thephysical,biological,andphysiologicaldifferencesthatexistbetweenracial

biologicalvariations 07
groupsanddistinguishonegroupfromanother.
negotiationwithclientstoincludeaspectsoftheirfolkpracticeswiththe
culturalaccommodation 07
traditionalhealthcaresystemtoimplementessentialtreatmentplans.
isthemeansbywhichcultureisshared.Bothverbaland
nonverbalcommunicationsarelearnedinonesculture.
Communication145 Communicationisthemostsignicantproblemthatpresents
itselfinworkingwithcrossculturalgroups.

anappreciationofandsensitivitytoaclient'svalues,beliefs,practices,lifestyle,
culturalawareness 07
andproblemsolvingstrategies.
aninabilitytorecognizethedifferencesbetweenone'sownculturalbeliefs,
culturalblindness 07
values,andpracticesandthoseofanotherculture.
acombinationofculturallycongruentbehaviors,practiceattitudes,andpolicies
culturalcompetence thatallowsnursestouseinterpersonalcommunication,relationshipsskills,and 07
behavioralflexibilitytoworkeffectivelyincrossculturalsituations.
aperceivedthreatthatmayarisefromamisunderstandingofexpectationswhen
culturalconflict nursesareunabletorespondappropriatelytoanotherindividual'scultural 07
practicebecauseofunfamiliaritywiththepractice.
culturaldesire anintrinsicmotivationtoprovideculturallycompetentcare. 07
referstothedegreesofvariationthatisrepresentedamong
populationsbasedonlifestyle,ethnicity,race,interest,across
place,andplaceoforiginacrosstime.Itincludesother
aspectsofvariationamongpeople,suchassocialclass,
Culturaldiversity142 genderidentity,sexualorientation,physical
abilities/disabilitiesandcarebeyondmulticulturalism.
Culturaldiversityalsoreferstothechangingpopulationsof
theworldasitbecomesmoreofaglobalvillage.

theprocessthatpermitsnursestoseekopportunitiestoengageincrosscultural
culturalencounter 07
interactions.
theactofimposingone'sculturalbeliefs,values,andpracticesonindividuals
culturalimposition 07
fromanotherculture.
culturalknowledge informationaboutorganizationalelementsofdiverseculturesandethnicgroups. 07
?asystematicidentificationanddocumentationoftheculturecarebeliefs,
meanings,values,symbols,andpracticesofindividualsorgroupswithina
culturalnursingassessment holisticperspective,whichincludestheworldview,lifeexperiences, 07
environmentalcontext,ethnohistory,language,anddiversesocialstructure
influences(Leininger,2002,pp.117118).
assistive,supportive,facilitative,orenablingnurseactionsanddecisionsthat
culturalpreservation helptheclientsofaparticularculturetoretainandpreservetraditionalvalues,so 07
theycanmaintain,promote,andrestorehealth.
therecognitionthateachcultureshouldbejudgedonitsownmeritandnoton
culturalrelativism one'spersonalbeliefs;thevalueofthecultureasdefinedbyitsmeaningtoits 07
members.
culturalrepatterning assistive,supportive,facilitative,orenablingnurseactionsanddecisionsthat 07
 helppeopleofaparticularculturetochangeormodifyaculturalpracticefor
newordifferenthealthcarepatternsthataremeaningful,satisfying,and
beneficial.
ameasureoftheeffectiveintegrationofculturalawarenessandcultural
culturalskill 07
knowledgetoobtainrelevantdataandmeetneedsofculturallydiverseclients.
asetofbeliefs,values,andassumptionsaboutlifethatarewidelyheldamonga
groupofpeopleandthataretransmittedintergenerationally;thelearnedwaysof
culture 07
behavingthatarecommunicatedbyonegrouptoanotherinordertoprovide
testedsolutionstovitalproblems.
advocating,mediating,negotiating,andinterveningbetweentheclient'sculture
culturebrokering 07
andthebiomedicalhealthcarecultureonbehalfofclients.
thefeelingofhelplessness,discomfort,anddisorientationexperiencedbyan
cultureshock individualattemptingtounderstandoreffectivelyadapttoaculturalgroup 07
whosebeliefsandvaluesareradicallydifferentfromtheindividual'sculture.

disparities areusedtodescribeincongruentelements.

