Clinicians’ Knowledge, Attitudes, and Concerns Regarding Bioterrorism After a Brief Educational Program

Supervisor Training: A Promising Approach to Addressing Impairment in the Workplace

OBJECTIVE

This study presents a pilot evaluation of a new online training program created to improve supervisors' ability to protect worker safety by recognizing and responding to signs of impairment from diverse causes.

METHODS

The study design relied on a mixed-methods approach with two waves of surveys and interviews immediately after training completion and after 3 months to gauge changes in participants' perceived knowledge and competencies.

RESULTS

Participants had a positive reaction to training and found it relevant to their job responsibilities and aligned with existing organizational safety programs, practices, and policies. There was statistically significant improvement in perceived impairment knowledge and competencies. The study also provided early indications of training transfer.

CONCLUSIONS

The study offers encouraging results that may be used to improve the impairment recognition and response training for supervisors and support future investigations of its impact.

Nurses' and Medical Officers' Knowledge, Attitude, and Preparedness Toward Potential Bioterrorism Attacks

Terrorist attacks are increasingly becoming more lethal and less discriminate. The threat of bioterrorism is increasing daily. The ease of production and the broad availability of biological agents and technical know-how have led to a further spread of biological weapons and an increased desire among nations as well as terrorists to have them. Health professionals in emergency departments are expected to play crucial roles in the management of victims of bioterrorism when bioterrorism occurs. This study explored the knowledge, attitudes, and preparedness of emergency department nurses and medical officers (MOs) toward potential bioterrorist attacks in Ghana. This qualitative study utilized focus group discussions and semistructured interviews to explore the knowledge, attitudes, and preparedness of emergency department nurses and MOs toward potential bioterrorist attacks in Ghana. Data were subjected to a qualitative content analysis in which three main thematic categories were developed. These thematic categories are as follows: (a) differences in bioterrorism knowledge between emergency department nurses and emergency department MOs, (b) unprepared emergency department nurses and MOs for care during bioterrorism attacks, and (c) positive attitudes of emergency department nurses and MOs toward bioterrorism preparedness. Although emergency MOs had better knowledge of bioterrorism than their nursing counterparts, both groups of health professionals were unprepared to respond to any form of bioterrorism. Both nurses and MOs indicated the need for staff education and infrastructure readiness to be able to respond effectively to a bioterrorist attack. A well-prepared emergency department and health professionals against bioterrorism could prevent high casualty rates in a bioterrorist attack and also serve a dual purpose of dealing with other natural disasters when they occur.

Assessing Community Reactions to Ebola Virus Disease and Other Disasters: Using Social Psychological Research to Enhance Public Health and Disaster Communications

Drawing on the lessons learned from previous disaster and disease outbreak studies over the past two decades, in the following article we review research related to social psychological assessment of community attitudes, knowledge, and beliefs associated with the recent Ebola outbreak and other public health threats, and discuss the use of this information to assist in future disaster planning and crisis communications. Psychologists, physicians, and others in the healthcare field need to be aware of these developments and involved with preparations related to mitigating the psychological impact of Ebola disease outbreaks among different populations, as well as other potential public health threats in the future.

Disaster Medicine and Public Health Preparedness of Health Professions Students: A Multidisciplinary Assessment of Knowledge, Confidence, and Attitudes

Objective

This study assessed disaster medicine knowledge and competence and perceived self-efficacy and motivation for disaster response among medical, nursing, and dental students.

Methods

Survey methodology was used to evaluate knowledge, comfort, perceived competency, and motivation. Also, a nonresponder survey was used to control for responder bias.

Results

A total of 136 responses were received across all 3 schools. A nonresponder survey showed no statistical differences with regard to age, gender, previous presence at a disaster, and previous emergency response training. In spite of good performance on many knowledge items, respondent confidence was low in knowledge and in comfort to perform in disaster situations. Knowledge was strong in areas of infection control, decontamination, and biological and chemical terrorism but weak in areas of general emergency management, role of government agencies, and radiologic events. Variations in knowledge among the different health professions were slight, but overall the students believed that they required additional education. Finally, students were motivated not only to acquire more knowledge but to respond to disaster situations.

