Learning of Student Learning of Student Nurse Volunteers in Nurse Volunteers in

Federal Disaster Federal Disaster ExerciseExercise

University of Portland University of Portland Portland, OregonPortland, Oregon

Diane Vines, R.N., Ph.D.Diane Vines, R.N., Ph.D.andand

Lori Chorpenning, R.N., M.S.Lori Chorpenning, R.N., M.S.

University of PortlandUniversity of Portland Established in 1901Established in 1901 3200 students3200 students Teaching, Faith, Teaching, Faith,

ServiceService Faith-based Faith-based

institutioninstitution

UP School of NursingUP School of Nursing

Large undergraduate Large undergraduate programprogram

Graduate programsGraduate programs- Master’s entry program- Master’s entry program- Clinical Nurse Leaders - Clinical Nurse Leaders Masters programMasters program- Doctorate of Nursing - Doctorate of Nursing Practice program Practice program beginning Summer 2008beginning Summer 2008

TOPOFF 4 Disaster ExerciseTOPOFF 4 Disaster Exercise 15,000 participants15,000 participants

Scenario-Terrorists bring Scenario-Terrorists bring radioactive material into radioactive material into the U.S.the U.S.

Guam, Portland and Guam, Portland and PhoenixPhoenix

TOPOFF 4 GoalsTOPOFF 4 Goals Policy and strategic issues Policy and strategic issues Difficult decisionsDifficult decisions Essential functionsEssential functions Common operating picture Common operating picture

University of Portland University of Portland ParticipationParticipation

The athletic center The athletic center as site of 50 bed as site of 50 bed stabilization area stabilization area (medical care (medical care point)point)

Student nurses, Student nurses, faculty, and staff faculty, and staff volunteersvolunteers

UP ParticipationUP Participation

Importance of Disaster Importance of Disaster PreparednessPreparedness

ACHNE White Paper on disaster ACHNE White Paper on disaster preparednesspreparedness

ANA White PaperANA White Paper Essentials of Baccalaureate NursingEssentials of Baccalaureate Nursing Homeland Security training fundsHomeland Security training funds

Literature ReviewLiterature ReviewDisaster exercisesDisaster exercises Stimulating training (Jasper et al, 2005)Stimulating training (Jasper et al, 2005) Importance of simulation (Smith, 2007)Importance of simulation (Smith, 2007) Multidisciplinary team in Israel (Waisman Multidisciplinary team in Israel (Waisman

et al (2006)et al (2006) Healthcare worker training in a rural Healthcare worker training in a rural

community hospital drill (Vinson, 2007)community hospital drill (Vinson, 2007)

Literature ReviewLiterature ReviewStudent nurse involvement in Student nurse involvement in

exercisesexercises Physical injuries focus (Jennings-Physical injuries focus (Jennings-

Sanders et al, 2005)Sanders et al, 2005) Clayton State University students Clayton State University students

increased confidence in caring for increased confidence in caring for patients (Eichelberger & Odom, patients (Eichelberger & Odom, 2006)2006)

Literature ReviewLiterature ReviewProvider reactions to disaster Provider reactions to disaster

exercisesexercises Communication (Behney et al, 2006)Communication (Behney et al, 2006) Responders experienced stress Responders experienced stress

reactions (Burkle, 1996)reactions (Burkle, 1996) Exercise reactions similar to actual Exercise reactions similar to actual

disaster (Sanner & Wolcott, 1983)disaster (Sanner & Wolcott, 1983)

Literature Review Literature Review Curricular implicationsCurricular implications Disaster preparedness -basic Disaster preparedness -basic

competency (Pattillo, 2003)competency (Pattillo, 2003) Competency for entry-level RN’s- Competency for entry-level RN’s-

International Coalition for Mass International Coalition for Mass Casualty Education (INCMCE) now Casualty Education (INCMCE) now called National Emergency called National Emergency Preparedness Education Coalition Preparedness Education Coalition (NEPEC) (NEPEC)

Literature ReviewLiterature Review No increase in teaching disaster No increase in teaching disaster

preparedness (Weiner et al, 2005)preparedness (Weiner et al, 2005) Lecture only (Weiner, 2005)Lecture only (Weiner, 2005) Barrier- time (Martin et al, 2006)Barrier- time (Martin et al, 2006)

Study DesignStudy DesignSurvey instrumentSurvey instrument1. Category1. Category2. Role2. Role3. Experience during drill3. Experience during drill4. Feelings during drill 4. Feelings during drill 5. Problems or challenges5. Problems or challenges6. What worked well6. What worked well

Study Design Study Design Data CollectionData Collection After drillAfter drill Likert ScaleLikert Scale DebriefingDebriefing