theabilityofindividualstocontrolnatureandtoinfluencefactorsinthe
environmentalcontrol 07
environmentthataffectthem.
ethnicity thesharedfeelingofpeoplehoodamongagroupofindividuals. 07
thebeliefthatone'sownculturalgroupdeterminesthestandardsbythatanother
ethnocentrism 07
group'sbehaviorisjudged.
referstoallresidentswhowerenotaU.Scitizenatbirth,
Foreignborn
regardlessoftheircurrentlegalorcitizenstatusorthose
whoseparentswerenotU.S.citizens.

reassociatedwithinequityinsocialstructuresbasedon
particularcharacteristicssuchasethnicity,race,immigrant
status,gender,age,andsexualorientation(Levineetal,
2011).Healthdisparitiesstemfromcharacteristicshistorically
linkedtodiscrimination.Theyarealsoexpressedin
Healthdisparites differencesinmorbidityandmortalityratesamongpopulation
groupslinkedtofactorssuchasraceorethnicity,religion,
socioeconomicstatus,gender,mentalhealth,sexual
orientation,placeoforigin,andresidence.

asthedegreetowhichanindividualhasthecapacityto
obtain,communicate,process,andunderstandbasichealth
Healthliteracy informationandservicestomakeappropriatehealthcare
decisions.

Healthequity isconcernedwithprovidingsocialjusticeinhealthsothat
individualsarenotdisadvantagedfromachievingthehighest
possiblestandardofhealthbasedonmembershipinagroup
 thathashistoricallybeendisadvantaged

immigrant foreignbornpersonresidentintheUnitedStates. 07
personsinboththenurse'sandtheclient'slanguageswhoassistbytranslating
interpreters 07
nurseclientinteractions.
individualswhoarenotcitizens,butarelegallyallowedtoliveandworkinthe
lawfulpermanentresidents 07
UnitedStates,usuallybecausetheyfulfilllabordemandsorhavefamilyties.
noncitizenswhoarelegallyallowedtobothliveandworkintheUnitedStates,
legalimmigrants 07
oftenbecausetheyfulfilllabordemandsorhavefamilyties.
personsadmittedtotheUnitedStatesforalimiteddurationandforaspecified
nonimmigrants 07
purpose.
ofvulnerablepopulationsoccurswhenasegmentofthe
populationhasbeenexcludedfromthemainstreaminsocial,
economic,cultural,orpoliticallife.Marginalizationis
marginalization broughtaboutbypolicies,practices,andprogramsthathave
relegatedthesepopulationstothefringeofsocietyandwhich
preventsthemfrommeaningfullyparticipatinginsociety.

nonverbalcommunication
prejudice
Perceptionoftime
theuseofbodylanguageorgesturestosendinformationthatcannotormaynot
07
besaidverbally.
theemotionalmanifestationofdeeplyheldbeliefs(stereotypes)aboutagroup. 07
referstopast,present,andfuturetimeaswellastothe
durationofandperiodbetweenevents.

isthephysicaldistancemaintainedbetweenindividuals
Personalspace duringaninteraction

qualityofcare ameasureoftheachievementofpositivehealthoutcomes. 07
aprimarilysocialclassificationthatreliesonphysicalmarkerssuchasskincolor
race 07
toidentifygroupmembership.
aformofprejudicethatoccursthroughtheexerciseofpowerbyindividualsand
racism 07
institutionsagainstpeoplewhoarejudgedtobeinferior.
personswhoseekprotectionintheUnitedStatesbecauseoffearofpersecution
refugees 07
intheirhomeland.
arethecircumstancesinwhichpeopleareborn,growup,live,
Socialdeterminantsofhealth work,age,andthesystemsputinplacetodealwithillness.

