Beyond Disaster Preparedness: Building a Resilience-Oriented Workforce for the Future

Global consensus statement on simulation-based practice in healthcare

ABSTRACT

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

KEY RECOMMENDATIONS

Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.

CALL FOR ACTION

We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy

BACKGROUND

Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not.

SCOPE AND FINDINGS

We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths.

CONCLUSIONS

Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes.

Jordanian Nurses' Perceptions of Disaster Preparedness and Core Competencies

OBJECTIVE

This study aims to identify the Jordanian nurses' perception of their disaster preparedness and core competencies.

METHODS

A descriptive, cross-sectional research design was used. The data was collected via an online self-reported questionnaire using the disaster preparedness evaluation tool and the core disaster competencies tool.

RESULTS

A total of 126 nurses participated in the study. Jordanian nurses had moderate to high levels of core disaster competencies and moderate levels of disaster preparedness. Core disaster competencies and disaster preparedness levels differed based on previous training on disaster preparedness, and the availability of an established emergency plan in their hospitals. Lastly, a previous training on disaster preparedness and core disaster competencies were statistically significant predictors of disaster preparedness among Jordanian nurses.

CONCLUSIONS

Organizational factors and environmental contexts play a role in the development of such capabilities. Future research should focus on understanding the barriers and facilitators of developing core disaster competencies and disaster preparedness among nurses.

Healthcare and successive natural disasters: Lessons still to be learned

This article explores the increasing impact of natural disasters on healthcare leadership and disaster preparedness, particularly in Fort McMurray, Alberta. It underscores the importance of building disaster resilience in healthcare, distinguishing between emergencies, disasters, and catastrophes, and advocating for a multi-dimensional resilience approach. The need for robust electronic communication channels and comprehensive family-oriented evacuation plans, considering family and pet safety, is emphasized. The protection of vulnerable patients, the importance of resilient healthcare infrastructure, and dedicated protective equipment for first responders are also discussed. The article highlights the critical role of government support in flood prevention and disaster preparedness. Through the experiences of Fort McMurray, the article demonstrates the necessity of comprehensive disaster planning and the crucial role of healthcare systems in rapid recovery and adaptation in the face of disasters. It aims to contribute to an improved understanding and strategies for managing such critical situations in the future.

Developing hospital resilience domains in facing disruption era in Indonesia: a qualitative study

BACKGROUND

The studies of hospital resilience have been of increasing importance during the last decade due to disasters and pandemics. However, studies in developing the domain and indicators of hospital resilience were limited mainly on disaster response. A few studies of hospital resilience focused on how to deal with disruptions such as environmental turbulence, rapid technological changes, and changes in patient preferences. This study aims to develop domains and indicators of hospital resilience in facing the disruption era.

METHODS

This qualitative study focused on exploring the domains and indicators to face disruptions that have been identified in the first exploratory phase of the studies. Key informants included hospital experts from the government, medical practitioners, and academics. A total of 20 key informants were involved in semi-structured interviews which were conducted face-to-face, via telephone and Zoom. Data was analyzed using a grounded theory approach to discover domains for a resilient hospital.

RESULTS

The study identified a number of domains that are fundamental for a hospital to become a resilient in the face of disruption. These include readiness to face digital transformation, effective leadership, and flexibility in managing resources among others. Situation awareness and resilience ethos, implementation of marketing management, networking, and disaster anticipation are found to be equally important. These domains focused on the hospital's ability to deal with specific shocks from different perspectives as the result of changes from disruptions which are inevitable within the organizational business environment.

CONCLUSIONS

The domains identified in the study are able to respond to the limitations of the concept of hospital resilience, which is currently more focused on hospital disaster resilience. They can be used to measure hospital resilience in the context of the volatility, uncertainty, complexity, and ambiguity (VUCA), which are relevant to the context of the Indonesia hospital industry.

