During the response phase of an emergency or disaster, we are operating in reaction mode. Decisions need to be made rapidly using the information at hand. And then, leaders must attend to the aftermath, “the consequences or after effects of a significant unpleasant event.”  This is the beginning of recovery.

Recovery planning should be an element of the disaster planning discussed in previous sections. Ideally, the plan would anticipate the partnerships and relationships that could be leveraged to recreate access to service that may have been lost or impacted (service continuity). In the Book from NCBI on health Resilient and Sustainable communities after disasters (Institute of Medicine, 2015), the chapter on health care (p41) identifies 4 key strategies that drive success for recovery for the health care sector:

1. Use multidisciplinary team-based care strategies to meet multifaceted health care needs
2. Ensure continuity of access to healthcare services
3. Use information technology to drive decision making and inform future planning
4. Leverage health care coalitions and other relationships with local care providers for health services strategic decision making and alignment of clinical resources.

In the aftermath, there could be a variety of impacts that will need to be assessed and for which recovery plans are needed.   The types of impacts that can be anticipated, depending on the nature of the emergency, might include:

• Impacts to the health of victims and responders and bystanders both in the immediate and long term.
  • Injury, exposure to toxins, stress induced impacts
• Lack of access to health care and social support resources disrupting continuity of care
  • Exacerbation of chronic conditions and delay of acute care
• Loss of infrastructure, communications, or facilities or supplies
• Loss of critical information (charts, records)
• Increased social vulnerability – housing, income, supports.

There may be opportunities to explore new ways of doing things out of necessity. Therefore, the goals of recovery can and perhaps should include the opportunity to address chronic shortcomings in the system. The phase that has been recently used when thinking about pandemic recovery is to “build back better’

Therefore, the early post Disaster priorities will be:

1. Conducting the post-disaster assessment of needs
2. Restore critical infrastructure and services (tent facility for example)
3. Ensure availability of required workforces
4. Coordinating volunteers and other professionals from outside the community
5. Setting the stage for intermediate-term recovery.

For this last point, there may be opportunities, for intermediate recovery, to explore new ways of doing things out of necessity. Therefore, the goals of recovery planning can, and perhaps should, include the opportunity to address chronic shortcomings in the system.  The phrase that has been recently used when thinking about pandemic recovery is to “build back better’.

The innovation approach to rebuilding the health care services can also be broadened to the broader. community view.  “Importantly, many of the approaches used by a community to address entrenched health disparities and health care costs are similar to those used to meet post-disaster health care needs, Sustaining approaches beyond the response and early recovery stages of disaster is one way to improve long –term access to care.” (Institute of Medicine, 2015, pg23).

Activity #1

Review the following article The public Health response during and after the Lac-Megantic train derailment tragedy: a case study (Généreux, et al, 2014) articulates lessons learned through the complex public health response, in the immediate, medium and longer-term.

After reviewing the article, reflect on the following questions.  Please note lesson 5 (risk communications) and pay particular attention to lesson 6 (long term impacts of the tragedy).

If you are interested in this community framework for disaster recovery, you may want to follow this theme in the later works by the authors Généreux, M., Petit, G, Roy M., Maltais, D., O’Sullivan, T.  (2018). The “Lac-Mégantic tragedy” seen through the lens of the EnRiCH Community Resilience Framework for High-Risk Populations. Canadian journal of public health. 109(2): 261.

Resilience

The common definition of resilience is the ability to recover quickly from illness, change, or misfortune, buoyancy. Resilience is typically desired in the response to and recovery from impactful emergencies or disasters. Weaving in the supports for staff resilience throughout planning, preparedness and response actions can therefore be of great benefit. By ensuring that the significant psychological impacts are anticipated and addressed, close to real time, we can aim to keep staff as safe as possible from longer term risks.

The Institute for HealthCare Improvement (IHI) in 2020, prepared a tool kit called Psychological PPE: Promote Health Care Workforce Mental Health and Well-Being as well as a Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic.

These materials note that “While many staff are currently experiencing distress related to their work, others are not but are at risk of mental health sequela in the future as the pandemic response continues.” The toolkit provides recommendations on individual and system level actions owned by the unit and team leaders that provide protection and support for staff’s mental health that can be deployed both before providing care and after a shift has ended.”  This model recognizes that resilience is more than an individual character trait and can be treated as a ‘team function or support’.  Some example strategies include pairing workers together to serve as peer support in a ‘buddy system’ and facilitating opportunities to recognize and show gratitude.  The toolkit also provides literature evidence and other actionable examples.

This work builds upon an article by Shanafelt, et al (2020) titled “ Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID Pandemic.   The authors presented a memorable framework for thinking about what supports health care workers needed to stay calm and address their own anxieties to reduce the negative impacts on their physical and psychological safety.

The framework was presented as “five requests” from health care professionals to their organization:

• Hear Me – listen to lived experience to understand and address concerns
• Protect Me – reduce the risk of acquiring COVID 19 and/or being a transmitter to family
• Prepare Me – provide training and support for high quality care in different settings
• Support Me – acknowledge demands and human limitations in times of great patient needs
• Care for Me – provide holistic support for team members and families if isolation is required.

Some of the practical actions that were suggested include:

• Well-being huddles focusing on what matters more/most to care teams
• Peer support and coaching networks
• Skilled conversations on “what is getting in the way of more good days”
• Joint risk assessments and co-design of safety systems
• Accommodations/ supports for illness/injury
• Awesome rounds – sharing what was good and went well
• Express gratitude and aim to reframe negatives to find something positive where possible
• Link appreciation to meaning, shared purpose and shared identities.

Even with plans and practice to support resilience in the response teams, it is reasonable to anticipate that the path to recovery will not be linear.  In an excellent paper by the Kings Fund organization in the UK, the authors state that “In the aftermath of a traumatic event, successful recovery does not just happen”

• Covid-19 recovery and resilience: what can health and care learn from other disasters?.

They note that people experience a range of emotional responses at different phases of a disaster and they share four priorities that require conscious attention and action, related to psychosocial distress, to support recovery and resilience.

Activity #2

Please read the article mentioned above and check all the priorities mentioned in the article. It will take some synthesis from the reading as there is not a clear list or priorities presented.

1. Identifying and assessing the level of community need
2. Assess psychosocial distress – adults and children)
3. Activities that bring people together to share disaster experiences – “sense making in community”
4. Ensuring inequities are addressed so that some communities are not left behind in recovery
5. Making collaboration work
6. Prioritizing workforce wellbeing

Add other spurious priorities to be checked ….

• Ensuring provincial standards for recovery are followed
• Focus first on financial and economic impacts

Activity #3

To end this module of the course. Please take the time to pause and integrate this information.  As nursing leaders, you will likely be called upon to respond to emergencies and perhaps a disaster during your career.  It will be very important during this time for you to also take care of yourself and your own well-being.  In the spirit of preparedness, please take time to participate in this reflection exercise that was prepared for the first anniversary of the COVID 19 response.

The video runs for 35 minutes so please allow some extra time and quiet space in your life to allow this to have impact.

Video: The First Anniversary of the COVID-19 Pandemic: An Invitation to Pause, Reflect and Remember (35:44)

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