Socialjustice isconcernedwithvaluesofimpartialityandobjectivityata
systemsorgovernmentallevelandisfoundedonprinciplesof
fairness,equity,respectforselfandhumandignity,and
tolerance
 thewayinwhichaculturalgroupstructuresitselfaroundthefamilytocarryout
socialorganization 07
rolefunctions.
socioeconomicstatus ameasureofeconomicachievementbyanindividualorgroup;classidentity. 07
space thephysicaldistancebetweenindividualsduringaninteraction. 07
ascribingcertainbeliefsandbehaviorsaboutagivenracialandethnicgroupto
stereotyping 07
anindividualwithoutassessingforindividualdifferences.
orientationtopast,present,and/orfutureaswellastothedurationofandperiod
time 07
betweenevents.
foreignbornpersonsresidingintheUnitedStateswhomayhaveenteredthe
unauthorizedimmigrants 07
countryillegallyorwhosepermissiontostaymayhaveexpired.
theuseoflanguageintheformofwordswithinagrammaticalstructureto
verbalcommunication 07
expressideasandfeelingsandtodescribeobjects.
causativefactorinvadingasusceptiblehostthroughanenvironmentfavorableto
agent 12
producedisease,suchasabiologicalorchemicalagent.
anepidemiologicalstudydesignedtoinvestigateassociationsbetweenexposures
analyticepidemiology orcharacteristicsandhealthordiseaseoutcomes,oftenwithagoalof 12
understandingtheetiology(ororiginsandcausalfactors)ofdisease.
atypeofincidenceratedefinedastheproportionofpersonsexposedtoanagent
attackrate 12
whodevelopthedisease,usuallyforalimitedtimeinaspecificpopulation.
bias asystematicdeviationofobservedvaluesfromthetruevalue. 12
canbeviewedagainstthebackgroundofanunderlyingcohort.Thedesignusesa
samplefromthecohortratherthanfollowingtheentirecohortovertime.
casecontroldesign 12
Becauseitusesonlysamplesofcasesandnoncases,itisamoreefficientdesign,
althoughitissubjecttocertaintypesofbias(Rothman,2002).
participantsareenrolledbecausetheyareknowntohavetheoutcomeofinterest
casecontrolstudy 12
(cases)ortheyareknownnottohavetheoutcomeofinterest(controls).
theproportionofpersonsdiagnosedwithaparticulardisorder(i.e.,cases)that
casefatalityrate(CFR) 12
diewithinaspecifiedperiodoftime.
anepidemiologicalstudyinwhichsubjectswithoutanoutcomeofinterestare
classifiedaccordingtopastorpresent(orfuture)exposuresorcharacteristicsand
cohortstudy 12
followedovertimetoobserveandcomparetheratesofsomehealthoutcomein
thevariousexposuregroups.
anepidemiologicalstudyinwhichhealthoutcomesandexposuresor
characteristicsofinterestaresimultaneouslyascertainedandexaminedfor
crosssectionalstudy 12
associationinapopulationorsample,providingapictureofexistinglevelsofall
factors.
reflectsthecumulativeeffectoftheincidencerateoverthetimeperiod,whether
cumulativeincidencerate 12
itisamonth,ayear,orseveralyears.
anepidemiologicalstudydesignedtodescribethedistributionofhealth
descriptiveepidemiology 12
outcomesaccordingtoperson,place,andtime.
determinants factorsthatinfluencetheriskforordistributionofhealthoutcomes. 12
thepatternofahealthoutcomeinapopulation;thefrequenciesoftheoutcome
distribution 12
accordingtovariouspersonalcharacteristics,geographicregions,andtime.
abiasthatmayoccurinecologicstudiesbecauseassociationsobservedatthe
ecologicfallacy grouplevelmaynotholdtruefortheindividualsthatcomposethegroups,or 12
associationsthatactuallyexistmaybemasked.
thisapproachexpandsepidemiologicstudiesbothupwardtobroadercontexts
ecologicmodel (suchasneighborhoodcharacteristicsandsocialcontext)anddownwardtothe 12
geneticandmolecularlevel.
 amodelthatlookstowardmanyfactorsorcombinationsandlevelsoffactors
ecologicalmodel contributingtodisease,suchasthecomplexsetoffactorsthatcause 12
cardiovasculardisease.
anepidemiologicstudyinwhichonlyaggregateorgroupdata,suchas
ecologicstudy 12
populationrates,areusedratherthandataonindividuals.
allofthosefactorsinternalandexternaltotheclientthatconstitutethecontextin
whichtheclientlivesandthatinfluenceandareinfluencedbythehostand
environment 12
agenthostinteractions.Thesumofallexternalconditionsaffectingthelife,
development,andsurvivalofanorganism.
occurrenceofadiseasewithinanareathatisclearlyinexcessofexpectedlevels
epidemic 12
(endemic)foragiventimeperiod.
epidemiologictriangle interactionamongthehost,agent,andenvironment. 12
studyofthedistributionofdisease,orotherhealthrelatedstatesandeventsin
humanpopulations,asrelatedtoage,sex,occupation,ethnicity,andeconomic
epidemiology 12
statusinordertoidentifyandalleviatehealthproblemsandpromotebetter
health.
astateofcompletephysical,mental,andsocialwellbeing,andnotmerelythe
absenceofdiseaseorinfirmity.Fourmodelsofhealth,orderedfromnarrowto
broad,are(1)clinicalhealth,theabsenceofdisease;(2)roleperformance
health 12
health,theabilitytosatisfactorilyperformone'ssocialroles;(3)adaptivehealth,
flexibleadaptationtotheenvironment;and(4)eudaemonistichealth,self
actualizationandtheattainmentofone'sgreatesthumanpotential.
alivingorganism,humanoranimal,inwhichaninfectiousagentcanexistunder
host 12
naturalconditions.
theproportionofthepopulationatriskwhoexperiencetheeventoversome
incidenceproportion 12
periodoftime.
thefrequencyorrateofnewcasesofanoutcomeinapopulation;providesan
incidencerate 12
estimateoftheriskofdiseaseinthatpopulationovertheperiodofobservation.
athreelevelmodelofinterventionsbasedonthestagesofdisease,designedto
levelsofprevention prevent,halt,orreversetheprocessofpathologicalchangeasearlyaspossible, 12
therebypreventingdamage.
keyepidemiologicalindicatorsofinteresttonurses.Mortalityratesare
informativeonlyforfataldiseasesanddonotprovidedirectinformationabout
mortalityrates 12
eitherthelevelofexistingdiseaseinthepopulationortheriskofgettingany
particulardisease.
thecourseofadiseaseprocessfromonsettoresolutionwithoutinterventionby
naturalhistoryofdisease 12
humans.
negativepredictivevalue proportionofpersonswithanegativetestwhoarediseasefree. 12
aconcentrationinspaceandtimeofadiseaseevent,suchthatagraphof
pointepidemic frequencyofcasesovertimeshowsasharppoint,usuallysuggestiveofa 12
commonexposure.
aformofepidemiologyinwhichlaypeoplegatherscientificdataaswellas
popularepidemiology mobilizeknowledgeandresourcesofexpertstounderstandtheoccurrenceand 12
distributionofadiseaseorinjury.
theproportionofpersonswithapositivescreeningordiagnostictestwhodo
positivepredictivevalue 12
havethedisease(theproportionof"truepositives"amongallwhotestpositive).
ameasureofexistingdiseaseinapopulationataparticulartime(i.e.,the
prevalenceproportion 12
numberofexistingcasesdividedbythecurrentpopulation).
