader Deanna Gordon, Nursing Education Barbara Polivka, Nursing Education Gloria Kieffer, PHN/DON Kelly Taulbee, PHN Sheryl McCorkle, OHA representative

3. Partnering with Directors of Nursing Began September 2006 and has evolved into the Advisory Group. We look to the partners to provide Information about our curriculum and the delivery methods Access to the PHN workforce Support and encouragement for their staff who are participating in the program

4. Our Charge To develop a blended learning curriculum to assure preparedness of PHNs in cases of mass casualty events. Initial Preparation Generating a list of practice competencies Constructing the curriculum content

5. PHN Competencies for a Public Health Surge Event Competencies exist for disaster preparedness for: PH generalist (Gebbie et al (2002); Gebbie & Merrill (2002)) RN generalist (INCME; Stanley (2005) & Weiner (2005) No specific competencies exist for Public Health Nurses during a Public Health surge event

6. PHN Competencies for Surge Developed based on multiple existing documents Subjected to 3 Delphi rounds PHNs DONs State and national experts in preparedness Revised and refined based on Delphi responses

7. PHN Competencies for Surge 25 PHN Competencies 10 Prevention Competencies 8 Response Competencies 7 Recovery Competencies Competencies were driving force for curriculum content

8. PHN Competencies for Surge - Prevention Personal preparedness Crisis, crisis management, emergency, disaster, catastrophe, surge Recognize unusual events Roles of local, state, and national response entities Legal authority of PH agencies Incident Command System (ICS) Role of PHN in surge Equipment for emergency communication LHDs Disaster plan Legal/ethical issues in PHN practice in surge

9. PHN Competencies for Surge - Response Rapid needs assessment Integrate PHN into ICS Outbreak investigation PH triage Psychosocial needs PHN technical skills Mass dispensing PPE Chain of evidence Health education Collaborate with response partners Risk communication

10. PHN Competencies for Surge -Recovery Debriefings & After Action Reports Identify modifications to disaster plan Psychosocial impact PH impact Health education Community partnerships Health service referrals

11. Competency Assessment Longitudinal study Hiking Workshop = Time 1 1 year later = Time 2 Current confidence in ability to perform each competency Current training need for each competency 1�5 Scale (1=low; 5=high)

12. Competency Assessment, Time 1 Respondents (N=180) All from Ohio 62% at least BSN prepared 29% DONs; 42% PHNs 49% in job more than 5 years

13. Competency Assessment - Preparedness Low Confidence, High Training Needs Legal authority of local, state, and national disaster response entities Public health triage principles Demonstrate correct use of available equipment used for emergency communication Identify legal and ethical issues related to PHN practice in surge

14. Competency Assessment - Response Low Confidence, High Training Need Indicators of mass exposure Perform public health triage Preserve possible evidence and chain of custody Demonstrate delivery of risk communication

15. Competency Assessment - Recovery Low Confidence, High Training Need Participate in debriefings and after action reports (AARs) Identify modifications needed to the disaster plan Assess immediate and long-term health impact of the event

16. DONs (red) vs. PHNs (blue)� Recognize unusual events/early indicators Current confidence- DONs: 3.6 (0.7); PHNs 2.9 (0.75) Need for training: DONs: 3.0; PHNs 3.5 Current confidence- DONs: 3.6 (0.7); PHNs 2.9 (0.75) Need for training: DONs: 3.0; PHNs 3.5

17. DONs (red) vs. PHNs (blue)� Describe PHN functional role in the plan Current confidence- DONs: 3.6 (0.9); PHNs 2.7 (0.8) Need for training: DONs: 3.0; PHNs 3.7Current confidence- DONs: 3.6 (0.9); PHNs 2.7 (0.8) Need for training: DONs: 3.0; PHNs 3.7

18. DONs (red) vs. PHNs (blue)� Participate in After Action Reports (AAR) Current confidence- DONs: 3.5 (0.9); PHNs 2.6 (1.1) Need for training: DONs: 3.0 (1.0); PHNs 3.5 (1.1)Current confidence- DONs: 3.5 (0.9); PHNs 2.6 (1.1) Need for training: DONs: 3.0 (1.0); PHNs 3.5 (1.1)

19. Shaping the Content through Blended Learning The Trail Guide: Consists of 12 mileposts presenting a variety of learning experiences. The Hiking Workshop: An in class session which relates nursing actions to the stages of disaster response. Based on 25 PHN Competencies related to surge events 4 major objectives � each Trail Guide milepost and Hiking Workshop module has sub objectives -Primary target audience are PHN � staff and administrative levels Once both the Trail Guide and Hiking workshop are completed � 50 continuing ed hours. Based on 25 PHN Competencies related to surge events 4 major objectives � each Trail Guide milepost and Hiking Workshop module has sub objectives -Primary target audience are PHN � staff and administrative levels Once both the Trail Guide and Hiking workshop are completed � 50 continuing ed hours.

