Running head: HEALTH PROJECT PAPER PART II 1

Health Project Paper Part II

Sammi Shepard

Jason Rowe

Megan Parrish

Jocelyn Alexander

Mamie Swift

Madeleine Hughes

Old Dominion University

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Health Project Paper Part II

Disaster preparedness is a vastly growing topic that every person, university, region and

nation should educate themselves on. It is imperative that individuals and organizations have a

plan if a disaster were to strike the community. In order to increase your chances of survival, one

must be fully educated on all aspects of disasters. Last semester, our community health group

decided to assess the Old Dominion University (ODU) population and discovered the lack of

knowledge related to disaster preparedness. Through utilization of an online survey, we were

able to discover that college students needed a quick and easy way to prepare themselves.

Therefore, this semester, we designed a website utilizing local resources to instill the necessary

knowledge in the minds of residents in the Hampton Roads region.

We expanded our aggregate from the ODU community to include Tidewater Community

College, Norfolk State University, Thomas Nelson Community College, Hampton University,

Norfolk Drug Court, and the elderly population at the Art of Healthy Aging Convention.

Although we were able to reach out to a variety of organizations and universities, it was our goal

to educate many more individuals and groups in the Hampton Roads area. Thus, we hope the

next community health group will build on these ideas and educate a wider variety of groups,

possibly regional or at the state level. The scope of this paper will define the health issues related

to the aggregate, interventions that were utilized, as well as evaluating these interventions to

recommend changes for future research and education.

Planning

Aggregate Health Problems

The nursing diagnoses of the aggregate identified during the assessment phase were

knowledge deficit, readiness for enhanced knowledge, and risk for injury. The nursing diagnosis
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of knowledge deficit is related to the lack of awareness to emergency preparedness and

resources, as evidenced by the merely 40% who had an emergency kits, some solely containing

few items such as food, water, a flashlight, and cash. In addition, lack of knowledge was

evidenced by the 46.1% of surveyed individuals with no knowledge that Old Dominion

University had an Office of Emergency Management as a resource. The second nursing diagnosis

was readiness for enhanced knowledge related to emergency preparedness, as evidenced by the

aggregate taking pamphlets, verbalizing interest in the issue, and providing contact information

for additional information on emergency preparation. Lastly, risk for injury was a health problem

of our aggregate, related to the lack of knowledge on emergency preparedness and lack of an

emergency plan or evacuation transportation in the event of an emergency. This was evidenced

by the 90% of surveyed individuals without a written emergency plan and 47% without

evacuation transportation.

Planning an Intervention

After assessing and identifying nursing diagnoses for the aggregate, it was necessary to

plan an intervention for the health problems of the aggregate. The prioritized health issue based

on the information above was knowledge deficit because it evolves into risk for injury and

readiness for enhanced knowledge. The aggregate was eager to learn more information on the

topic and their emails were collected to provide additional information about emergency

preparedness. This included knowledge on emergency kits, alerts to follow, and resources

available in the local area. Considering the nursing diagnosis of knowledge deficit, the best

intervention for the aggregate is to provide education regarding their areas of deficit. Creating a

website was the best option to utilize in order to implement this intervention in an organized

manner with the vast amount of information available on emergency preparedness.

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The ultimate goal of the intervention is to create awareness and provide relevant

information that can be utilized for our aggregate to establish an emergency plan individualized

to their needs. The knowledge provided on the website allows the aggregate to sign up for

various alert systems, create an emergency kit, and learn a variety of evacuation routes in their

area; all which are necessary to create a plan tailored to their needs. The objectives mutually

agreed upon were the aggregate will sign up for Hampton Roads alert system upon receiving

education, will learn evacuation routes individualized to them within one month of education,

will create an emergency kit within one month of education, and will create a written plan within

one month of education.

Alternative Interventions

The main intervention utilized this semester was the creation of the website. This website

was created through a free application and viewed as a prototype by professionals. Therefore, we

were able to get various feedback and constructive criticism from different members of the

community on what to change. Some alternative interventions that relate to the website include:

creating the website with a .com or .net domain name, careful phrasing such as emergency

instead of disasters, include other social media besides Twitter, increase mobile capabilities,

emphasize violence-related emergencies, include links to Ready Virginia and Federal Emergency

Management Agency (FEMA), and provide advice for mobility-impaired or disabled students

during emergencies.