proportion atypeofratioinwhichthedenominatorincludesthenumerator. 12
proportionatemortalityratio
theproportionofalldeathsthatareattributabletoaspecificcause. 12
(PMR)
publichealth organizedcommunityeffortsdesignedtopreventdiseaseandpromotehealth. 12
measureofthefrequencyofahealtheventinadefinedpopulationduringa
rate 12
specifiedperiodoftime.
reliability theprecisionofthemeasure;itsconsistencyorrepeatability. 12
risk theprobabilityofsomeeventoroutcomewithinaspecifiedperiodoftime. 12
identifiesindividualswithunrecognizedhealthriskfactorsorasymptomatic
screening 12
diseaseconditionsinpopulations.
seculartrends longtermpatternsofmorbidityormortality(i.e.,overyearsordecades). 12
theproportionofpersonswhoactuallyhaveadiseasewhowillhaveapositive
sensitivity screeningordiagnostictest;ortheprobabilitythatapersonwithadiseasewill 12
becorrectlyclassifiedbythetest.
thebranchofepidemiologythatstudiesthesocialdistributionandsocial
socialepidemiology determinantsofhealthanddisease(BerkmanandKawachi,2000;Kawachiand 12
Berkman,2003;Krieger,2001).
theproportionofpersonswhodonothaveadiseaseandwhowillhavea
specificity negativescreeningordiagnostictest,ortheprobabilitythatapersonwithout 12
diseasewillbecorrectlyclassifiedbythetest.
involvesthesystematiccollection,analysis,andinterpretationofdatarelatedto
surveillance 12
theoccurrenceofdiseaseandthehealthstatusofagivenpopulation.
theaccuracyofatestormeasurement;howcloselyitmeasureswhatitclaimsto
measure.Inascreeningtest,validityisassessedintermsoftheprobabilityof
validity 12
correctlyclassifyinganindividualwithregardtothediseaseoroutcomeof
interest,usuallyintermsofsensitivityandspecificity.
thecomplexinterrelationsoffactorsinteractingwitheachothertoinfluencethe
webofcausality 12
riskforordistributionofhealthoutcomes.
AIDSisthesymptomaticphaseofHIVinfection,andconsistsof
acquiredimmunodeficiency
immunodeficiencyresultingincancersandinfectionsthataffectbodysystems, 14
syndrome(AIDS)
suchasthecentralnervoussystem.
sexuallytransmitteddiseasecausedbytheorganismChlamydiatrachomatisthat
chlamydia causesinfectionoftheurethraandcervix.Infectionsmaybeasymptomatic,and 14
resultinseveremorbidityifleftuntreated.
asystemofprovidingmedicationsforclientswithtuberculosisinfectionin
directlyobservedtherapy
whichtheclientismonitoredtomaximizeadherencetothemedicationregimen 14
(DOT)
andtreatment.
avirusthatattacksthegenitalsandsacralnerve.Infectionischaracterizedby
genitalherpes painfullesionsthatpresentasvesiclesandprogresstoulcerationsonthemale 14
andfemalegenitals,buttocks,orupperthighs.
genitalwarts cauliflowerappearinggrowthsthatarecausedbyhumanpapillomavirus. 14
asexuallytransmitteddiseasecausedbythebacteriumNeisseriagonorrhoeae,
gonorrhea resultingininflammationoftheurethraandcervixanddysuria;oritmayresult 14
innosymptoms.
avirusthatistransmittedbythefecaloralroute.Theclinicalcourseofhepatitis
Arangesfrommildtosevereandoftenrequiresprolongedconvalescence.Onset
hepatitisAvirus(HAV) 14
isusuallyacutewithfever,nausea,lackofappetite,malaise,andabdominal
discomfort,followedafterseveraldaysbyjaundice.
avirusthatistransmittedthroughexposuretobodyfluids.Infectionresultsina
hepatitisBvirus(HBV) clinicalpicturethatrangesfromaselflimitedacuteinfectiontofulminant 14
hepatitisorhepaticcarcinoma,possiblyleadingtodeath.
avirusthatistransmittedthroughexposuretobloodandbodyfluids.HCV
hepatitisCvirus(HCV) infectionmaypresentwithsuchmildsymptomsthatitgoesunrecognized.Itis 14
themostcommonchronicbloodborneinfectionintheUnitedStates.
highlyactiveantiretroviral
therapy(HAART)
HIVantibodytest
HIVinfection
humanimmunodeficiency
virus
humanpapillomavirus
incidence
incubation
injectiondruguse
nongonococcalurethritis
partnernotification
pelvicinflammatorydisease
perinatalHIVtransmission
prevalence
sexuallytransmitteddiseases
syphilis
tuberculosis
Alternatecarecenters522 maybeusedtoshelterpatientswithmedicalneedsdesignated
takingacombinationofthreeormoreantiretroviraldrugs. 14
alaboratoryprocedurethatdetectsantibodytoHIV.Enzymelinked
immunosorbentassay(ELISA)isthetestcommonlyusedinscreeningbloodfor 14
theantibodytoHIV;theWesternblotisusedastheconfirmatorytest.
infectionwithhumanimmunodeficiencyvirus;aphaseofthisinfectionis
subclinical,butinfectedindividualsremaincapableoftransmittingthevirusby 14
specificbehaviors.
thevirusthatcausesHIVinfectionandAIDS. 14
asexuallytransmitteddiseasethatresultsingenitalwarts(condylomata
acuminata)thatgrowinthevulva,vagina,cervix,urinarymeatus,scrotum,or 14
perianalarea.AlinkexistsbetweenspecificHPVtypesandcervicalcancer.
inepidemiology,thenumberofnewcasesofinfectionordiseasethatoccurina
14
definedpopulationinaspecifiedperiodoftime.
timeintervalbeginningwiththeinvasionoftheinfectiousagentandcontinuing
untiltheorganismmultipliestosufficientnumberstoproduceahostreaction 14
andclinicalsymptoms.
includesintravenousandsubcutaneousdruginjection,thelatterusuallyoverthe
14
abdominalarea.
inflammationoftheurethrafrommicroorganismsotherthanNeisseria
gonorrhoeae;Chlamydiatrachomatishasbeenimplicatedasthecauseof50%of 14
cases.
identifyingandlocatingcontactsofpersonswhohavebeendiagnosedwitha
transmissiblediseaseinordertonotifythemofexposureandencouragethemto 14
seekmedicaltreatment.
infectionofthefemalereproductiveorgans,specificallythefallopiantubesand
endometrium,resultingininfertilityand/orectopicpregnancy.Acutesymptoms
andsignsincludelowerabdominalpain,increasedvaginaldischarge,urinary 14
frequency,vomiting,andfever.PIDresultsfromuntreatedgonorrheaand
chlamydia.
transmissionofHIVfromthemothertothefetusorinfantduringpregnancy,
14
delivery,orbreastfeeding.
thenumberorpercentageofpersonsinagivenpopulationwithadiseaseor
conditionatagivenpointintime.Alsotheproportionofexistingcasesofa 14
healthoutcomeinapopulationataparticulartime.
communicablediseasessuchasgonorrhea,chlamydia,andHIVinfectionthat
14
canbetransmittedbysexualactivity.
aninfectioussexuallytransmitteddiseasecausedbyabacteriumTreponema
pallidum;characterizedbytheappearanceoflesionsorchancresthatmay
14
involveanytissue.Relapsesarefrequentand,aftertheinitialchancreand
secondarysymptoms,syphilismayexistwithoutsymptomsforyears.
aninfectiousdiseasecausedbythebacteriumMycobacteriumtuberculosis.Itis
transmittedbyairbornetransmission,resultinginpulmonarysymptomsand
14
wasting.Infectioncanbelatentandasymptomatic,laterprogressingtoactive
infection.
asNonambulatorycare/Hospitaloverow,forexample,
careofnonambulatorypatientswithlessintensemedical