Study DesignStudy DesignData analysisData analysis Quantitative and qualitative Quantitative and qualitative Compared responses of victims and Compared responses of victims and

caregiverscaregivers Emotions experienced and Emotions experienced and

suggestions for improvement suggestions for improvement

Findings – Demographics and Findings – Demographics and RolesRoles

7

17

11

2 2

4

2

0

2

4

6

8

10

12

14

16

18

AEMUP Senior Junior Freshman Faculty

Total respondants

Victim

Caregiver

45 total 45 total participantsparticipants– 32 served 32 served

as victimsas victims– 13 served 13 served

as as caregiverscaregivers

Nursing Student Responses: Nursing Student Responses: This will enhance my nursing This will enhance my nursing

student abilitiesstudent abilities

6

2

12

5 5

2

0

1

4

1

0

2

4

6

8

10

12

StronglyAgree

Agree Disagree StronglyDisagree

No Opinion

This w ill enhance my nursing student abilities

Victim

Caregiver

Nursing Student Responses: Nursing Student Responses: This will enhance my future skills This will enhance my future skills

as a as a practicing nursepracticing nurse

5

3

14

2

5

2

0 0

4 4

0

2

4

6

8

10

12

14

StronglyAgree

Agree Disagree StronglyDisagree

No Opinion

This w ill enhance my future skills as a practicing nurse

Victim

Caregiver

Preparation for ExercisePreparation for ExerciseWas the training sufficient:Was the training sufficient:

Was the info received sufficient:Was the info received sufficient:

Prepared for real disaster:Prepared for real disaster:

Preparation for ExercisePreparation for ExerciseExperience felt realistic:Experience felt realistic:

0

1

2

3

4

5

6

7

8

9

10

Strongly Agree Agree Disagree Strongly Disagree No Opinion

The drill felt realistic

AEMUP

Senior

Junior

Freshman

Preparation for ExercisePreparation for Exercise Would participate in future drills:Would participate in future drills:

0

2

4

6

8

10

12

14

16

18

Strongly Agree Agree Disagree Strongly Disagree No Opinion

I would participate in a future disaster drill

AEMUP

Senior

Junior

Freshman

I was Anxious…I was Anxious…

Caregivers Caregivers

Victims Victims

0

1

2

3

4

5

6

7

8

9

Strongly Agree Agree Disagree Strongly Disagree No Opinion

Caregiver anxiety

Before drill

During drill

0

2

4

6

8

10

12

14

16

Strongly Agree Agree Disagree Strongly Disagree No Opinion

Victim anxiety

Before drill

During drill

Emotions Experienced during drillEmotions Experienced during drill BoredomBoredom 2727 ConfusionConfusion 2222

CompetenceCompetence 1919

CompassionCompassion 1313

HelplessnessHelplessness 77 EmpathyEmpathy 55 FrustrationFrustration 11 AnxietyAnxiety 11 CuriousCurious 11 SupportedSupported 11

ComfortableComfortable 11 Cared ForCared For 11

Suggestions for Suggestions for ImprovementImprovementRole performanceRole performance

CaregiverCaregiver Act more like victimsAct more like victims Wanted child victims Wanted child victims Severely affected victimsSeverely affected victims Wanted more preparation Wanted more preparation Better definition of caregiver roleBetter definition of caregiver role

Suggestions for Suggestions for ImprovementImprovement

Curriculum improvementCurriculum improvement More disaster preparedness More disaster preparedness More preparation beforehandMore preparation beforehand

Suggestions for ImprovementSuggestions for ImprovementInformationInformation Underclassmen- more simulations Underclassmen- more simulations More informationMore information Wanted handoutWanted handout

Suggestions for ImprovementSuggestions for ImprovementOperational Operational Too slow Too slow Better clock placement Better clock placement Better data collectionBetter data collection Better preparation on use of studentsBetter preparation on use of students

Discussion of FindingsDiscussion of Findings Caregivers more negative in Caregivers more negative in

assessment of value of exerciseassessment of value of exercise

Anxiety for allAnxiety for all

Not sufficiently realisticNot sufficiently realistic

Discussion of FindingsDiscussion of Findings Encourage assertivenessEncourage assertiveness

More preparation is neededMore preparation is needed

Agreement- participation in future drillsAgreement- participation in future drills

Need for Further StudyNeed for Further Study Simulation should be realisticSimulation should be realistic

Students should participate moreStudents should participate more

ConclusionsConclusions Valuable learning experienceValuable learning experience

Suggestions sharedSuggestions shared

Questions ?Questions ?

Diane Vines: vines@up.eduDiane Vines: vines@up.edu Lori Chorpenning: chorpenn@up.eduLori Chorpenning: chorpenn@up.edu

ReferencesReferences Behney, A., Briet, M., & Phillips, C. (2006). Pediatric Mass Casualty: Behney, A., Briet, M., & Phillips, C. (2006). Pediatric Mass Casualty:

Are You Ready. Are You Ready. Journal of Emergency Medicine, Journal of Emergency Medicine, 32(3), 241-245.32(3), 241-245. Burkle, F. (1996). Acute Phase Mental Health Consequences of Burkle, F. (1996). Acute Phase Mental Health Consequences of

Disasters: Implications for Triage and Emergency Medical Disasters: Implications for Triage and Emergency Medical Services. Services. Annals of Emergency Medicine, Annals of Emergency Medicine, 28(2), 119-128. 28(2), 119-128.