Another intervention that could aid in the completion of the objectives would be

providing a pre and post evaluation before and after giving presentations to different groups in

the community. It is also important for future groups to continue to individualize each

presentation to the aggregate characteristics. For example, if educating college students you
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would want to include cheap and easy to access information versus the more expensive

emergency kits that adults with a large family need to buy. We also could have contacted the

colleges and universities earlier in the semester to get feedback and criticism sooner from the

aggregate regarding the website. This would have allowed more time for an analysis of the

evaluation portion of this clinical. Lastly, collaboration with surrounding community health

nursing programs could have widened the scope of our education and created a wider variety of

aggregate characteristics.

All of these interventions have the same probability of occurring. The biggest limitation

is not utilizing your full potential. Almost every person we contacted was more than happy to

help us with what we needed for our project. All you have to do is get the courage, take the time,

and gain the respect deserved to accomplish what is necessary for this clinical experience. It is

the decision of the student how much work they choose to do, what they want to get out of this

clinical, and the amount of education provided to the community.

Intervention

In our planning section, objectives were listed that were to be met through careful

planning of an intervention. These objectives, of course, hinge on the accessibility and

practicality of these interventions. Using a free online host, we were able to create a one-stop

shop for all things concerning emergency and disaster preparedness for students in the Hampton

Roads area. To make the website readily accessible to students in the Tidewater area, we chose to

create both a desktop and mobile version so that the information could be accessed using a

desktop computer or mobile device. The landing page was designed with simplicity in mind,

displaying our three major content areas in the center of the page.
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The content areas included a live twitter feed, support services in times of need, flood

maps and evacuation routes, a do-it-yourself (DIY) kit for college students, and an alerts page

that links students with their respective colleges alerts system to sign up for text and email

notification in times of an emergency or disaster. The live twitter feed is comprised of alert

systems from every major college in the Hampton Roads area, along with police and city

emergency management services. Students no longer need to subscribe to all of these feeds

separately to access the most updated information on weather, emergencies or other situations in

their city or on campus. They can simply click on the twitter logo and be sent to a page that has

all of the alerts displayed in a scrollable, searchable page.

One of the more important features listed on the website is a support service from the

American Red Cross allowing students to let their friends and family know they are safe

following a disaster. This service also allows them to search for the statuses of family members

who may have been affected by the same or other disasters. Statuses are simply updated on the

American Red Cross web server through registering yourself as Safe following a disaster. This

service is very helpful in times of phone line outages or heavy volume following many disasters

where text and calls may be unavailable. The City of Norfolk flood maps are listed as well since

flooding is extremely dangerous for those residing in the City of Norfolk. These maps list flood

prone areas and live updates from the City of Norfolk showing whether or not these areas are

safe to travel to and from. Evacuation routes during a hurricane event are extremely important

for students to understand. The Virginia Department of Emergency Management lists these

routes in their Hurricane Guide, which is made available through our website.

The DIY kit was an intervention developed directly from our data, which showed the

majority of students surveyed did not have a disaster kit at home. This kit was created with a
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college budget in mind and limited us to spending roughly $20 on items to get students through a

period in which they may be without power and water which can lead to hypothermia,

dehydration, and injury. The kit includes advice on which items to include along with a link to

purchase each item individually if desired.

Signing up for alert systems is the easiest way a student can stay in touch with their

campuses respective emergency management office. These alert systems send out text, phone

and email alerts the second a disaster strikes, allowing students to make calculated moves based

on the threat at hand. Unfortunately, many students are not signed up to receive alerts and may

be in the dark when an emergency situation is ongoing. The alerts section of our website allows

easy, one-click access to be directed to their campuses alerts registration page.

Another intervention that addresses the knowledge deficit of our aggregate was in-person

presentations. We were able to present all of the information we have gathered about emergency

preparedness at Drug Court in Norfolk and Art of Healthy Aging at the Virginia Beach

Convention Center. Through formal discussion, we were able to evaluate that there was a serious

knowledge deficit about how to create a plan, emergency kit, and evacuation. We were able to

tailor our information to make it more accessible and applicable to these individuals. We utilized

the knowledge of emergency bus routes for those that do not own cars, handed out pamphlets for

those who have a lack of access to the internet, and kept affordability in mind when creating an

ideal emergency kit. For the elderly, we made sure to discuss prescription medication and

making sure they always had it readily available in case of emergency.

