Natural disasters are scary, devastating, and sometimes fatal. There are many organizations that jump in to help when disasters occur, and Hope Force International is one of them. Tina Busby, FNP, RN, works for a group of Federally Qualified Community Health Centers, called NOAH-Neighborhood Outreach Access to Healthcare, part of Honor Health, a larger medical system in the greater Phoenix area, made up of multiple medical group practices and multiple hospitals.
She and her husband also volunteer with Hope Force International, a Christian-based disaster relief organization that, as Busby says, “works nationally and internationally to provide disaster services as well as services to help communities rebuild after disaster. It uses volunteers, both professionals and nonprofessionals, from multiple nations.”
Busby answered questions about her work with the organization.
How did you become involved with Hope Force International (HFI)?
My husband and I have known the founders of HFI, Jack and Cheri Minton, since 2000 while serving with them in another faith-based ministry, Mercy Ships International. Since their conception of HFI, we have both had a desire to be involved, and we were finally able to complete our training and become HFI reservists about 6 years ago.
How does volunteering work? Are you put on alert or called in at certain times? How are you able to get time off from work?
When there is a disaster, HFI sends out a text message followed by an email to all reservists putting them on standby for possible deployment and asking them to pray and assess whether it is the right time for them to go and serve.
Because I have always been a part of a medical team, I have more notice and have not served with HFI immediately after a disaster. For the last few years, I have been a part of medical teams returning to both Haiti and Nepal. These HFI teams work with local community partnerships to show the love of Christ and advance His name. Since completing my education as an NP, I have felt a strong call from the Lord, that my skills and talents are to be used for His glory. Thus, I have tried to work in situations that allow for enough flexibility in my schedule to be able to serve others in this way.
Because we have a large family that is spread out all over the nation, finding a NP position with enough time off for both is almost impossible, and so, for the last seven years I have worked in a Per Diem or On Call position. Basically, I have an irregular schedule, and I fill in the open provider slots in multiple clinics, so that I am able to have control over my schedule and time off.
What do you do as a volunteer with HFI? How many times have you worked as a volunteer?
As a volunteer with HFI, my role has been to be a medical provider on multiple medical teams in both Haiti and Nepal, where I’ve traveled three times each with HFI. I have wanted to also help in other capacities, such as immediately after a disaster such as the recent hurricanes in Texas, Puerto Rico, and now the Bahamas. But at this point in my life, my resources (time and funds) are limited, and I also have a part-time job to keep up.
What did you enjoy most about volunteering for HRI?
I enjoy the people, all created in the image of God, both my teammates and those we are serving. I love seeing God work in so many different ways. I love meeting and making new friends and having the opportunity to serve alongside old friends. Having the luxury of going back to the same communities over the last few years, I love seeing how people’s hearts are becoming more responsive to Him and the great love He has for them.
What have been your greatest challenges?
My greatest challenge currently is that my husband, also a nurse, hasn’t been able to travel with me the last few years, due to his work schedule. Keeping my work and personal schedule flexible enough to serve, along with having the financial resources to serve, are always challenges. Some of the travel, long flights, and exciting bus rides, can be challenging for me as well.
What have been your greatest rewards?
Some of my greatest rewards have been the bonding of teammates and feeling the pleasure of God. I often personalize Eric Liddell’s quote to read, God gave me a compassionate heart and made me a healer. When I serve the least of the least, whether that’s at home or abroad, I feel His pleasure.
What would you say to someone who was considering volunteering for Hope Force International?
I would say, attend a Reservist Training and then go as God leads you! If you’re a nurse, we could really use you! We’ve just had to recently cancel an upcoming medical team to Haiti because we did not have enough nurses able to go.
Once you go, your life will never be the same and you will be “spoiled for the ordinary!”
When nurses think about volunteering, they may imagine doing so somewhere in their own backyard. While all type of volunteering to help others is important and valuable, there are many different types—some may even take you across the world. Meggin Tallman RN, BSN, now a Pediatric Critical Care Nurse at Children’s Hospital of Alabama, has volunteered a number of times with Mercy Ships. She wants to spread the word about this amazing organization, so she answered our questions.
What is Mercy Ships?
Mercy Ships volunteer Nurse Meggin Tallman plays the Ukelele with a patient onboard the Africa Mercy.