Conclusions

Health care students must be adequately educated to assume roles in disasters that are a required part of their professions. This education also is necessary for further disaster medicine education in either postgraduate or occupational education. As students’ performance on knowledge items was better than their perceived knowledge, it appears that a majority of this education can be achieved with the use of existing curricula, with minor modification, and the addition of a few focused subjects, which may be delivered through novel educational approaches. (Disaster Med Public Health Preparedness. 2013;7:499-506)

Bioterrorism education effect on knowledge and attitudes of nurses

Context:

The most important way against bioterrorism is reinforcement of knowledge of health and medical team to diagnose and rapid reaction during these events.

Aims:

To assess the effect of bioterrorism education on knowledge and attitudes of nurses.

Settings and Design:

the setting of study was one of the infectious disease wards, emergency rooms or internal wards of the hospitals under supervision of Mazandaran University of Medical Sciences.

Materials and Methods:

In this pre-experimental study, 65 nurses who had all inclusion criteria are selected by accessible sampling method. Data on nurses knowledge and attitudes toward bioterrorism were collected using a self-administered questionnaire before and after two two-h sessions education. After a month of education, the units responded to questionnaire again.

Statistical Analysis Used:

A descriptive statistics Wilcoxon tests and Spearman correlation coefficient were used.

Results:

Before education, the majority of units (96.9%) had low knowledge about bioterrorism (0-33.3% score of 100%),whereas after education, the majority of them (100%) had good knowledge(well done) (66.7-100% score of 100%). And majority of units (96.9%) before education had indifferent attitude toward bioterrorism (33.4-66.6% score of 100%), whereas a majority of them (98.5%) after education had positive attitude (66.7-100% score of 100%).

Conclusions:

The education has a positive effect on nurses’ knowledge and attitudes and it can be a guideline for administrators of the Ministry of Health and medicine for planning to achieve the goals of preventive and defense against bioterrorism.

Disaster preparedness: what training do our interns receive during medical school?

Disaster preparedness training is a critical component of medical student education. Despite recent natural and man-made disasters, there is no national consensus on a disaster preparedness curriculum. The authors designed a survey to assess prior disaster preparedness training among incoming interns at an academic teaching hospital. In 2010, the authors surveyed incoming interns (n = 130) regarding the number of hours of training in disaster preparedness received during medical school, including formal didactic sessions and simulation, and their level of self-perceived proficiency in disaster management. Survey respondents represented 42 medical schools located in 20 states. Results demonstrated that 47% of interns received formal training in disaster preparedness in medical school; 64% of these training programs included some type of simulation. There is a need to improve the level of disaster preparedness training in medical school. A national curriculum should be developed with aspects that promote knowledge retention.

Education of veterinary medical and other public health providers: linking interventions with health outcomes

A systematic literature review was performed to summarize the nature, implementation, outcomes, and long-term impacts of previously instituted interventions and programs aimed at educating veterinary public health providers. A logic model was developed to direct the literature search strategy, provide a framework for evaluating the relationship between veterinary public health professional education and their associated population health outcomes, and guide future training development and recommendations for the education of veterinary health professionals. Our literature review indicates that there is a relative lack of published literature that connects veterinary public health educational interventions to population health outcomes. Reasons for the lack of evidence to connect educational programs and population health outcomes include the evaluation of outcomes on a short-term rather than intermediate- or long-term basis, a lack of experimental studies, and infrequent grounding in population health or educational theory. Future intervention recommendations as suggested in the reviewed articles are also summarized.