Although our presentation at Drug Court was brief, it was thorough and participants

demonstrated a greater knowledge in emergency preparedness after the presentation and an

interest in learning more. Although this was separate from our main intervention of the creation
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of the website, research has shown that after completing a simple mini-course in emergency

preparedness, students had a 31.9% improvement from their scores taken before the class was

taken (Miller, Rambeck, & Snyder, 2014). This research supports the success of our intervention,

along with the collection of qualitative data from formal discussion after the presentation was

concluded.

We also utilized community resources from the Office of Emergency Management

(OEM) at Old Dominion University to supply informational packets and small first aid kits to

give away to further reinforce the education given and to maintain interest. Our partnership with

the OEM along with the Norfolk MRC was just one of the ways we began to build a foundation

for emergency preparedness and response. The Journal of Nursing Education stated that a

university based medical reserve corp engages faculty, students, university personnel, volunteers

and the community in a collaborative effort to carry out assessment, clinical judgement and

implementation of decision making skills during an emergency situation (Culley, 2010). Our

partnership with the Norfolk MRC and ODU OEM will hopefully lead to the founding of an

ODU MRC which involves all of the constituents listed above, placing ownership of emergency

management in the hands of our aggregate.

Barriers to Interventions

During the implementation phase, we encountered issues in marketing and evaluation.

Interventions, especially those along the same lines as ours, require accessibility to the internet

and the ability to find our website with ease. In addition to these issues, we needed validation

that our content was not only desirable, but also, helpful. To combat issues surrounding

marketing and accessibility, we looked into upgrading from a free web server to a server which

would allow more room for detailed content while also hosting a domain name (.com or .net).
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Currently, we are on a free server for the purposes of presentation and evaluation and our

visibility is limited when searching on engines such as Google or Yahoo. Obtaining a .com or

.net domain name, or obtaining affiliation with ODU and securing a .edu domain, will increase

visibility and allow us to market the website more efficiently. This will also make our website

more marketable and trustworthy, increasing the number of viewers and subscribers.

To determine if our content was of value, we reached out to emergency management

officials from colleges around Hampton Roads and solicited information regarding the content of

our website. This allowed us to obtain feedback from professionals in the field which ultimately

will lead to re-tooling of the content to best suit our population. This also served as a chance to

further market our website as leaders in emergency management in Hampton Roads can help in

distribution our resources to their respective students.

Evaluation

The evaluation step of the nursing process began with revisiting the goals and objectives.

As previously stated, the ultimate goal of the intervention was to raise awareness and provide

relevant information that can be utilized for our aggregate to establish an emergency plan

individualized to their needs. Our group measured our evaluation using a questionnaire as well as

multiple sources of qualitative feedback. After presentations, the presenters held a meaningful

discussion and gathered data. Our aggregate stated that they left the presentation feeling more

prepared and highly likely to take action in the form of an evacuation route, a written plan, and

an emergency kit; and signing up for alerts. From this information, our goal was concluded as

partially met, for although the aggregate stated they would act on these steps, an evaluation was

not taken to assess whether the steps were carried through.

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With respect to our website intervention, we initially considered recruiting students to

review our website and assessing their opinion of its usefulness with a Likert scale questionnaire

post-viewing. However, after consideration, it was decided that a prudent course of action would

be to submit our website for review to local university emergency management officials for their

qualitative feedback in case we were counseling our colleagues to take unnecessary, or worse,

harmful actions towards the remediation of the nursing diagnosis of knowledge deficit regarding

emergency preparedness. In addition to eliminating potential risk, we hoped to benefit from their

considerable expertise in the field in which we are applying our efforts.