AmericanRedCross health,safety,anddisasterreliefprogramsinaffiliationwiththeInternational 23
BioSense
bioterrorism
BioWatch
CBRNEthreats
CitiesReadinessInitiative medicalsuppliesduringalargescalepublichealthemergency,suchasa
CommunityEmergency
ResponseTeam(CERT)
communityresilience
Crisisstandardsofcare515 standardsneedtobeexploredanddiscussedwithall
DisasterMedicalAssistance
Team(DMAT)
Emergencyoperationscenter Ifthedisasterexceedslocalresources,thecountyorcity
515
needs.
anationalorganizationthatseekstoreducehumansufferingthroughvarious
CommitteeoftheRedCross.
adatasharingprogramtofacilitatesurveillanceofunusualpatternsorclustersof
diseasesintheUnitedStates.Itsharesdatawithlocalandstatehealth 23
departmentsandisapartoftheBioWatchsystem.
theintentionaluseofapathogenorbiologicalproducttocauseharmtoahuman,
animal,plant,orotherlivingorganisminordertoinfluencetheconductof 23
governmentortointimidateorcoerceacivilianpopulation.
anearlywarningsystemforbiothreatsthatusesanenvironmentalsensorsystem
23
totesttheairforbiologicalagentsinseveralmajormetropolitanareas.
chemical,biological,radiological,nuclear,andexplosivethreatstopublicsafety. 23
aprogramtoaidcitiesinincreasingtheircapacitytodelivermedicinesand
23
bioterrorismattackoranuclearaccident.
programsponsoredbytheFederalEmergencyManagementAdministrationto
traincommunitycitizensinthebasicsofdisasterpreparednessandresponse.
Usingthetraining,CERTmemberscanassisttheirneighborsandcoworkers 23
followinganeventwhenprofessionalrespondersarenotimmediatelyavailable
tohelp.
buildsonthepremisethathealthyindividuals,families,andcommunitieswith
accesstohealthcareandknowledgebecomesomeofournation'sstrongest 23
assetsindisasterincidents.
enablethehealthcareoperationsnecessarytoallocatescarce
resourcesinadifferentmannertosaveasmanylivesas
possible(InstituteofMedicine[IOM],2012).Crisis
communitystakeholdersinthepreparednessphase.
Communityengagementiskeytothisprocess.
ateamconsistingofapproximately30volunteersincludingphysicians,nurses,
andotheralliedhealthpersonnelwhotrainasagrouptoperformspecific
emergencyfunctionsduringadisaster.UponactivationoftheNationalDisaster 23
MedicalSystem,eachmemberbecomesanautomaticandtemporaryemployee
oftheU.S.PublicHealthService.
emergencymanagementagency(EMA)willcoordinate
activitiesthroughanEmergencyOperationsCenter(EOC).
TheEOCprovidescentralfunctionsatastrategiclevelto
overseetheemergencysituation.Ingeneral,localresponders
withinacountysignaregionalorstatewidemutualaid
agreementtoallowthesharingofneededpersonnel,
equipment,services,andsupplies.
 fifteensupportfunctionsthatprovideamechanismtobundlefederal
resources/capabilitiestosupportthenation.Examplesoffunctionsinclude
EmergencySupportFunctions
transportation,communications,andenergy.EachESFentailsacoordinatorand 23
(ESFs)
primaryandsupportagenciesthatworktogethertocoordinateanddeliverthe
fullbreadthofFederalcapabilities.
areimplementedtoaidindividualsinmaintainingtheir
independencewiththegeneralpopulationshelter.Required
FNSSincludereasonablemodicationtopolicies,practices,
andprocedurestoaccommodateindividualswithfunctional
Functionalneedssupport needsaswellasaccesstodurablemedicalequipmentwithin
services522
theshelterenvironment(e.g.,walkers,beds,ventilators),
consumablemedicalsupplies(e.g.,ostomysupplies,
dressings).