Eichelberger, L., & Odom, S. (2006). Disaster response: a clinical Eichelberger, L., & Odom, S. (2006). Disaster response: a clinical experience: students and faculty reflecting on Hurricane Katrina. experience: students and faculty reflecting on Hurricane Katrina. American Journal of Nursing, 106American Journal of Nursing, 106(9), 72AAA-72DDD. (9), 72AAA-72DDD.

International Coalition For Mass Casualty Education. (2003, July). International Coalition For Mass Casualty Education. (2003, July). Educational competencies for registered nurses responding to Educational competencies for registered nurses responding to mass casualty incidentsmass casualty incidents. Retrieved November 27, 2007, from . Retrieved November 27, 2007, from http://www.incmce.org/competenciespage.htmlhttp://www.incmce.org/competenciespage.html

ReferencesReferences Jasper, E., Miller, M., Sweeney, B., Berg, D., Feuer, E., & Reganato, Jasper, E., Miller, M., Sweeney, B., Berg, D., Feuer, E., & Reganato,

D. (2005). Preparedness of hospitalas to respond to a radiological D. (2005). Preparedness of hospitalas to respond to a radiological terrorism event as assessed by a full-scale exercise. terrorism event as assessed by a full-scale exercise. Journal of Journal of Public Health Management and Practice, 11Public Health Management and Practice, 11(6), S11-S16. (6), S11-S16.

Jennings-Sanders, A., Frisch, N., & Wing, S. (2005). Nursing Jennings-Sanders, A., Frisch, N., & Wing, S. (2005). Nursing students' perceptions about disaster nursing. students' perceptions about disaster nursing. Disaster Disaster Management and Response, 3Management and Response, 3(3), 80-85.(3), 80-85.

Martin, S., Bush, A., & Lynch, J. (2006). A National Survey of Martin, S., Bush, A., & Lynch, J. (2006). A National Survey of Terrorism Preparedness Training Among Pediatric, Family Practice, Terrorism Preparedness Training Among Pediatric, Family Practice, and EmergencyMedicine Programs. and EmergencyMedicine Programs. Pediatrics, Pediatrics, 118 (3), 620-626.118 (3), 620-626.

Pattillo, M. M. (2003). Mass casualty disaster nursing course. Pattillo, M. M. (2003). Mass casualty disaster nursing course. Nurse Nurse Educator, 28Educator, 28(6), 271-275.(6), 271-275.

Sanner, P., & Wolcott, B. (1983). Stress Reactions among Sanner, P., & Wolcott, B. (1983). Stress Reactions among Participants in Mass Casualty Simulations. Participants in Mass Casualty Simulations. Annals Annals of of Emergency Emergency Medicine, Medicine, 12(7), 426-428.12(7), 426-428.

ReferencesReferences Smith, R. (2007). Making a Case for Integration of DisasterSmith, R. (2007). Making a Case for Integration of Disaster

Preparedness Content in Associate Degree Nursing Programs. Preparedness Content in Associate Degree Nursing Programs. Thinking & Thinking & Learning in Nursing, Learning in Nursing, 2 (4), 100-104.2 (4), 100-104.

Vinson, E. (2007). Managing Bioterrorism Mass Casualties in an Vinson, E. (2007). Managing Bioterrorism Mass Casualties in an Emergency Department: Emergency Department: Lesson Learned From a Rural Community Lesson Learned From a Rural Community Hospital Disaster Drill. Hospital Disaster Drill. Disaster Disaster Management and Response, Management and Response, 5 (1), 18-215 (1), 18-21

Waisman, Y., Amir, L., Mor, M., Figenberg, Z., Aharonson, L., Peleg, K., et Waisman, Y., Amir, L., Mor, M., Figenberg, Z., Aharonson, L., Peleg, K., et al. al. (2006). Prehospital Response & Field Triage in Pediatric Mass (2006). Prehospital Response & Field Triage in Pediatric Mass Casualty Incidents : The Israeli Experience. Casualty Incidents : The Israeli Experience. Clinical Pediatric Emergency Clinical Pediatric Emergency

Medicine, Medicine, 7(1), 52-58.7(1), 52-58. Weiner, E. F. (2005). A national curriculum for nurses in emergency Weiner, E. F. (2005). A national curriculum for nurses in emergency

preparedness and response. preparedness and response. Nursing Clinics of North America, 40,Nursing Clinics of North America, 40, 469- 469-479.479.

Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency preparedness curriculum in nursing schools in the United States. preparedness curriculum in nursing schools in the United States. Nursing Nursing

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