Mercy Ships is an international faith-based organization bringing hope and healing to the world’s forgotten poor. As many as 5 billion people lack access to safe, affordable surgical and anesthesia services worldwide, and less than 6% of all operations are delivered to the world’s poorest countries. Marginalized populations continue to suffer due to a lack of trained health care providers, inadequate infrastructure, and disproportionate out-of-pocket healthcare costs.
Mercy Ships programs offer holistic support to developing nations striving to make health care accessible for all. Since 1978, Mercy Ships has delivered services to more than 2.56 million direct beneficiaries. Mercy Ships owns and operates the Africa Mercy which is the world’s largest non-governmental hospital ship and is dedicated to the continent of Africa. Mercy Ships has an average of 1,000 volunteer crew, from up to 40 nations, serving onboard the Africa Mercy each year.
How did you get involved with Mercy Ships? Why did you decide to volunteer?
I had always had a dream to serve in developing countries upon completion of my nursing degree. I just really have a service heart, and I feel that I now have a set of skills that are desperately needed all over the world. If I am called to help and have the ability to, then how could I not volunteer?
As a new graduate, I got the opportunity to serve with the hospital I worked for, for a month in Zambia. Following that trip, I knew this was something I was uniquely called to do. When I got home, I really jumped into researching organizations doing medical missions on the continent of Africa, and when I discovered Mercy Ships, my mind was blown that they could do all the things that they do and help the amount of people they do. I instantly applied.
How long were you a volunteer? How did you get time off work?
My first service on the Africa Mercy was in Madagascar for just under four months and the second was just under three months in Cameroon. Those trips were somewhat easier to manage as I was a travel nurse at the time and could plan trips in between contracts. This last service with Mercy Ships was for six weeks in Guinea, and I, thankfully, have a boss who has a heart for missions as well. We were able to work together to help me take a leave of absence so I could fill a critical need the ship had for a pediatric ICU nurse.
What did you do with Mercy Ships? How many people did you help (estimate)?
On board the Africa Mercy I worked in D ward, which is the maxilla-facial ward, and my role was a pediatric ICU nurse. That being said, I treated kids and adults alike with ailments ranging from large tumors of the face and neck to cleft lips and palates to things as serious as neural tube defects.
In terms of how many people I specifically have helped, I don’t think that is calculable. Sure, I had my patients that I helped with medicines and wound dressings and those types things, but we also played games with patients and colored and sang songs. It’s just impossible to truly know the number of hearts and lives you affect both in the profession of nursing and just in life in general. That fact is even more so true on board the Africa Mercy, as it truly is a floating metal box of hope and healing…the patients aren’t the only people who leave the ship changed for the better.
What did you enjoy most about your experience?
Meggin Tallman, Ward Nurse (Paediatric ICU), with a patient on Deck 7.
I think if I had to choose one thing I liked most, it would be that we got to see the healing effects of love and compassion. All the interventions on the ship are surgical, so we have an instant gratification factor where the patient goes into the OR looking one way and comes out looking better. But many of these patients have endured terrible hurt and pain that surgery and medicine can’t fix. That’s where the games and songs and love come in. When you see that healing, you never forget it.
What were your greatest challenges?
I would say probably everyone who has ever served on board the Africa Mercy would say that the number one challenge is living in a tin box with 400 other people from 40 different nations. It is a challenging experience, but it grows on you.
What were your greatest rewards?
It is just such an honor to be able to be a part of the work of Mercy Ships and to play a small role in the life changes that take place on board the Africa Mercy.
What would you say to someone who was considering volunteering for Mercy Ships?
Do it! Not only will you be a part of changing people’s lives in a way that you could never have imagined, but you will come away changed too. I know it sounds crazy and scary and way too big for you–I’ve been there. But take the leap of faith; you won’t regret it.
My work overseas has made it evident that pursuing an advanced practice degree would make me that much more helpful in developing countries, which is why I am now earning my FNP at the University of North Alabama. Education is truly the greatest resource that you never have to worry about fitting in a duffle bag. I think that is an important thing to note when considering working in a low-resource setting.
No matter how hard you try to avoid it, it happens. The nurse becomes the patient. Whether you’ve given birth, had surgery, or a horrible case of the flu, there are times in life when conditions will send you to the hospital. And being on the proverbial other side of the hospital bed, as Jenny Ang, MSN, ARNP, FNP-BC, an NP in Washington State, says. So how can nurses be good patients?