Nurses' intentions to respond to bioterrorism and other infectious disease emergencies

Although nurses historically have responded to natural disasters, little is known about nurses' intentions to respond during bioterrorism and other infectious disease emergencies where they and their families may be at risk. To investigate that question, we surveyed nurses following their participation in a class on bioterrorism. Participants (N = 292) completed a Personal/Professional Profile (PPP), Test of Bioterrorism Knowledge (BT Knowledge), and an Intention to Respond (IR) instrument. IR was measured by participants' scores on their likelihood to care for patients (0 = extremely unlikely, 10 = extremely likely) for each of 10 infectious disease scenarios reflecting different infection risk. We calculated scores for each scenario, totaled them, and examined the total IR related to the participant's PPP and scores on BT Knowledge. Additionally, we examined participants' written comments explaining the reasons for their IR. Total IR scores ranged from 8-100 (mean and median of 70). The IR was higher in scenarios where the infection risk was lower. Overall IR scores were positively related to BT Knowledge and having had previous emergency and disaster experience. Those less likely to respond had dependent children and more years in nursing. Results indicate that nurses differentiated risks associated with different infectious disease situations and may decide to respond during a real emergency based on such information. Implications for nursing administrators and nursing educators are discussed.

Biologic and chemical terrorism in children: an assessment of residents' knowledge

This study was conducted to determine the baseline fund of knowledge of pediatric and emergency medicine residents at a single institution in the medical management of pediatric victims of biologic and chemical terrorism. A test covering essential content was developed and validated by experts. The test was given anonymously to volunteer pediatric and emergency medicine residents at a single institution. The test was readministered 5 months after a lecture on the content. The 34 pediatric residents and 15 emergency medicine residents scored a median of 65% and 73%, respectively (P = .03). Residents from both specialties combined scored a median of 70% correct versus those residents who did not attend the lecture. Pediatric and emergency medicine residents are significantly unprepared to manage pediatric victims of biologic and chemical terrorism. Education curriculums on this topic must be incorporated into these residencies. The traditional lecture format may not be the most effective technique.

Developing disaster preparedness competence: an experiential learning exercise for multiprofessional education

BACKGROUND

The hurricane disasters of 2005 and the threat of pandemic infectious diseases compel medical educators to develop emergency preparedness training for medical students and other health care professional students.

DESCRIPTION

This article describes an experiential exercise for learning a number of the general core competencies in the 2003 AAMC report titled "Training Future Physicians about Weapons of Mass Destruction." A modified tabletop exercise for medical and veterinary students, which was developed and implemented in 2005, is described. The exercise focused on Highly Pathogenic Avian Influenza (HPAI), an emerging infectious disease scenario that raised the possibility of biological attack. The students were assigned roles in small groups, such as community physicians, hospital personnel, public health officials, veterinarians, school nurses, and emergency managers. Fifteen faculty members were recruited from these various areas of expertise. Pre- and posttesting of medical students showed significant gains in knowledge. The authors describe the scenario, small-group role playing, study questions, injects, Web sites and readings, and evaluation tools.

CONCLUSIONS

This experiential exercise is an effective, inexpensive, and easily adapted tool for promoting multiple competencies in mass health emergency preparedness for a variety of health care students including medical, veterinary, public health, and nursing students.

Integrating Emerging Infections Education into Medical Education: An Innovative Approach

INTRODUCTION

All graduating physicians should be competent with the basic principles of contagious disease outbreak detection and management. In order to educate our students and residents on this important topic, we created a three-hour workshop that included a case-based simulation exercise, and we offered a two-week medical student course in Emerging Infections and Bioterrorism.

METHODS

Twenty-two emergency medicine residents and sixty-four senior medical students rotating in the emergency department of an urban university tertiary referral center participated in a three-hour workshop between July 2005 and April 2006. Pre- and post- workshop surveys given immediately before and immediately following each session were used to determine participant satisfaction and self-reported knowledge and confidence in outbreak response. In March 2006 we offered a medical student elective course in Emerging Infections and Bioterrorism. Thirteen fourth-year medical students from a variety of specialties attended the two-week course. The course focused on selected topics in emerging and re-emerging infections and addressed general principles of infection control and biological disaster planning for healthcare facilities. A survey was given to all graduating fourth-year medical students in 2005 and 2006, before and after creation of the didactic course, to evaluate their comfort and perceived knowledge of outbreak detection and containment.