We contacted emergency management professionals in five local colleges: our own

Associate Director of Emergency Management at ODU and his counterparts at Norfolk State

University (NSU), Tidewater Community College (TCC), Thomas Nelson Community College

(TNCC) and Hampton University with an email asking three open-ended questions:

1. What information in the website did you find most helpful?

2. Was any information provided unhelpful or even potentially harmful?

3. What other information do you think would fit well in a website targeted towards

college students and addressing disaster preparedness issues?

We received very illuminating feedback from ODU, TCC and Hampton University

emergency preparedness personnel, who shared generously of their time through responding via

email and, in the case of Hampton University, a phone interview. While we were not able to

share our website with personnel from TNCC and NSU, we were able to communicate with them

by phone. As it turns out, the reasons we were unable to secure their feedback were in

themselves informative, and will be addressed later.

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Those professionals responding were strongly in favor of our collected links for signups

to the email, text and push notifications offered to students such as TCC and ODU Alerts, and

pointed that out as a particularly beneficial addition to our website. Also strongly supported was

the suggestion of students compiling an emergency kit, with suggested items being within the

financial means of a student population. There was some diversity of opinion on how this aim

should be achieved, for instance, one suggested a ready made kit and one noted that it was

important to not seem like we were promoting the particular brands we linked to on our

webpage. However, the kit-related content on the website was praised by all responders.

Additionally, flood maps were considered valuable information, as was the twitter feed.

However, some responders encouraged us to further emphasize social media by including

Facebook and other links in addition to twitter towards the end of keeping students informed.

Perhaps most importantly, all responders indicated that no incorrect or potentially harmful

information was contained on our website.

Limitations of Evaluation Process

With respect to our in-person presentations, our evaluation was hampered by our inability

to follow up with the same individuals to see if long term changes in knowledge or behavior had

taken place. Although the information gleaned from post-presentation discussions was useful and

informative, it was obtained in an informal manner and subject to recall bias and lack of

standardization. This is a known deficit of nursing-related education programs in the disaster

education field. Future efforts will be improved by the inclusion of a pre- and posttest Likert

scale questionnaire to quantitatively assess impact of disaster training, as carried out in a pilot

study in Indonesia (Alim, Kawabata & Nakazawa, 2015).

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Evaluation of our website was impeded by several organizational and logistical factors.

For instance, the reason for the development of the National Incident Management System

(NIMS) and the associated Incident Command System (ICS) became very apparent as we

attempted to identify who were the closest analogues to our ODU contact, the Associate Director

of the Office of Emergency Management. Even within offices notionally addressing similar roles

in campus preparedness, very different modes of department organization were observed.

For instance, three of the schools surveyed (ODU, TCC and TNCC) placed their

emergency preparedness offices under the auspices of the administrative side of the school,

which was an organizational strategy very similar to the Finance and Administration branch

seen in ICS. By contrast, Hampton University and NSU used quite a different organizational

structure, grouping emergency preparedness resources under the auspices of the campus police

force, which is very much like the Operational division of ICS management. Due to these

differences, it was more time-consuming than expected to identify which individuals would be

appropriate to ask for feedback on our website, leaving them only about a week to get back to us

with their recommendations.

Interestingly, there was a marked cultural difference between these two organizational

strategies as well. Hampton University and NSU personnel were much more direct and less

discursive in their communications, a tendency one of them attributed to their military and law

enforcement backgrounds. Neither communicated by email, and additionally, the Chief of Police

at NSU was extremely security-minded, refusing to click on the website link in the email without

clearance from NSUs Information Technology department, which did not arrive in time for our

presentation. Unfortunately, our free website caused other problems as well, as the TNCC server
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refused to accept emails containing it. This unexpected obstacle will hopefully be overcome in

the future when our content is associated with an .edu or .com domain name, as noted above.

Recommendations for Further Action

Our group put a great deal of effort into the website, which with additional work can

serve as a valuable resource for local college students. Future groups participating in the Norfolk

MRC community health clinical group could potentially adapt the website and content already

created in order to improve by implementing both the professional feedback and current

research. Additionally, students may wish to expand the aggregate reached by our internet

presence beyond the university setting. Research has shown that most emergency preparedness

materials are not as accessible to those who are deaf or hard of hearing within the elderly

population (Neuhauser, et al., 2013). As the aggregate expands, the variety of populations should

also be considered with the information presented.

