Tener Goodwin Veenema

The public health crisis of child sexual abuse in low and middle income countries: An integrative review of the literature

PURPOSE Theoretical and empirical studies conducted to ascertain the incidence and characteristics of child sexual abuse (CSA) in developing countries around the world are inconsistent and poorly synthesized. In order to prevent and respond to these heinous acts, clinicians and policymakers require a substantive body of evidence on which to base interventions and treatment programs. The purpose of this study is to conduct an integrative review of the literature concerning CSA in non-industrialized nations. Ultimately, this evidence could be used to drive research and policy implementation in this area. METHODS An integrative literature review of publications identified through a comprehensive search of five relevant databases (PubMed, CINAHL, EMBase, PsycINFO, and Web of Science) regarding the incidence and characteristics of all forms of child sexual assault in low and middle-income countries (LMICs) since 1980. Independent and collective thematic assessment and analysis was utilized to identify major concepts of the phenomenon. FINDINGS Forty-four articles were identified. These represented 32 separate low or middle-income countries. More studies were identified in low-income countries, and there was a disproportional distribution of studies conducted on regions of the world. CSA has been identified at all levels of society in nearly every region and continent of the world. It is being falsely perceived as a new phenomenon in some developing countries, most likely as a result of increases in CSA reporting. Researching and discussing CSA is difficult because of the sensitive and taboo nature of the topic. Four major themes emerged including difficulty of accurate measurement, barriers to reporting, barriers to justice, and the false perception of CSA as a new phenomenon. Themes of early marriage, human trafficking, sexual coercion and forced first sex, and males as victims have been identified as characteristics and topics placing individuals at risk for CSA. Poverty and its resultant social or family strain are exacerbating factors to CSA. CONCLUSIONS There is inadequate representation of CSA research in LMICs, and an increasing awareness that sexual abuse of children is an endemic threat to the health and safety of children worldwide. This review lays the foundation for an array of further areas of analysis to explore the expanse of unanswered questions that remain regarding the phenomena of CSA in low and middle-income countries. CLINICAL RELEVANCE Healthcare workers hold a unique position and responsibility for identifying and responding to CSA.

Children Seeking Refuge: A Review of the Escalating Humanitarian Crisis of Child Sexual Abuse and HIV/AIDS in Latin America

&NA; Early identification and intervention for victims of child sexual abuse (CSA) is essential to halting the spread of HIV in Latino populations because children who are sexually abused are at an increased risk of contracting HIV. The recent influx of unaccompanied children into the United States exposed histories of victimization, vulnerability to CSA, and suggested an epidemic of CSA in Latin America. CSA has been identified as a contributory event to HIV infection. The aim of our research was to identify factors associated with CSA and Latin Americans. A systematic review and a document search were conducted on factors associated with CSA in Latin America. Victimization was associated with lifelong risk factors for HIV. Males were consistently underrepresented in the published CSA literature and machismo attitudes may contribute to abuses of sexual power by males and contribute to males not reporting or under‐reporting victimization.

Quality of healthcare services provided in disaster shelters: An integrative literature review

BACKGROUND Globally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters. OBJECTIVES To determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents. METHODS An integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar). RESULTS Limited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services. CONCLUSIONS A small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse.

Progress on a Call to Action: Nurses as Leaders in Disaster Preparedness and Response

This article provides an update on the progress of the “Call to Action: Nurses as Leaders in Disaster Preparedness and Response.” A steering committee, initiated, directed, and supported by the Veterans Emergency Management Evaluation Center of the US Department of Veterans Affairs, has undertaken the work of bringing together subject matter experts to develop a vision for the future of disaster nursing. The ultimate goal is to ensure that every nurse is a prepared nurse. As one result of this work, the Society for the Advancement of Disaster Nursing has held its inaugural meeting in December 2016.

Education for developing and sustaining a health care workforce for disaster readiness

The United States needs a national health care and public health workforce with the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. This requires that all of our nations nurses and health care providers have unrestrained access to high-quality, evidence-based, competency-driven education and training programs. Programs of study for disaster readiness in both the academic and service sectors are limited in number. Those that do exist may be based upon consensus rather than competency and be price prohibitive. They may fail to fully capitalize on existing educational technologies and may not be accessible to all providers. Nurse leaders are ideally positioned to recognize, advocate, and support the need for a broad array of learning options to strengthen the readiness of the health care workforce for disaster response. This article reviews current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.

Nurse leaders' response to civil unrest in the urban core

Inequalities in society, culture, and finance have resulted in civil unrest, rioting, and intentional violence throughout our history. Nowhere is this currently more apparent than in the cities of Ferguson and Baltimore. It is not the civil unrest itself, but the resulting rioting and intentional violence that can create a disaster situation. This increases the care burden of health care providers during times when the governmental structure may be overwhelmed or functioning in a less than optimal manner. Beginning with the death of Michael Brown, civil unrest over the last 2 years has necessitated a closer examination of the role nurse leaders play in preparing their staff and facilities for potential results of this civil unrest. The similarities between the results of rioting and violence and natural disaster are obvious, but the differences are significant. Without adequate preparation, providers may not offer the appropriate response. Attention to the 10 “musts” for preparedness for civil unrest will facilitate a planning process and provide for a better response and recovery when communities face these issues.