Humanitarian sector (international non-governmental organisations) support to the community in Goma city/DRC during the COVID-19 pandemic period: Expectations and reality

COVID-19 was the largest public health emergency to disrupt social life and health systems worldwide. The pandemic affected all world continents creating fear and stress in many aspects of social life. The pandemic spread from China to Europe, then to Africa carrying with it all the negative impacts affecting population wellbeing. The COVID-19 pandemic was declared in the Democratic Republic of Congo (DRC) in March 2020 and created huge shock and stress countrywide. Goma city accommodates more than 30 international non-governmental humanitarian organisations (HO) who have sought to support local communities to help them overcome COVID-19 stress. Few studies to date have considered the role of these HO from the perspective of the beneficiary populations. This is a descriptive, analytical study, reporting data collected from a survey questionnaire to 100 community members (including 21 healthcare professionals) in Karisimbi health zone in Goma city in DRC. The study's main aim was to explore how community members viewed the contribution and impact of HO actions during COVID-19 in Goma city. We identified some important mis-matches between community expectations and HO actions which must be addressed in future outbreaks. First, community members had big expectations of HO in terms of practice support to tackle the pandemic (including providing handwashing devices and mobile support teams), yet the vast majority of respondents reported seeing little or no such actions. This can create resentment against HO and it is critically important that they rapidly engage with communities at the start of any outbreak to understand their needs and concerns and develop strategies to directly respond to these. Second, HO played a very limited role in dissemination of information about COVID-19 and were not trusted messengers. Our findings showed that most people's preferred source of information about COVID-19, specifically vaccines, was local healthcare workers-particularly those who were known well and therefore trusted. HO (and national responders) should therefore map trusted spokespersons (including healthcare professionals) in the targeted communities and involve them in the planning and implementation of interventions as essential steps in the response. Among our respondents, social media played a large role in information sharing. Further research is needed to understand the role that social media (particularly Facebook and WhatsApp which were most frequently used) could play in sharing messages from trusted sources, including official government communications. Collectively, these actions could help create a positive attitude towards COVID-19 vaccine and similar interventions in future outbreaks.

The Effects of Disaster Nursing Education Program on Beliefs in General Disaster Preparedness, Disaster Response Self-Efficacy, and Psychological Resilience in Nursing Students: A Single-Blind, Randomized Controlled Study

AIM

This study was conducted to evaluate the effects of a disaster nursing and management education program on beliefs in general disaster preparedness, disaster response self-efficacy, and psychological resilience in nursing students.

METHOD

The sample consisted of nursing students receiving undergraduate education in Istanbul, Turkey. Participants were randomly divided into the intervention ( n = 65) and control ( n = 66) groups. The intervention group was given an eight-module education program with theoretical and applied components. Data were collected using the Belief in General Disaster Preparedness Scale, the Disaster Response Self-Efficacy Scale, and the Brief Resilience Scale.

RESULTS

The mean Belief in General Disaster Preparedness Scale, Disaster Response Self-Efficacy Scale, and Brief Resilience Scale scores of the intervention group were higher than those of the control group.

CONCLUSION

The disaster nursing and management education program provided to nursing students was determined to increase beliefs in general disaster preparedness, disaster response self-efficacy, and psychological resilience.

Impact of workplace displacement during a natural disaster on computer performance metrics: A 2-year interrupted time series analysis

BACKGROUND:

Remote working may enhance company resiliency during natural disasters and other events causing workplace displacement.

OBJECTIVE:

We conducted an interrupted time series analysis to investigate the impact of Hurricane Harvey on employee computer use during and after a seven-month displacement period from the physical workplace.

METHODS:

Ergonomic software was used to collect information on employees’ computer usage.

RESULTS:

Although there was no change in total computer use in response to the hurricane (β 0.25), active computer use significantly declined (β –0.90). All measured computer use behaviors returned to baseline prior to the complete return to the physical workspace.

