Preparedness for anthrax attack: the effect of knowledge on the willingness to treat patients

Knowledge, attitudes, and practices associated with bioterrorism preparedness in healthcare workers: a systematic review

Introduction

Bioterrorism is an important issue in the field of biosecurity, and effectively dealing with bioterrorism has become an urgent task worldwide. Healthcare workers are considered bioterrorism first responders, who shoulder essential responsibilities and must be equipped to deal with bioterrorism. This study aims to extract and summarize the main research components of the bioterrorism knowledge, attitude, and practice dimensions among healthcare workers.

Method

This study utilized a systematic review research design based on the PRISMA 2020 guidelines. A literature search was conducted in the PubMed, Web of Science, and Scopus databases for peer-reviewed literature, and the Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of the literature.

Result

A total of 16 studies were included in the final selection. Through the analysis and summary of the included studies, three main aspects and 14 subaspects of the knowledge dimension, three main aspects and 10 subaspects of the attitude dimension, and two main aspects and six subaspects of the practice dimension were extracted.

Conclusion

This study conducted a literature review on bioterrorism knowledge, attitudes, and practices for healthcare workers based on the PRISMA 2020 guidelines. The findings can guide improvements in health literacy and provide beneficial information to professional organizations that need to respond effectively to bioterrorism.

Risk Factors for Death or Meningitis in Adults Hospitalized for Cutaneous Anthrax, 1950-2018: A Systematic Review

BACKGROUND

Cutaneous anthrax accounts for approximately 95% of anthrax cases worldwide. About 24% of untreated patients die, and many cases are complicated by meningitis. Here, we explore clinical features of cutaneous disease associated with poor outcomes.

METHODS

A systematic review identified 303 full-text articles published from 1950 through 2018 that met predefined inclusion criteria. Cases were abstracted, and descriptive analyses and univariate logistic regression were conducted to identify prognostic indicators for cutaneous anthrax.

RESULTS

Of 182 included patients, 47 (25.8%) died. Previously reported independent predictors for death or meningitis that we confirmed included fever or chills; nausea or vomiting; headache; severe headache; nonheadache, nonmeningeal signs; leukocytosis; and bacteremia. Newly identified predictors included anxiety, abdominal pain, diastolic hypotension, skin trauma, thoracic edema, malignant pustule edema, lymphadenopathy, and evidence of coagulopathy (all with P < .05).

CONCLUSIONS

We identified patient presentations not previously associated with poor outcomes.

'Senior Nursing Students and Interns' Concerns and Willingness to Treat Patients with COVID-19: A Strategy to Expand National Nursing Workforce during the COVID-19 Pandemic

Background

The coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.

Objective

This study aimed to measure senior nursing students and intern's willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.

Methods

This quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants' willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.

Results

Out of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants' feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).

Conclusion/Recommendation

There is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

Healthcare workers' willingness to respond following a disaster: a novel statistical approach toward data analysis

BACKGROUND

The willingness of healthcare workers (HCW) to respond is an important factor in the health system's response capacity during emergencies. Although much research has been devoted to exploring this issue, the statistical methods employed have been predominantly traditional and have not enabled in-depth analysis focused on absenteeism-prone employees during emergencies. The present study employs an innovative statistical approach for modeling HCWs' willingness to respond (WTR) following an earthquake.

METHODS

A validated questionnaire measuring knowledge, perceptions, and attitudes toward an earthquake scenario was distributed among Israeli HCWs in a hospital setting. Two regression models were employed for data analysis - a traditional linear model, and a quantile regression model that makes it possible to examine associations between explanatory variables across different levels of a dependent variable. A supplementary analysis was performed for selected variables using broken line spline regression.

RESULTS

Females under the age of forty, and nurses were the most absenteeism-prone sub-groups of employees (showed low WTR) in earthquake events. Professional commitment to care and perception of efficacy were the most powerful predictors associated with WTR across all quantiles. Both marital status (married) and concern for family wellbeing, designated as statistically significant in the linear model, were found to be statistically significant in only one of the WTR quantiles (the former in Q10 and the latter in Q50). Gender and number of children, which were not significantly associated with WTR in the linear model, were found to be statistically significant in the 25th quantile of WTR.

