National Health Security Strategy Research Articles

US national health security strategy

The role and importance of US health security as one of the major national security priorities is outlined. The US National Security Strategic Objectives for building community resilience and strengthening and maintaining disaster response systems are discussed. Priorities have been identified to promote social cohesion, improve the coordination of health and human services, and build a culture of resilience by promoting physical, behavioral and social health. In order to successfully prevent and mitigate emerging threats, active and timely awareness in any situation of early detection and better use of resources is of particular importance.

Exploring National Nursing Readiness for a Radiological or Nuclear Incident: A Cross-Sectional Study

IntroductionAs the largest component of the United States health care workforce, nurses will play a critical role in radiological or nuclear disaster medical response. Despite this, the United States’ schools of nursing are not currently providing radiation content (75% teach zero or <1 hour), and much of the current nursing workforce may not have received adequate response education and training. Nurses working in emergency departments and those who work at hospitals within the Radiation Injury Treatment Network will be relied on heavily, but little is known about whether these nurses possess the knowledge and skills needed to care for and protect patients after a radiation emergency. Current federal and state radiological/nuclear preparedness plans may be built on false assumptions of readiness, which would have serious implications for national preparedness and the National Health Security Strategy. The purpose of this study was to assess nurses' knowledge and skill in emergency radiological or nuclear response and determine their willingness to use mobile technology for education and training in response to a large-scale radiation event. MethodsDescriptive cross-sectional survey of registered nurse members of the Emergency Nurses Association and/or those employed at Radiation Injury Treatment Network centers. ResultsKnowledge scores were low for all respondents. Prior attendance at a Radiation Emergency Medical Management course, use of online resources, and having a preparedness plan were associated with higher scores. Experience with a radiation emergency was associated with the highest score. Nurses are willing to use mobile technology during a radiological or nuclear disaster response. DiscussionKey nurses may not possess adequate knowledge or clinical competence to participate in radiation response activities. The results of this assessment identified educational gaps and areas to strengthen nursing education and clinical skills.

Preparedness and Community Resilience in Disaster-Prone Areas: Cross-Sectoral Collaborations in South Louisiana, 2018.

Objectives. To determine how community-based organizations (CBOs) define priorities for bolstering community resilience, challenges in addressing these priorities, and strategies to address challenges.Methods. The Community Resilience Learning Collaborative and Research Network (C-LEARN) is a multiphase study examining opportunities to improve community resilience to the threats of disaster and climate change in South Louisiana. Phase I of C-LEARN involved using the National Health Security Strategy and Implementation Plan for directed content analysis of key informant interviews with CBO representatives from 47 agencies within South Louisiana between February and May 2018.Results. CBO interviewees highlighted the importance of forging relationships and building trust through diverse cross-sector collaborations and partnerships before disasters. Such collaborations and partnerships were shown to tailor disaster response to the needs of particular communities and populations as well as address key challenges such as gaps in information, services, and resources.Conclusions. Our results encourage a culture of community resilience and community preparedness through partnerships and community-engaged strategies. C-LEARN will utilize the results of our interviews in the design of phase II of our agency-level coalition-building intervention.

National Assessment of Nursing Schools and Nurse Educators Readiness for Radiation Emergencies and Nuclear Events.

Nurses will play a crucial role in responding to a public health emergency resulting from nuclear war or other large-scale release of radiation into the environment and in supporting the National Health Security Strategy. Schools of nursing are ultimately responsible for developing a competent nursing workforce prepared to assess a population's public health emergency needs and respond to these low-frequency but high-impact events. This responsibility includes the provision of specific content and training regarding how to respond and care for patients and communities in the event of a nuclear or radiation emergency. To date, however, there has been a lack of empirical evidence focusing specifically on nursing schools' capacity to prepare nurses for radiation emergencies and nuclear events, as well as perception of risk. This study employed a cross-sectional survey administered to a nationwide sample of nursing school administrators and faculty to assess content, faculty expertise, planning, and perception of risk related to radiation emergencies and nuclear events.

How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project.

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions’ strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.

Society for the Advancement of Disaster Nursing: Exploring the Path to Excellence.