accommodateavarietyoffunctionalneedsforindividualssuchasassistance
generalpopulationshelters 23
withactivitiesofdailyliving.
theU.S.DepartmentofHomelandSecuritywascreatedthroughtheHomeland
HomelandSecurityActof
SecurityActof2002,consolidating20previouslydisparateagenciesunderone 23
2002
unifiedorganization.
HomelandSecurityExercise developedtohelpstatesandlocaljurisdictionsimproveoverallpreparedness
andEvaluationProgram withallnaturalandhumanmadedisasters.Theprogramhelpshomeland 23
(HSEEP) securityleaderscreateexerciseprogramsfortheircommunity.
HomelandSecurity directedtheSecretaryofHomelandSecuritytodevelopandadministerthe
PresidentialDirective5 NationalIncidentManagementSystem(NIMS),aunified,alldiscipline,andall 23
(HSPD5) hazardsapproachtodomesticincidentmanagement.
issuedinDecemberof2003,itestablishednationalpoliciestostrengthenthe
HomelandSecurity
preparednessoftheUnitedStatestoprevent,protectagainst,respondto,and
PresidentialDirective8 23
recoverfromthreatenedoractualterroristattacksandmajordisasters,andit
(HSPD8)
includedagoalfornationalpreparedness.
establishedanationalstrategythatenablesalevelofpublichealthandmedical
HomelandSecurity
preparednesssufficienttoaddressarangeofpossibledisasters.Itdoesso
PresidentialDirective21
throughfourcriticalcomponentsofpublichealthandmedicalpreparedness:(1) 23
(HSPD21),PublicHealthand
biosurveillance,(2)countermeasuredistribution,(3)masscasualtycare,and(4)
MedicalPreparedness
communityresilience.
actsofindividualsthatcausedevastationanddestruction,suchaswar,terrorist
humanmadedisaster 23
bombings,orriots.
accidents/disasterscausedbyindividualsthatcancausedevastationand
humanmadeincident 23
destruction.
Interprofessional508
providesopportunitiesfornursestosupportemergencypreparednessand
MedicalReserveCorp(MRC) 23
responseintheirlocaljurisdictions.
actionsdesignedtoeitherpreventsomething(e.g.,adisaster)fromhappeningor
mitigation 23
reducetheseverityofitseffects.
asigneddocumentbyatleasttwoorganizationsthatoutlinesthewaysinwhich
mutualaidagreement 23
collaborationandcoordinationwilloccurbetweenthematthetimeofadisaster.
NationalDisasterMedical providesnursestheopportunitytoworkonspecializedteams,suchasthe 23
System(NDMS) NationalNurseResponseTeam(NNRT)andtheDisasterMedicalAssistance
 Team(DMAT).
NationalHealthSecurity focusesspecificallyonthenationalgoalsforprotectingpeople'shealthinthe
23
Strategy(NHSS) caseofdisasterinanysetting.
providesallresponderswithprotocolandcommonlanguageforhowresponders
NationalIncidentManagement canworktogether.Ongoingeducationandtrainingarestressedforall
23
System(NIMS) responders.Responderspracticeandevaluatetheirskillsandtheirabilityto
workwithoneanotherthroughdisasterdrillsandexercises.
establishednationalguidelinestostrengthenthepreparednessoftheUnited
NationalPreparedness
Statestoprotectagainst,respondto,andrecoverfromthreatenedoractual 23
Guidelines(NPG)
terroristattacksandmajordisasters.
aguideforconductinganationwideallhazardsresponse,builtuponscalable,
NationalResponseFramework flexible,andadaptablecoordinatingstructurestoalignkeyrolesand
23
(NRF) responsibilitiesacrosstheNation,linkingalllevelsofgovernment,
nongovernmentalorganizations,andtheprivatesector(DHS,2008d,pi).
recognizesthatthehealthofhumansisconnectedtothe
healthofanimalsandtheenvironment,andtheOneHealth
Onehealth517 conceptintegrationindisasterpreparednessandresponse
requiresinterprofessionaleffortsatglobal,national,andlocal
levels(CDC,2013).