CONCLUSIONS

This study contributes to both methodological and practical aspects. Quantile regression provides a more comprehensive view of associations between variables than is afforded by linear regression alone. Adopting an advanced statistical approach in WTR modeling can facilitate effective implementation of research findings in the field.

Ebola crisis response in the USA: Communication management and SOPs

This research focuses on the 2014 Ebola crisis response by emergency managers in the Dallas-Fort Worth (DFW) Metropolitan region in the State of Texas, U.S.A. It examines the patterns of crisis communication and the use of Standard Operating Procedures (SOPs) during the first month of the crisis. Primary data collected from 24 face-to-face interviews and 12 online surveys are analyzed. The research identifies elements contributing to organizational failures, which by their very nature gain public and media attention, and also explicates the less mentioned successful decisions made by response agencies in the DFW region. It is important to investigate both failures and successes to help inform organizational learning for better preparedness to future health crises. Findings suggest that, although there was a breakdown in communication between small city governments/ municipalities and higher levels of government at the State and Federal levels, prior training and collaborative relationships helped in improvised decision-making. Takeaways for practitioners include reiterating the importance of establishing SOPs, merits of flexibility, and improvisational decisions for shared learning.

Willingness of Firefighting Program Students to Work in Disasters—Turkey

Introduction

Firefighting is an important profession during disasters. Firefighters are on duty for many vital functions, including fire extinguishing, search and rescue work, and evacuation of disaster victims to a safe zone. In case of a disaster situation, it is vital to have willing personnel to work in disasters. In the literature, type of disaster, individual demographic factors, family factors, and workplace factors have been identified as factors that influence health care personnel’s willingness to work during a disaster. However, little is known about firefighters and firefighter candidates’ willingness to work in a disaster.

Hypothesis/Problem

This study was aimed to identify the willingness of civil defense and firefighting program students to work in different disasters after graduation and the factors associated with their willingness.

Methods

The universe of this descriptive, epidemiological study was 1,116 students of civil defense and firefighting programs in Turkey. They were from 11 different universities. In the research study, a sample was not chosen as it was aimed at reaching the whole universe. A standardized survey form of 58 questions, prepared by researchers, was used to gather data.

Results

The rate of participation was 65.5%. Of the students, 82.8% said that after graduation they would like to work in disasters, whereas 16.2% were indecisive. The students were less willing to work in nuclear accidents (42.4%) and epidemic disasters (32.1%). In chi-square analysis, “willingness of students to work in disasters after graduation” (dependent variable) and the independent variables: “university of student,” “exercising regularly,” “having a hobby related to disaster,” “having been educated about disaster,” and “being satisfied from the received education” were found statistically significant. When students’ willingness to work in disasters after graduation (ref=unwilling) was analyzed with multi-variate analysis, only “university of students” and “having a hobby related to disasters” were found statistically significant.

Conclusion

Overall, 16.2% of the students stated that they were indecisive to work in disasters in the future, and 1.0% of them stated that they did not want to work in disasters. Moreover, willingness of students to work in nuclear accident and contagious disease disasters has been found to be lower compared to other disaster types.

KayaE, AltintasH. Willingness of firefighting program students to work in disasters—Turkey. Prehosp Disaster Med. 2018;33(1):13–22.

Health Care Student Knowledge and Willingness to Work in Infectious Disease Outbreaks

OBJECTIVE

Health care workers are critical first responders. Understanding which factors motivate their willingness to work (WTW) during infectious disease outbreaks may guide improvements in preparedness. The perspective of health care students, the future workforce, remains largely unexplored. This study compared factors influencing WTW among medical, nursing, and pharmacy students.