CONCLUSION:

Despite a transient period of reduced activity during closure of the workplace building, productivity returned to normal prior to the employees’ return to a commercial workspace. The ability to work remotely may improve resiliency of employees to perform workplace tasks during events causing workplace displacement.

Social and psychological resources moderate the relation between anxiety, fatigue, compliance and turnover intention during the COVID-19 pandemic

Purpose

The workplace health management lessons to be learned from the pandemic are important. However, few studies have examined the relationship between workplace anxiety, resources and behaviors during the pandemic. Therefore, this paper aims to investigate the relationship between anxiety, fatigue, compliance, turnover intention and social and psychological resources during the COVID-19 pandemic by applying the conservation of resources (COR) theory.

Design/methodology/approach

Path analysis was carried out using data obtained from a questionnaire survey conducted on 2,973 Chinese employees of Japanese companies in China.

Findings

The analysis showed that anxiety had a positive correlation with compliance, but simultaneously had a positive correlation with fatigue and turnover intention; psychological resources moderated to weaken the relationships between anxiety and compliance/fatigue; social resources moderated to strengthen the negative correlation between compliance and willingness to leave.

Research limitations/implications

This study targeted employees of Japanese companies in China. Therefore, in the future, it is necessary to verify generalizability as to whether it applies to employees of companies of other nationalities in other countries. Also, the authors used newly developed scales instead of the general psychological scales. Therefore, it is necessary to verify the reproducibility using a more general scale.

Practical implications

Anxiety encourages compliance practices but also increases fatigue and willingness to leave. Therefore, a method of inciting anxiety and making employees follow rules reduces the strength of an organization. To overcome this dilemma, managers need to provide psychological and social resources.

Originality/value

This study is the first to show how effective social and psychological resources are in the management of anxiety and fatigue in achieving high performance during the COVID-19 pandemic. This study was conducted in the very early days of the COVID-19 pandemic with the cooperation of employees working for Japanese companies in China. However, the importance of utilizing resources in a crisis revealed by this study can be applied to all kinds of disasters.

Highlights:

-The current study is the result of a survey conducted on employees of Japanese companies in China in the early days of the COVID-19 pandemic.

-Anxiety had a positive effect of promoting compliance and a negative effect of increasing fatigue and willingness to leave the job.

-Psychological resources mitigated these effects of anxiety and, as a result, reduced fatigue and willingness to leave.

-Social resources enhanced the effect of compliance on reducing willingness to leave.

-Workplace health problems caused by the COVID-19 pandemic should be addressed by increasing employee resources on a regular basis, rather than aggravating anxiety.

Health System Resiliency and the COVID-19 Pandemic: A Case Study of a New Nationwide Contingency Staffing Program

When COVID-19 emerged, the U.S. Veterans Health Administration (VA) was in the process of implementing a national contingency staffing program called Clinical Resource Hubs (CRHs). CRHs were intended to provide regional contingency staffing for primary and mental health clinics experiencing staffing shortages primarily through telehealth. Long-term plans (year 2) included emergency management support. Early in the implementation, we conducted semi-structured interviews with CRH directors and national program leaders (n = 26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. We found that the CRH program was flexible and nimble enough to allow VA to leverage providers at hubs to better respond to the demands of COVID-19. Actions taken at hubs to sustain patient access and staff resiliency during the pandemic included supporting call centers and training VA providers on virtual care delivery. Factors that facilitated CRH’s emergency response included hub staff expertise in telehealth and the increased acceptability of virtual care among key stakeholders. We conclude that hub providers serving as contingency staff, as well as specialization in delivering virtual outpatient and inpatient care, enabled VA health system resiliency and recovery during the COVID-19 pandemic.

