Joan M. Culley

Use of a Computer-Mediated Delphi Process to Validate a Mass Casualty Conceptual Model

Since the original work on the Delphi technique, multiple versions have been developed and used in research and industry; however, very little empirical research has been conducted that evaluates the efficacy of using online computer, Internet, and e-mail applications to facilitate a Delphi method that can be used to validate theoretical models. The purpose of this research was to develop computer, Internet, and e-mail applications to facilitate a modified Delphi technique through which experts provide validation for a proposed conceptual model that describes the information needs for a mass-casualty continuum of care. Extant literature and existing theoretical models provided the basis for model development. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships, and indicators in the model. The majority of experts rated the online processes favorably (mean of 6.1 on a seven-point scale). Using online Internet and computer applications to facilitate a modified Delphi process offers much promise for future research involving model building or validation. The online Delphi process provided an effective methodology for identifying and describing the complex series of events and contextual factors that influence the way we respond to disasters.

A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures

INTRODUCTION Mass casualty incidents (MCIs) include natural (eg, earthquake) or human (eg, terrorism or technical) events. They produce an imbalance between medical needs and resources necessitating the use of triage strategies. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number. There is limited research on the validation of triage system efficacy in determining the priority of care for victims of MCI, particularly those involving chemicals. OBJECTIVE To review the literature on the validation of current triage systems to assign on-site treatment status codes to victims of mass casualties, particularly those involving chemicals, using actual patient outcomes. METHODS The focus of this article is a systematic review of the literature to describe the influences of MCIs, particularly those involving chemicals, on current triage systems related to the on-site assignment of treatment status codes to a victim and the validation of the assigned code using actual patient outcomes. RESULTS There is extensive literature published on triage systems used for MCI but only four articles used actual outcome data to validate mass casualty triage outcomes including three for chemical events. Currently, the amount and type of data collected are not consistent or standardized and definitions are not universal. CONCLUSIONS Current literature does not provide needed evidence on the validity of triage systems for MCI in particular those involving chemicals. Well designed studies are needed to validate the reliability, sensitivity, and specificity of triage systems used for MCI including those involving chemicals.

Development and Validation of a Mass Casualty Conceptual Model

PURPOSE To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. DESIGN The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. METHODS Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. FINDINGS Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). CONCLUSIONS Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. CLINICAL RELEVANCE This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

The role of the Medical Reserve Corps in nursing education.

Graduates of baccalaureate nursing programs are expected to demonstrate basic competency in responding to emergencies, including those related to emergency preparedness and disaster response. Faculty find it challenging to provide learning experiences that enable students to use appropriate assessment, clinical judgment, and decision making skills during disaster, mass casualty, and other emergency situations. This article describes a partnership between a school of nursing and a university health service to form a Medical Reserve Corps. The partnership resulted in unique and diverse learning experiences for nursing students in collaboration with volunteers from other professional disciplines and laypeople. The Medical Reserve Corps provides opportunities for students to experience emergency preparedness and disaster responses firsthand and to develop competencies required for generalist nursing practice.

A Validation Study of 5 Triage Systems Using Data From the 2005 Graniteville, South Carolina, Chlorine Spill

INTRODUCTION Lack of outcomes-based research results in uncertainty about the effectiveness of any of the current triage systems in determining priority of care during actual chemical disasters. The purpose of this study was to determine whether the level of injury severity extrapolated from 5 triage systems correlated with actual injury severity outcomes of victims exposed to a chlorine disaster. METHODS Using secondary data analysis, data for 631 victims were merged, de-identified, and analyzed. Using logic models from the triage systems, the actual injury severity was compared with the extrapolated injury severity classifications. RESULTS Analysis showed weak to modest correlations between the extrapolated injury severity triage outcome classifications and the actual injury severity outcomes (Spearman correlation range 0.38 to 0.71, P < .0001). There was slight to fair agreement between the extrapolated injury severity triage outcome classifications and the actual injury severity outcomes (weighted κ = - 0.23 to 0.42). DISCUSSION The extrapolated injury severity triage outcome categories from the 5 triage systems did not agree with the actual injury severity categories. Oxygen saturation measured by pulse oximetry provides early indications and is very predictive of outcome severity in incidents involving irritant chemical exposures such as chlorine, and should be a part of a mass casualty protocol for any irritant chemical incident. Additional research is needed to identify the most sensitive clinical measures for triaging victims of toxic inhalation disasters.

Engaging a chemical disaster community: lessons from Graniteville.