Major disasters occurring within the Unites States require nursing participation as a component of a successful response. Disaster nursing includes the care of populations affected by disasters, public health emergencies, and mass casualty events, both natural and man-made. A unique knowledge base, abilities, and skills are needed to respond appropriately to health care and human service needs resulting from these events. Despite prior efforts to advance disaster nursing as a specialty, none were sustainable and a professional framework for establishing standards and guidelines remains lacking. Disaster nursing is a complex arena where the intersection of competence, scope of practice, regulation, and clinical guidelines continues to evolve. Professional credibility and our contribution to disaster response lie in our ability to articulate and advance professionalism. Disaster nursing as a specialty practice requires a similar foundational framework to nursing specialties recognized by the American Nurses Association within a model of professional practice in order to ensure population outcomes that are reflective of safe, quality, evidence-based practice. It is time to define a disaster nursing scope of practice, establish standards for care, identify best practices, and pursue the establishment of an independent professional organization within the field of disaster nursing. This will establish the necessary foundation for optimizing nursing's contribution to and support of the National Health Security Strategy. (Disaster Med Public Health Preparedness. 2017;11:641-646).

The National Health Security Strategy and Implementation Plan: An Overview

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Synopsis of a Public Health Emergency Preparedness Critical Incident Registry

As called for in the National Health Security Strategy, health departments currently use a number of "after action report" formats to collect data from actual public health emergency responses. The 2009 H1N1 pandemic revealed significant weaknesses in the use of these approaches, especially the absence both of reflective root-cause analyses and of a framework to describe performance in terms of public health emergency preparedness capabilities. To address these deficiencies and to develop an effective approach to learning from actual public health emergencies, we sought to understand how the concept and operations of a "critical incident registry," common in health care and other industries, could be adapted to meet the National Health Security Strategy objectives.

Measuring and Assessing Public Health Emergency Preparedness

The National Health Security Strategy calls for a systematic quality improvement efforts to improving health security. In addition, since 2001, billions of dollars have been spent on public health emergency preparedness at the federal, state, and local levels. Policy makers must now ask has this investment been effective, and in what way to measure this investment. Whether the goal is to ensure accountability to policy makers or to facilitate quality improvement, valid and reliable measures of preparedness are needed. Measuring and assessing the state of the nation's preparedness, however, are challenging. This article explores the current measurement climate and potential for improvement.

Building Community Resilience: What Can the United States Learn From Experiences in Other Countries?

Community resilience (CR) is emerging as a major public policy priority within disaster management and is one of two key pillars of the December 2009 US National Health Security Strategy. However, there is no clear agreement on what key elements constitute CR. We examined exemplary practices from international disaster management to validate the elements of CR, as suggested by Homeland Security Presidential Directive 21 (HSPD-21), to potentially identify new elements and to identify practices that could be emulated or adapted to help build CR. We extracted detailed information relevant to CR from unpublished case studies we had developed previously, describing exemplary practices from international natural disasters occurring between 1985 and 2005. We then mapped specific practices against the five elements of CR suggested by HSPD-21. We identified 49 relevant exemplary practices from 11 natural disasters in 10 countries (earthquakes in Mexico, India, and Iran; volcanic eruption in Philippines; hurricanes in Honduras and Cuba; floods in Bangladesh, Vietnam, and Mozambique; tsunami in Indian Ocean countries; and typhoon in Vietnam). Of these, 35 mapped well against the five elements of CR: community education, community empowerment, practice, social networks, and familiarity with local services; 15 additional practices were related to physical security and economic security. The five HSPD-21 CR elements and two additional ones we identified were closely related to one another; social networks were especially important to CR. While each disaster is unique, the elements of CR appear to be broadly applicable across countries and disaster settings. Our descriptive study provides retrospective empirical evidence that helps validate, and adds to, the elements of CR suggested by HSPD-21. It also generates hypotheses about factors contributing to CR that can be tested in future analytic or experimental research.

The Common Ground Preparedness Framework: A Comprehensive Description of Public Health Emergency Preparedness

Currently, public health emergency preparedness (PHEP) is not well defined. Discussions about public health preparedness often make little progress, for lack of a shared understanding of the topic. We present a concise yet comprehensive framework describing PHEP activities. The framework, which was refined for 3 years by state and local health departments, uses terms easily recognized by the public health workforce within an information flow consistent with the National Incident Management System. To assess the framework's completeness, strengths, and weaknesses, we compare it to 4 other frameworks: the RAND Corporation's PREPARE Pandemic Influenza Quality Improvement Toolkit, the National Response Framework's Public Health and Medical Services Functional Areas, the National Health Security Strategy Capabilities List, and the Centers for Disease Control and Prevention's PHEP Capabilities.

H1N1 Influenza, Public Health Preparedness, and Health Care Reform

In December 2009, the Department of Health and Human Services will present to Congress its first-ever national health security strategy. Dr. Nicole Lurie writes that national health security will not be achievable without key elements of reform.