Crisis Preparedness of Healthcare Manufacturing Firms during the COVID-19 Outbreak: Digitalization and Servitization

For healthcare manufacturing firms, creating a crisis-prepared product and service portfolio and operational processes is essential for their long-term prosperity. In this paper, we examine how healthcare manufacturing firms cope with the operational disruptions and opportunities associated with the COVID-19 pandemic. We highlight the central role of organizational resilience and examine whether servitization and digitalization can improve the organizational resilience of healthcare manufacturing firms. On the basis of the organizational information processing theory, we suggest that servitization and digitalization can improve the stability and flexibility of operations, which make healthcare manufacturing firms more resilient to the COVID-19 pandemic. The hypotheses were tested using survey data from 163 manufacturing firms located in China. The results indicate that both servitization and digitalization improve the organizational resilience of healthcare manufacturing firms, leading to higher firm growth during the COVID-19 pandemic. Moreover, organizational resilience mediates the impacts of servitization and digitalization on firm growth. Environmental dynamism strengthens the relationship between digitalization and organizational resilience. This study offers new insights for healthcare manufacturing firms to prepare for crisis events and achieve sustainable development in a highly competitive environment.

Incorporating Mental Health Research into Disaster Risk Reduction: An Online Training Module for the Hazards and Disaster Workforce

There is an expansive and growing body of literature that examines the mental health consequences of disasters and large-scale emergencies. There is a need, however, for more explicit incorporation of mental health research into disaster risk reduction practices. Training and education programs can serve as a bridge to connect academic mental health research and the work of disaster risk reduction practitioners. This article describes the development and evaluation of one such intervention, the CONVERGE Disaster Mental Health Training Module, which provides users from diverse academic and professional backgrounds with foundational knowledge on disaster mental health risk factors, mental health outcomes, and psychosocial well-being research. Moreover, the module helps bridge the gap between research and practice by describing methods used to study disaster mental health, showcasing examples of evidence-based programs and tools, and providing recommendations for future research. Since its initial release on 8 October 2019, 317 trainees from 12 countries have completed the Disaster Mental Health Training Module. All trainees completed a pre- and post-training questionnaire regarding their disaster mental health knowledge, skills, and attitudes. Wilcoxon Signed Rank tests demonstrated a significant increase in all three measures after completion of the training module. Students, emerging researchers or practitioners, and trainees with a high school/GED education level experienced the greatest benefit from the module, with Kruskal–Wallis results indicating significant differences in changes in knowledge and skills across the groups. This evaluation research highlights the effectiveness of the Disaster Mental Health Training Module in increasing knowledge, skills, and attitudes among trainees. This article concludes with a discussion of how this training can support workforce development and ultimately contribute to broader disaster risk reduction efforts.

Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review

The critical role of the health workforce in the function of the health care system is undeniable. In times of disaster and public health emergency, the importance of this valuable resource for the organization multiplies. This scoping review was conducted to identify, analyze, and categorize interventions to improve willingness to work in times of disaster as well as the existing knowledge gaps in the topic. For this purpose, four databases were searched. These included Scopus, PubMed, WOS, and World Health Organization observatory, and they were searched for papers published from July 2000 to September 2020. Studies of the English language that described strategies to improve human resources for health willingness to work during times of disaster/public health emergency were included. Full-text papers were screened by authors and data extraction was done according to self-designed form. Framework analysis identified key interventions based on human resources for health action framework. From 6246 search results, 52 articles were included, a great portion of which was published in 2020 probably due to the COVID-19 pandemic. Northern America was the region with most studies. From 52 included studies, 21 papers have reported the interventions to improve willingness to work and 31 papers have explored factors that affected a willingness to work. The interventions used in the studies were categorized into five themes as Leadership, Partnership, Financing, Education, and Organizational policies. The most and least interventions were financial and partnership respectively. The review identified a wide range of feasible strategies and interventions to improve human resources for health's willingness to work at times of disaster that are expected to be effective. Organizations should let the staff know these decisions and as a necessary step in every organizational intervention remember to evaluate the impacts.