Climate Change–Related Water Disasters’ Impact on Population Health

PURPOSE Rising global temperatures have resulted in an increased frequency and severity of cyclones, hurricanes, and flooding in many parts of the world. These climate change-related water disasters (CCRWDs) have a devastating impact on communities and the health of residents. Clinicians and policymakers require a substantive body of evidence on which to base planning, prevention, and disaster response to these events. The purpose of this study was to conduct a systematic review of the literature concerning the impact of CCRWDs on public health in order to identify factors in these events that are amenable to preparedness and mitigation. Ultimately, this evidence could be used by nurses to advocate for greater preparedness initiatives and inform national and international disaster policy. DESIGN AND METHODS A systematic literature review of publications identified through a comprehensive search of five relevant databases (PubMed, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, Scopus, and Web of Science) was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach in January 2017 to describe major themes and associated factors of the impact of CCRWDs on population health. FINDINGS Three major themes emerged: environmental disruption resulting in exposure to toxins, population susceptibility, and health systems infrastructure (failure to plan-prepare-mitigate, inadequate response, and lack of infrastructure). Direct health impact was characterized by four major categories: weather-related morbidity and mortality, waterborne diseases/water-related illness, vector-borne and zoonotic diseases, and psychiatric/mental health effects. Scope and duration of the event are factors that exacerbate the impact of CCRWDs. Discussion of specific factors amenable to mitigation was limited. Flooding as an event was overrepresented in this analysis (60%), and the majority of the research reviewed was conducted in high-income or upper middle-/high-income countries (62%), despite the fact that low-income countries bear a disproportionate share of the burden on morbidity and mortality from CCRWDs. CONCLUSIONS Empirical evidence related to CCRWDs is predominately descriptive in nature, characterizing the cascade of climatic shifts leading to major environmental disruption and exposure to toxins, and their resultant morbidity and mortality. There is inadequate representation of research exploring potentially modifiable factors associated with CCRWDs and their impact on population health. This review lays the foundation for a wide array of further areas of analysis to explore the negative health impacts of CCRWDs and for nurses to take a leadership role in identifying and advocating for evidence-based policies to plan, prevent, or mitigate these effects. CLINICAL RELEVANCE Nurses comprise the largest global healthcare workforce and are in a position to advocate for disaster preparedness for CCRWDs, develop more robust environmental health policies, and work towards mitigating exposure to environmental toxins that may threaten human health.

Call to Action: The Case for Advancing Disaster Nursing Education in the United States

PURPOSE Climate change, human conflict, and emerging infectious diseases are inexorable actors in our rapidly evolving healthcare landscape that are triggering an ever-increasing number of disaster events. A global nursing workforce is needed that possesses the knowledge, skills, and abilities to respond to any disaster or large-scale public health emergency in a timely and appropriate manner. The purpose of this article is to articulate a compelling mandate for the advancement of disaster nursing education within the United States with clear action steps in order to contribute to the achievement of this vision. DESIGN AND METHODS A national panel of invited disaster nursing experts was convened through a series of monthly semistructured conference calls to work collectively towards the achievement of a national agenda for the future of disaster nursing education. FINDINGS National nursing education experts have developed consensus recommendations for the advancement of disaster nursing education in the United States. This article proposes next steps and action items to achieve the desired vision of national nurse readiness. CONCLUSIONS Novel action steps for expanding disaster educational opportunities across the continuum of nursing are proposed in response to the current compelling need to prepare for, respond to, and mitigate the impact of disasters on human health. U.S. educational institutions and health and human service organizations that employ nurses must commit to increasing access to a variety of quality disaster-related educational programs for nurses and nurse leaders. CLINICAL RELEVANCE Opportunities exist to strengthen disaster readiness and enhance national health security by expanding educational programming and training for nurses.

Increasing Emergency Preparedness.

Examining the issues faced by U.S. health care organizations—and the policies to address them.

Guidance in Managing Patients Following Radiation Events.

The threat of a radiological or nuclear disaster is ever-present. If such an event were to occur, hospitals would experience a surge of patients and advanced practice nurses (APNs) in the emergency department would be expected to immediately respond. To mitigate the effects of the disaster, treat patients, and prevent self-contamination, APNs must be well informed of nuclear disaster management and clinical treatment of radiation exposure. Understanding the effects of exposure, pathophysiology of radiation syndromes, and the basic tenants of radiation safety is essential for APNs. APNs will be required to utilize personal protective equipment during treatment and perform unique tasks including disaster triage, decontamination, environmental management, and radiological survey while tending to the psychological needs of affected individuals. An integrative review of peer-reviewed literature was conducted regarding the nursing clinical guidelines for radioactive/nuclear disaster management, revealing limited information pertaining to the role of nursing in radiological emergency management and decontamination.