METHODS

A printed survey was administered to 631 medical, nursing, and pharmacy students. The questionnaire elicited information regarding prior disaster training, disease-related knowledge, and WTW in the setting of infectious diseases with contact or respiratory transmission.

RESULTS

Analyses of the 579 respondents (92% response rate) demonstrated that students were less fearful for their health and more willing to work during outbreaks with contact transmission than during those with respiratory transmission. Medical students were the most fearful for their health, but they demonstrated the greatest WTW, followed by nursing students, and then pharmacy students. Medical students were also the most knowledgeable about infectious diseases. Prior disaster training was associated with greater WTW.

CONCLUSIONS

Extent of disease-related knowledge and prior disaster training appear to influence WTW. Our findings, taken in the context of a remarkable underemphasis on disaster preparedness in health care curricula, call for a broader incorporation of disaster training to improve the WTW of health care students, and, ultimately, health care workers. (Disaster Med Public Health Preparedness. 2017;11:694-700).

Survey of Nursing Students' Self-Reported Knowledge of Ebola Virus Disease, Willingness to Treat, and Perceptions of their Duty to Treat

The purpose of this study was to explore nursing students' self-reported knowledge of Ebola Virus Disease (EVD), willingness to treat patients with EVD, and student perceptions of duty to treat patients with EVD. The researchers developed the Survey of Nursing Student Self-Reported Knowledge of EVD, Willingness to Treat, and Perceptions of Duty to Treat, a quantitative tool with open-ended questions to inform the responses. On-line survey software was used for gathering anonymous data. A mixture of descriptive, nonparametric, and parametric statistics were used to describe, compare, and examine relationships between variables. Results demonstrated that licensed students scored significantly higher on self-reported knowledge of EVD than their prelicensure student counterparts (P=.039). Licensed students and prelicensure students did not differ on self-assessed willingness to treat (P>.05). The students had significantly higher willingness-to-treat scores when self-reported knowledge scores were higher (P=.007) and when they were older (P=.004). Willingness to treat was not influenced by whether one was partnered or single (P>.05) or had children or did not have children (P>.05). In conclusion, basic EVD knowledge and training appears to be critical to ensure willingness to treat. However, it is imperative that students have an indepth understanding of the principles of infectious diseases in general.

Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review

Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.

Reporting for duty during mass casualty events: a survey of factors influencing emergency medicine physicians

BACKGROUND

Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking.

OBJECTIVE

We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation.

METHODS

We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010.

RESULTS

A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario.

CONCLUSIONS

Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended.

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.

Who is willing to risk his life for a patient with a potentially fatal, communicable disease during the peak of A/H1N1 pandemic in Israel?

Background:

The willingness of healthcare workers to risk their lives for a patient with a potentially fatal, communicable disease is a major concern, especially during a pandemic where the need for adequate staffing is crucial and where the public atmosphere might enhance anxiety and fear of exposure.

Objective:

To examine the relationships between the willingness of healthcare workers to risk their lives for a patient with a potentially fatal A/H1N1 flu, and knowledge of personal protection against infection, and trust in colleagues, workplace preparedness and the effectiveness of safety measures, during the winter A/H1N1 pandemic in Israel.

Materials and Methods:

A questionnaire was distributed to healthcare workers in 21 hospitals in Israel between 26 November 2009 and 10 December 2009 (the peak of the winter A/H1N1 flu outbreak). The questionnaire was completed by 1147 healthcare workers.

Results:

Willingness to risk one's life for a patient was significantly lower in females, respondents of younger age (18–24 years), administrative staff, and those with a non-academic education, as well as among those with a less knowledge about safety measures and among those with less trust in colleagues, in work place preparedness, and in the effectiveness of safety measures.

Conclusions:

Willingness to risk one's life for a patient is related to knowledge of safety measures, and trust in colleagues and work place preparedness. Education programs to enhance trust in colleagues, improve work place preparedness, and safety measures are recommended, especially for healthcare workers who are young, inexperienced, female, or administrative staff.