Another research article reviewed the current literature about emergency preparedness

teaching for undergraduate nursing students. This article identified that while the emergency

preparedness education being given is using legitimate and relevant information, there is no one

current standard for all emergency preparedness education for nursing students to use as a

singular, collaborative guideline (Jose & Drufrene, 2014). Performing research on this or even

working to collaborate and create one is a possible future endeavor that could be attempted by

future groups using the information gathered during our work and applied to the aggregate.

Lastly, an interesting program mentioned by one of our emergency management contacts

is the innovative Personal Emergency Evacuation Plan at the College of William & Mary in

Williamsburg, Virginia (Personal Emergency Evacuation Plan, 2016). In this program, students

living on campus are required to file a personal evacuation plan including several critical details
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about what they intend to do in the necessity of a rapid evacuation, asking for two evacuation

sites distant from the college, transportation plans, and if they would be able to offer

transportation to other evacuating students.

This is a relatively small, simple intervention that gets students thinking about what they

would do in a crisis situation, and participation is ensured by having to have a plan on file in

order to register for classes. This intervention could fill a critical need. In a post-event analysis of

the a hurricane -related evacuation of the University of Texas Medical Branch in Galveston,

Texas, nursing researchers found that a major source of difficulty evacuating experienced by

students was related to a lack of specificity in their planning (Watson, Loffredo & McKee, 2011).

This difficulty, and its concomitant stress, could be alleviated by university-required prior

planning, and could even save lives.

Implications for Community Health Nursing

Although not immediately apparent to us at the beginning of our work with the Norfolk

MRC, nursing and emergency preparedness truly do go hand in hand. Fully addressing

emergency conditions requires a commitment to personal and community safety--physically, and

even emotionally, as the psychological sequelae of disasters can persist far longer than the acute

event (Watson, Loffredo & McKee, 2011). A commitment to primary prevention of injury via

remediating knowledge deficits regarding appropriate measures during a variety of crises can

make a tremendous difference in the health of the community.

By using the steps of the nursing process--assessment of the community, diagnosing its

vulnerabilities, risks and needs, planning a viable way of ameliorating those vulnerabilities,

intervening to create positive change in the community, and evaluating the fruits of our

preliminary efforts--community and public health can take nursing beyond the bedside and into
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the community, affecting many simultaneously in a proactive manner. Education about means of

preparing for unexpected adverse events is a critical role that nurses and other health

professionals can and should fill as a service to their community.

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References

Alim, S., Kawabata, M., & Nakazawa, M. (2015). Evaluation of disaster preparedness training

and disaster drill for nursing students. Nurse Education Today, 35(1), 25-31.

doi:10.1016/j.nedt.2014.04.016

Culley, J. (2010). The Role of the Medical Reserve Corps in Nursing Education. Journal Of

Nursing Education, 49(12), 708-711. doi:10.3928/01484834-20100930-04

Miller, J. L., Rambeck, J. H., & Snyder, A. (2014). Improving Emergency Preparedness System

Readiness through Simulation and Interprofessional Education. Public Health Reports,

129(Suppl 4), 129135.

Jose, M. M., & Dufrene, C. (2014, April). Educational competencies and technologies for

disaster preparedness in undergraduate nursing education: An integrative review. Nurse

Education Today, 34(4), 543-551. doi:10.1016/j.nedt.2013.07.021

Neuhauser, L., Ivey, S. L., Huang, D., Engelman, A., Tseng, W., Dahrouge, D., . . . Kealey, M.

(2013). Availability and Readability of Emergency Preparedness Materials for Deaf and

Hard-of-Hearing and Older Adult Populations: Issues and Assessments. PLoS ONE, 8(2).

doi:10.1371/journal.pone.0055614

William and Mary - Personal Emergency Evacuation Plan. Tribe Guide. (2016). Retrieved

December 13, 2016, from http://www.wm.edu/offices/fye/before-

arrival/tribeguide/checklist/emergencyevacplans/index.php

Watson, P. G., Loffredo, V. J., & Mckee, J. C. (2011). When a natural disaster occurs: Lessons

learned in meeting students' needs. Journal of Professional Nursing, 27(6), 362-369.

doi:10.1016/j.profnurs.2011.09.001