pandemic
PandemicandAllHazards enactedin2006toimprovethenation'sabilitytodetect,preparefor,andrespond
PreparednessAct(PAHPA)
personalprotectiveequipment
(PPE)
PointsofDispensing(POD)
ProjectBioShield
PublicHealthNursing
InterventionWheel
PublicHealthSecurityand
BioterrorismPreparednessand
ResponseActof2002
Psychologicalfirstaid
referstotheepidemicspreadoftheproblemoverseveralcountriesorcontinents. 23
23
toavarietyofpublichealthemergencies.
:equipmentneededtoperformaspecializedactivity;shouldbeusedtosafely
23
performneardangerousmaterials.
providesmedicalservicesandsuppliestotheentirepopulationwithin48hours
23
ofadisaster.
aprogramtodevelopandproducenewdrugsandvaccinesascountermeasures
23
againstpotentialbioweaponsanddeadlypathogens.
apopulationbasedpracticemodelthatencompassesthreelevelsofpractice
(community,systems,andindividual/family)and17publichealthinterventions.
23
Eachinterventionandpracticelevelcontributestoimprovingpopulationhealth,
providingapracticefoundation.
addressedtheneedtoenhancepublichealthandhealthcarereadinessand
23
communityhealthcareinfrastructures.
ublichealthnurseshaveaskillsetthatservestheir
communitywellindisaster,includinghealtheducationand
diseasescreening,massclinicexpertise,anabilitytoprovide
essentialpublichealthservices,communityresourcereferral
andliaisonwork,populationadvocacy,psychologicalfirst
aid,publichealthtriage,andrapidneedsassessment.