Public Health Is Essential: COVID-19's Learnable Moment for Medical Education

The COVID-19 pandemic, an unprecedented challenge for this generation of physicians and for the health care system, has reawakened calls to strengthen the United States' public health systems. This global event is also a "learnable moment" for medical education-an opportunity to decisively incorporate public health, including public health systems, through the continuum of medical education. Although medical educators have made progress in integrating public health content into medical curricula, "public health" is not a phrase that is consistently used in curricular standards, and public health colleagues are not identified as unique and critical partners to improve and protect health. The COVID-19 crisis has demonstrated how a strong public health system is necessary to support the health of patients and populations, as well as the practice of medicine. Partnerships between medical and public health communities, through individual- and population-based interventions, can also more effectively combat more common threats to health, such as chronic diseases, health inequities, and substance abuse.To achieve a more effective medicine-public health relationship in practice, curricula across the continuum of medical education must include explanations of public health systems, the responsibilities of physicians to their local and state governmental public health agencies, and opportunities for collaboration. Medical education should also prepare physicians to advocate for public health policies, programs, and funding in order to improve and protect the health of their patients and communities. Pandemic COVID-19 demonstrates with laser focus that all physicians are part of public health systems and that public health content has a distinct and essential place across the continuum of medical education to prepare physicians to participate in, collaborate with, and advocate for public health systems.

Capacity of local authority and community on epidemic response in Vietnam: Implication for COVID-19 preparedness

Local authority's response and community adaptive capacity are critically important for the prevention and control of infectious diseases, especially for the disease with an astonishing speed of spreading like COVID-19. This study aims to examine the perception on the capability of local authority's response and community adaptation among core workforces in responding to acute events in Vietnam. Health professionals, medical students, and community workers in all regions of Vietnam were invited to participate in a web-based survey from December 2019 to February 2020. The snowball sampling technique was utilized to recruit respondents. The Tobit multivariable regression model was used to identify associated factors. The results showed that based on a 0-10 numeric rating scale, the mean scores of the capacity of local agencies and community adaptation were 6.2 ± 2 and 6.0 ± 1.8, respectively. Regarding local authority competencies, the lowest score went to "Adequate equipment, infrastructures and funding for disease prevention". For community adaptation, the respondents evaluated the capacity on "Periodic training, equipment and drills to prepare for epidemic and disaster response" competency" with the lowest mark (5.2 ± 2.5). Overall, there were significant differences in the assessment of community adaptive capacity between urban and rural areas (p < 0.01). This study indicated the moderate capacity of the local authority and community adaptation on epidemics and disasters in Vietnam. It is critically necessary to develop the action plan, response scenario and strategies to optimize the utilization of equipment and human resources in combating epidemics for each setting.

Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership

Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.

Conducting an Evaluation Framework for Disaster Management under Adaptive Organization Change in a School System

This long-term study established a sustainable and resilient framework for enhancing organizational capacity and adaptability, based on adaptive thinking, for a school disaster prevention system (SDPS) for academic institutions located in a potential natural disaster area. Due to the movement of continental plates and the effects of tropical depressions, disasters occur frequently in Taiwan. We established a conceptual framework under aspects of organizational resilience for a SDPS for school institutions located in a potential disaster area under a choice experiment (CE) framework. We then evaluated the heterogeneity of staff perspectives on an adaptive disaster-mitigation program, as revealed by their preferences and estimated the marginal effects associated with various potential scenarios for such a program. We found that integrating stakeholder concerns about environmental issues, cooperating with local government drills, providing training to be disaster relief volunteers and cooperating with local government to implement disaster-prevention and protection projects were all valid program characteristics. This study also confirmed the existence of heterogeneity in the preferences of participants for adaptive management in SDPS context, as evidenced by their willing attitudes toward participation in education and training courses, participation in implementing disaster prevention and protection projects and undergoing training to be disaster relief volunteers. Specifically, the potential disaster prevention transformation program embodying these features was associated with the highest marginal willingness to work (MWTW). These outcomes can assist in the development and implementation of evaluation frameworks for organization-based management strategies in the context of SDPS.