20. Independent study 1 year to complete Independent study Can be completed individually or a small group in a LHD can work on it Pre and post test � Post test is completed with all the modules and the Hiking Workshop are done Each LHD in Ohio given hard copy of the Trail Guide content � content also available online Independent study 1 year to complete Independent study Can be completed individually or a small group in a LHD can work on it Pre and post test � Post test is completed with all the modules and the Hiking Workshop are done Each LHD in Ohio given hard copy of the Trail Guide content � content also available online

21. Trail Guide Modules You are special, Public Health Nurse Get yourself ready for the fight Know when to cry �wolf� Get down & dirty-your role in mass casualty incident Say Hello to Incident Command It�s all about relationships Put it in writing, please Can she make a Marcs tie-in, Billy Boy? Can you stand the heat? Get into the kitchen Ready, set, dispense! It�s not disease as usual Caring in the middle of chaos Module 1 � INCME 3 modules � online; Scope & Standards for PHNs; Bioterrorism & Emergency Readiness; Needs to be done before the Hiking Workshop Module 2 � FEMA personal preparedness module Module 3- CBRNE � chemical, biological, radiological/nuclear, explosive/incendiary agents Module 4-Nurses role in mass casualty events (Dr. Quereshi slides), Review agencies all hazard plan Module 5 � IS 700, IS 100, IS 200 Module 6-Notificaiton procedures for local & state HDs, PH emergency response guide Module 7-Community disaster plan-review; agency�s all hazard disaster plan; meet with county EMA director; Module 8-Identify agencies PIO (public info officer), Risk communication, pick up MARCs (Multi Agency Radio Communication System) radio Module 9-Participate in an exercise Module 10 � Mass dispensing webcast; national stockpile website; agency�s POD plan Module 11 � ID epidemiologist; state�s infectious disease manual; online Epidemiology course Module 12-web course on PH ethics; disaster behavioral healthModule 1 � INCME 3 modules � online; Scope & Standards for PHNs; Bioterrorism & Emergency Readiness; Needs to be done before the Hiking Workshop Module 2 � FEMA personal preparedness module Module 3- CBRNE � chemical, biological, radiological/nuclear, explosive/incendiary agents Module 4-Nurses role in mass casualty events (Dr. Quereshi slides), Review agencies all hazard plan Module 5 � IS 700, IS 100, IS 200 Module 6-Notificaiton procedures for local & state HDs, PH emergency response guide Module 7-Community disaster plan-review; agency�s all hazard disaster plan; meet with county EMA director; Module 8-Identify agencies PIO (public info officer), Risk communication, pick up MARCs (Multi Agency Radio Communication System) radio Module 9-Participate in an exercise Module 10 � Mass dispensing webcast; national stockpile website; agency�s POD plan Module 11 � ID epidemiologist; state�s infectious disease manual; online Epidemiology course Module 12-web course on PH ethics; disaster behavioral health

22. Hiking Workshop Preparedness (2 hrs) Response (2.5 hrs) Recovery (1.5 hrs) Hiking workshop is a seminar presentation � 3 modules, that includes didactic content; small group work; case study using Johnstown flood video as case Preparedness: Surge; PHN role in surge, state of the art in disaster management � includes a group exercise Response � Rapid needs assessment; Epidemiology; PH triage; Exercise � Disaster Response Recovery � Ongoing community assessment; mobilizing assets & linkages - exerciseHiking workshop is a seminar presentation � 3 modules, that includes didactic content; small group work; case study using Johnstown flood video as case Preparedness: Surge; PHN role in surge, state of the art in disaster management � includes a group exercise Response � Rapid needs assessment; Epidemiology; PH triage; Exercise � Disaster Response Recovery � Ongoing community assessment; mobilizing assets & linkages - exercise

23. Initial Partnering between Faculty and PHNs On September 19, 2006, DONs were invited to a Showcase offering to preview Initial draft of the Trail Guide Plans for the Hiking Workshop

24. Feedback from the Partners Spontaneous verbal suggestions and comments as the preview of the content was delivered. A final written evaluation form completed at the close of the showcase.

25. Participant Observations: Positives Focus on adult learning Low cost PHN focus (clear delineation on PHN role) Simplicity and thoroughness of content Convenience, self-paced and flexible

26. Participant Observations: Concerns Buy in from DONs Computer literacy and skills of staff Apprehension associated with on-line learning Something to �show for� after completion Printing of long documents Risk Communication Length of program, with each of 12 mileposts requiring 2 to 4 hours of work

27. DON Suggestions for Revisions Eliminate milepost completion requirements for Hiking Workshop Clarify PHN concepts of triage & surge Work with LHDs for PHN completion of course Use PHNs from field to present Hiking Workshop to articulate community partnerships, share stories and facilitate practice-related exercises.

28. Evolution of the Partnership Expansion from 2 PHNs on original OPHLI to the first Advisory Board Now Ohio DONs in general give their support and suggestions A synergistic energy nucleus has resulted.

29. Piloting the Hiking Workshop December 7, 2006, the pilot of the workshop was presented to PHNs Changes and Lessons learned: Module 2 was problematic: assessment of community and epidemiologic methods. Content tedious for participants. Content was refined. No overarching theme for content. Video of the Johnstown flood incorporated. Expectations for participation activities were confusing for faculty and for students. Guidelines clarified for discussion activities.

30. Implementation of Hiking Workshops To date, 9 workshops have been held in all 4 quadrants of Ohio since December 2006. A need was identified for interaction with a live person as participants progress through the Trail Guide. Thus, phone conferences were instituted

31. Summary of Participant Evaluations from Hiking Workshops Likert-like items rated on a 1 (lowest) to 5 scale (highest) related to meeting objectives, quality of instruction, and applicability of content averaged above a 4 point on most items.

32. Positive Comments about the Hiking Workshop Highlight was use of the Johnstown flood to anchor core concepts Good information with good format Interactions with peers beneficial High relevance to practice Better understanding of PHN role in preparedness

33. Suggested Changes for Hiking Workshop More of the same A lot of information in a short time Self learning module and registration through OHIOtrain

34. Next Steps Implementing post test for the Trail Guide Securing final evaluations Preparing for Train the Trainer

35. Concluding Thoughts