“When the caregiver suddenly becomes the one who needs care, it’s an extremely unsettling, vulnerable, and helpless feeling,” says Ang. “Nurse can be good patients by showing patience, kindness, and compassion to their caregivers, while trying not to micromanage their health care professionals.”
Over the years, Ang has cared for many doctors and nurses in the ICU for a number of diagnoses in critical situations. She says that, for the most part, these patients have been good ones. But it’s because they had their questions answered, were updated regularly on their care, and understood both the risks as well as the rationale behind what was being done for them. So what is a “not good patient” in Ang’s opinion? “Someone who requires an excessive, grossly unfair amount of time and resources from a nurse, compared to a patient in a similar circumstance,” she says. “I have had only one patient who was a nurse act this way, but countless other non-health care people behave like this.”
Ang says that as nurses, you tend to advocate for the best care for your patients. “When we become the patient, we tend to advocate for ourselves like a mama grizzly bear protecting her cubs.”
What can you do to be a good patient? Ang has some tips:
- Remember that your professional judgement is clouded when the case is personal.
- Remember that you’re in a vulnerable state.
- Don’t lash out at your health care providers out of defensiveness.
- Don’t micromanage your health care professionals. Remember they are pros, and have sworn the same oath to do no harm, just like you have.
- You are a professional. Remember to act like one.
“It makes many nurses defensive when they are suddenly in the position of being the patient. Like in any other field of work, it is not wrong to question a health care professional, but how you ask your question is key. Don’t be accusatory,” recommends Ang. “It is most appropriate to maintain positive, clear communication with the health care professionals caring for you when they come to check on you in your hospital room. Nurse know how the system works.”
Minorities are often not accurately represented in clinical trials. For example, although Hispanics comprise 17% of the population of the United States, in terms of participants in nationwide clinical trials, only 1% are of Hispanic origin. The All of Us Research Program is determined to change this.
Norma G. Cuellar, PhD, RN, FAAN, president of the National Association of Hispanic Nurses (NAHN) and a professor at the University of Alabama Capstone College of Nursing, took time to explain all about All of Us.
What is All of Us and how does it work? How is the program attracting participants?
The All of Us Research Program is a historic effort to gather data over many years from one million or more people living in the United States, with the ultimate goal of accelerating research and improving health.
After completing the consent process, participants will be asked to contribute information about their medical history and lifestyle. Participants, who come from all 50 states, may also be asked to have their physical measurements (blood pressure, height, and weight, etc.) taken at a local enrollment center and/or to donate blood and urine samples. They will have access to their study results, along with summarized data from across the program.
NAHN is a community partner in the Community & Provider Gateway Initiative (CPGI), a part of the All of Us Research Program with the National Institutes of Health. NAHN has joined the effort to promote awareness of the initiative among health care providers of Latinxs and the Latinx community. NAHN, like other partners, are holding local events within communities such as webinars, booths at festivals, and sharing information at local health fairs.
Additionally, the program has two mobile exhibits, called the All of Us Journey, which tours the U.S. to spread awareness and educate communities about the program. The second Journey bus has an enrollment center on it that allows visitors to enroll in the program on-site.
We now have more than 200,000 participants enrolled and are on target with our goal of having at least 75% of our participants come from historically underrepresented communities in biomedical research. This is why our work at NAHN to raise awareness within the community is so important.
Diversity is a core part of All of Us, and our goal is to achieve “quadruple diversity” – diversity of people, geography, health status, and data types.
What kind of data are you collecting and why? Who will be able to gain access to this data? What will they be using it for?
After participants complete the consent process, they will be asked to contribute information about their medical history and lifestyle and can even opt to share their electronic health record. The next step, participants will be asked to share their physical measurements (blood pressure, height and weight, etc.) and donate blood and urine samples, which is captured at a local enrollment center. This year, the program announced a partnership with Fitbit to enable participants to sync their wearable device with their All of Us account to share data such as the number of steps they take daily. As technology improves, the program hopes to increase the types of data it collects.
The program will have the scale and scope to enable research for a wide range of health research. A research program of this size will have the statistical power to detect associations between environmental and/or biological exposures and a wide variety of health outcomes.