publichealthsurge
publichealthtriage
rapidneedsassessment
overwhelmingneedformedicalassistanceduringanemergency. 23
involvesthesortingoridentificationofpopulationsforpriorityinterventions.In
epidemics,forexample,thepublichealthtriagefocusbecomesthepreventionof 23
secondaryinfection.
includesdeterminingofthemagnitudeoftheincident,definingthespecific 23

riskcommunication
Robertt.Stafforddisaster
reliefandemergency presidentialdisasteroremergencydeclaration.Iftheeventis
assistanceact515
specialneedsshelters
StrategicNationalStockpile
(SNS)
triage
vicarioustraumatization
Utilitarianframeworkp.521
healthneedsoftheaffectedpopulation,establishingprioritiesandobjectivesfor
action,identifyingexistingandpotentialpublichealthproblems,evaluatingthe
capacityofthelocalresponseincludingresourcesandlogistics,anddetermining
theexternalresourceneedsforpriorityactions.
theexchangeofinformationabouthealthorenvironmentalrisksamongrisk
assessorsandmanagers,thegeneralpublic,newsmedia,interestgroups,andso 23
on.
Whenstateresourcesandcapabilitiesareoverwhelmed,
governorsmay,throughprovisionsprovidedintheRobertT.
StaffordDisasterReliefandEmergencyAssistanceAct
(FEMA,2013e),requestfederalassistanceundera
consideredanincidentofnationalsignicance(apotentialor
highimpactdisaster),appropriateresponsepersonneland
resourcesareprovided.
designedforthoseindividualswhohavepreexistingconditionsresultingin
medicalimpairmentsandwhohavebeenabletomaintainactivitiesofdaily 23
livinginahomeenvironmentpriortothedisasteroremergencysituation.
aCDCmanagedprogramthatprovidesthenationalrepositoryofantibiotics,
chemicalantidotes,antitoxins,otherpharmaceuticals,andmedicalsuppliesand 23
equipmenttobeusedintheeventofaterroristattackormajornaturaldisaster.
decidingwhichinjuredorsickindividualsneedthemostimmediateattention
23
andbywhom.
fornursesduringadisaster/incident,thisoccursinresponsetolisteningto
survivors'storiesofthetraumaticevent(McLaughlin,Murray,andBenbenishty,
23
2005,p73).Therefore,mentalhealthworkersneedtoassistnursesaswellasthe
public.
Inextremeconditions,traditionalethicsofdoingthebestfor
everypatientmayshifttoautilitarianframeworkwhere
nursingsgoalbecomestodothegreatestgoodforthe
greatestnumberofindividuals(AmericanNurses
Association[ANA],2008,p.10).Inthesecircumstances,
eachpatientmaynotreceiveallthecarethatwouldoccur
undernormalconditions.