From Awareness to Action: Accounting for Infrastructure Interdependencies in Disaster Response and Recovery Planning

This paper highlights challenges and open questions pertaining to physical and social infrastructure system interdependencies and their implications for disaster response, recovery, and resilience planning efforts. We describe the importance of understanding interdependencies in disaster contexts and highlight limitations to existing approaches. Suggestions for understanding and addressing interdependencies focus on increasing availability of tools for assessing interdependencies and increasing stakeholder and decisionmaker uptake of infrastructure interdependency-related information in planning efforts.

Instilling Hope and Resiliency: A Narrative Photo-Taking Intervention During an Intercultural Exchange Involving 9/11 Survivors in Post 3/11 Japan

On March 11, 2011 ("3/11"), a magnitude 9.0 earthquake in Northeastern Japan triggered a tsunami and nuclear power plant meltdown that killed 16,000 people and displaced more than 470,000 people. Since 2012, a group of volunteer docents from the September 11th Families Association in New York City has traveled throughout Northeastern Japan and held organized meetings where 9/11 and 3/11 survivors share their experiences and stories of trauma as part of an intercultural exchange to promote posttraumatic recovery. We sought to elucidate whether participating 9/11 docents developed a sense of increased resiliency by participating in this international outreach. This study employed photo-taking as well as framing questions, which were developed by 9/11 docents from the August 2016 trip. These questions guided photo-taking and resulting photographs informed discussion in individual and group sharing sessions. This process helped identify codes that guided analysis. Participants acquired a deeper appreciation of their own ability to overcome adversity and experienced a gratifying desire to help 3/11 survivors better cope with their experiences. This narrative photo-taking and group sharing experience demonstrates that a cross-cultural exchange between survivors of different disasters can instill feelings of resilience among participants. It additionally provides early evidence of the efficacy of such an exchange in benefitting disaster survivors in the long term.

The pitfall of empathic concern with chronic fatigue after a disaster in young adults

BACKGROUND

Empathic concern (EC) is an important interpersonal resilience factor that represents positive adaptation, such as "relating to others" (a factor of posttraumatic growth [PTG]) after disaster. However, controversy exists regarding whether the changes in EC (e.g., the intra-personal change between the acute phase and the disillusionment phase) positively or negatively affect mental health after a disaster. We hypothesized that increased EC may increase chronic fatigue due to over-adjustment (hypothesis 1). We also hypothesized that increasing the changes in "relating to others" could decrease the changes in chronic fatigue (hypothesis 2).

METHODS

Forty-nine young, healthy volunteers (M/F: 36/13; age at 3 months after the disaster [3 months]: mean ± SD: 21.1 ± 1.7 years) underwent assessments of EC using the Japanese version of the Interpersonal Reactivity Index, chronic fatigue using the Japanese version of the Checklist Individual Strength (CIS-J) questionnaire, and "relating to others" using the Japanese version of the PTG inventory during the acute phase (3 months) and the disillusionment phase (1 year after the disaster). Pearson product moment correlations at 3 months and 1 year were determined for all scores related to EC. The changes (delta = degree of change from 3 months to 1 year) or scores at 1 year were entered into linear structural equation systems to test the hypotheses.

RESULTS

The delta of EC positively affected the delta of the CIS-J, and the delta of relating to others negatively affected the delta of the CIS-J. Both the EC and relating to others scores were negatively associated with the CIS-J score at 1 year. These results were in accordance with hypothesis 1 and 2.

CONCLUSIONS

We demonstrated the opposite effects of 2 types of ECs, i.e., stability (inherent disposition) and flexibility (degree of change), on the degree of chronic fatigue. Increasing EC with increasing chronic fatigue, but not the change in relating to others, may be a red flag for individuals during the disillusionment phase.