RESULTS

Overall, both students who participated in the workshop and those who participated in the didactic course (with or without the workshop) showed improvement in self-reported knowledge of outbreak detection and management, although the effect was statistically significant only for those participating in the didactic course. Due to the small numbers of emergency medicine residents who completed the surveys, we cannot comment on the effectiveness of the resident workshop, although there was a trend toward improved self-reported knowledge after the workshop. Students pursuing internal medicine, pediatrics, emergency medicine, and ENT were most likely to report that outbreak education was very important. Nearly all participants felt outbreak preparedness was not covered in existing curricula, and 92% thought the workshop was beneficial.

CONCLUSIONS

Most participants felt that outbreak preparedness was not adequately addressed in their curricula and almost all wanted more instruction. In addition, the didactic course and workshop improved self-reported student knowledge of the basic principles of contagious disease outbreak detection and management. Based on the results of our study, we propose integration of a three-hour simulation-based workshop with other instructional endeavors in emerging infections and biopreparedness into medical education curricula. We recommend the offering of a more comprehensive course for those pursuing emergency medicine and the primary care specialties, as they will be the most likely to encounter an outbreak. A web-based course may be a desirable alternative for institutions that could not otherwise add this training to their curriculum due to logistical reasons or time constraints. Further research is needed to determine the feasibility and effectiveness of these educational strategies.

Preparedness needs assessment in a rural State: themes derived from public focus groups

Recent studies have assessed preparedness training and the resource needs of public health and clinical professionals in responding to a crisis, but few have assessed the needs of the general public, especially in rural areas. The present study, based in a risk assessment and information-seeking theoretical framework, assessed the preparedness awareness, knowledge, and attitudes of the general public in a rural state through a series of focus groups. Six focus groups were conducted with 34 participants in 4 locations in Kansas (2 urban and 2 rural). Focus group interviews followed a standardized script. Participants from all 4 locations reported training and knowledge needs and desired training, knowledge, and emergency preparedness plans. Certain groups also reported a lack of familiarity with preparedness terminology, as well as different ideas about trusted sources and agencies responsible for providing preparedness training or information. Some diverging opinions from these focus groups were stratified by urban/rural status, indicating possible implications for future all-hazards training in rural regions of the nation. These results may be used for planning and improving training for the general public in both urban and rural areas.

The role of internists during epidemics, outbreaks, and bioterrorist attacks

Internists are well-positioned to play significant roles in recognizing and responding to epidemics, outbreaks, and bioterrorist attacks. They see large numbers of patients with various health problems and may be the patients' only interaction with the medical community for symptoms resulting from infectious diseases and injuries from radiation, chemicals, and/or burns. Therefore, Internists must understand early warning signs of different bioterrorist and infectious agents, proper reporting channels and measures, various ways that they can assist the public health response, and roles of different local, state, and federal agencies. In addition, it is important to understand effects of a public health disaster on clinic operations and relevant legal consequences.

A short medical school course on responding to bioterrorism and other disasters

The events of 9/11 highlighted the limitations of the United States health care system in responding to large-scale public health emergencies. The key for an effective response to any mass casualty event is preparedness; thus, the education of medical students has become a priority. The Association of American Medical Colleges (AAMC) recommended that the nation's medical schools should thoroughly educate students about the public health and emergency services systems to ensure coordinated responses to weapons of mass destruction or other public health threats. In response, The Texas A&M University System Health Science Center College of Medicine, partnering with the Defense Institute for Medical Operations (DIMO), developed a one-week block of required (but not graded) instruction, the "Leadership Course in Disaster Response," first given in 2003-04 to 72 second-year students and taught by six military experts from DIMO. The course goal is to (1) educate students on resources available for regional disaster response; (2) define principles of resource management in disaster response; (3) identify specific agents associated with bioterrorism; and (4) understand the psychosocial aspects of disasters. The course was well received, and the 2004-05 session was improved, based on student and faculty feedback. The authors describe the details of the course (specifically, how the course was tailored to fit the AAMC guidelines), changes in students' knowledge and attitudes, and how the course was improved.

Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.