Community engagement remains a primary objective of public health practice. While this approach has been adopted with success in response to many community health issues, it is rarely adopted in chemical disaster response. Empirical research suggests that management of chemical disasters focuses on the emergency response with almost no community engagement for long-term recovery. Graniteville, an unincorporated and medically underserved community in South Carolina was the site of one of the largest chlorine exposures by a general US population. Following the immediate response, we sought community participation and partnered with community stakeholders and representatives in order to address community-identified health and environmental concerns. Subsequently, we engaged the community through regular town hall meetings, harnessing community capacity, forming coalitions with existing local assets like churches, schools, health centers, and businesses, and hosting community-wide events like health picnics and screenings. Information obtained from these events through discussions, interviews, and surveys facilitated focused public health service which eventually transitioned to community-driven public health research. Specific outcomes of the community engagement efforts and steps taken to ensure sustainability of these efforts and outcomes will be discussed.

Social networking policies in nursing education.

Social networking use has increased exponentially in the past few years. A literature review related to social networking and nursing revealed a research gap between nursing practice and education. Although there was information available on the appropriate use of social networking sites, there was limited research on the use of social networking policies within nursing education. The purpose of this study was to identify current use of social media by faculty and students and a need for policies within nursing education at one institution. A survey was developed and administered to nursing students (n = 273) and nursing faculty (n = 33). Inferential statistics included &khgr;2, Fisher exact test, t test, and General Linear Model. Cronbach’s &agr; was used to assess internal consistency of social media scales. The &khgr;2 result indicates that there were associations with the group and several social media items. t Test results indicate significant differences between student and faculty for average of policies are good (P = .0127), policies and discipline (P = .0315), and policy at the study school (P = .0013). General Linear Model analyses revealed significant differences for “friend” a patient with a bond, unprofessional posts, policy, and nursing with class level. Results showed that students and faculty supported the development of a social networking policy.

A Continuing Education Program to Retrain Registered Nurses for Careers in Client-Focused Community Healthcare

The purpose of the grant-funded program was to address educational needs arising from the changing role of registered nurses in the delivery of healthcare because of shifts occurring from acute hospital-based care to primary care community-based services. The grant contributed the financial resources necessary to provide administrative support, develop the curriculum and teach the content. Taught jointly by nurse educators and community-based practitioners, the program provided 99 hours of classroom/college laboratory instruction and 96 hours of community-based clinical experiences flexibly structured to meet the needs of working nurses. It provided training at two educational sites for over 40 registered nurses who were unemployed, working in acute care and looking to cross over to community-based settings, or already in a community setting yet interested in sharpening their skills. Nurses were able to earn college credit or continuing education units (CEUs) for successful completion of the program.

Gleaning data from disaster: a hospital-based data mining method to study all-hazard triage after a chemical disaster.

OBJECTIVE To describe the methods of evaluating currently available triage models for their efficacy in appropriately triaging the surge of patients after an all-hazards disaster. DESIGN A method was developed for evaluating currently available triage models using extracted data from medical records of the victims from the Graniteville chlorine disaster. SETTING On January 6, 2005, a freight train carrying three tanker cars of liquid chlorine was inadvertently switched onto an industrial spur in central Graniteville, SC. The train then crashed into a parked locomotive and derailed. This caused one of the chlorine tankers to rupture and immediately release ~60 tons of chlorine. Chlorine gas infiltrated the town with a population of 7,000. PARTICIPANTS This research focuses on the victims who received emergency care in South Carolina. RESULTS With our data mapping and decision tree logic, the authors were successful in using the available extracted clinical data to estimate triage categories for use in our study. CONCLUSIONS The methodology outlined in this article shows the potential use of well-designed secondary analysis methods to improve mass casualty research. The steps are reliable and repeatable and can easily be extended or applied to other disaster datasets.

National nursing science priorities: Creating a shared vision

BACKGROUND Nursing science is essential to advance population health through contributions at all phases of scientific inquiry. Multiple scientific initiatives important to nursing science overlap in aims and population focus. PURPOSE This article focused on providing the American Academy of Nursing and nurse scientists in the Unites States with a blueprint of nursing science priorities to inform a shared vision for future collaborations, areas of scientific inquiry, and resource allocation. METHODS The Science Committee convened four times and using Delphi methods identified priorities with empirical evidence and expert opinion for prioritization, state of the science, expert interest, and potential target stakeholders. DISCUSSION Nursing science priorities for 2017 were categorized into four themes including: (a) precision science, (b) big data and data analytics, (c) determinants of health, and (d) global health. CONCLUSION Nurse scientists can generate new knowledge in priority areas that advances the health of the worlds populations.