Examples of the scientific opportunities presented by the program are:
- Develop ways to measure risk for a range of diseases based on environmental exposures, genetic factors, and interactions between the two
- Identify the causes of individual differences in response to commonly used drugs (commonly referred to as pharmacogenomics)
- Discover biological markers that signal increased or decreased risk of developing common diseases
And in May 2019, the program released their beta version of its interactive Data Browser, to provide a first look at the data that participants are sharing for health research. For researchers like myself, this is really exciting!
Participants, researchers, citizen scientists, and other members of the public may use the online tool to learn more about the All of Us participant community and explore summary data. Later, researchers will be able to request access to more in-depth data for use in a wide range of studies that may lead to more customized ways to prevent and treat disease.
The program is said to run for 10 years. So will researchers be accessing the information for the remaining nine years? Or do you need to hit a certain number of people to begin making the information available?
The program launched their beta version of its interactive Data Browser, and later, more in-depth data will be available through the Researcher Workbench. Researchers seeking access to more in-depth data than the public Data Browser will need to register, complete researcher ethics training, and sign a data use agreement.
Just as diversity in participants and in data types is important to All of Us, so is the diversity in researchers. As a researcher, I’m looking forward to seeing what opportunities to advance precision medicine will be possible with the All of Us unique data set.
How and why will this help research? In what ways?
Building a diverse research cohort of one million or more people will enable researchers to conduct medical research that is more reflective of the diverse population of the United States. Nationally, the growth of the Hispanic population has remained consistent, and it is expected to reach 28.6% by 2060. The All of Us Research Program will advance precision medicine and ensure that no one is left behind in future studies—including the Hispanic community.
For more information, visit JoinAllofUs.org.
So often today, you turn on the news to see that another shooting has happened in the nation. They happen at schools, movies, concerts, nightclubs, grocery stores, shopping malls, and even in health care facilities.
Do you know what you would do if you were around when an active shooter event took place? David W. McRoberts, CPP, a retired Law Enforcement Captain with 30 years of experience, is a security consultant for The Sullivan Group, is the Owner of Assured Assessments, Inc., and is the co-author of the course “Active Shooter Event in a Healthcare Environment.” McRoberts says that instead of becoming a victim who says after such an event, “I couldn’t believe what was happening, and there was nothing I could do,” nurses need to know that “There is always something each of us can do—but we must have thought it through in advance.”
Develop These 3 Habits
McRoberts says that nurses should subscribe to the following personal protection skills as their personal safety habits:
- Situational Awareness: Knowing exactly where they are, where they are moving to or from, and what exists around them in terms of their realistic ability to react to occurrences in their presence.
- It Can Happen Anywhere: Nurses must acknowledge that bad things happen—and often without warning. McRoberts says that this doesn’t mean nurses need to become paranoid, but rather, understand that shootings can happen anywhere.
- See the Threat: He also states that nurses must develop the ability to look for and see threats—and suspend disbelief. “They must take the first two habits and merge them into an ironclad ability to not become paralyzed with shock and fear and fall victim simply because they never once even considered the fact that they would need to function in a moment of the gravest extreme,” says McRoberts.
Shots Fired: What Do You Do?
When asked about the first thing that nurses should do, McRoberts says, “Because nurses are professional caretakers with ethical, moral, and personal value-based responsibilities in the care of others, this is not an easy circumstance to navigate. Active Shooter Events on average last about two minutes. Shooter victims can be random or specific individuals that the shooter targets.
“With that as a baseline, I believe that creating or increasing what law enforcement refers to as the ‘reactionary gap’ is essential. Simply put, this is creating more distance and/or cover between themselves and the threat. That may mean temporarily leaving the immediate area of patient care. Nurses may feel they are abandoning their patients, but they need to remember that these events are over in about two minutes. The brutal truth is that when faced with a person bent on shooting and killing people, nurses who are determined to remain stalwart and immovable will, in all probability, become victims themselves and incapable of delivering patient care. It’s better to have moved away from the threat and then return to patients when the event is over.”
Do You Interact?
What happens next? Do nurses provide aid? Should they talk with the shooter? “There are as many different scenarios to Active Shooter Events as there are events themselves; they are very dynamic events. A nurse’s first reaction to an injury resulting from an Active Shooter Event would be to render aid. Perhaps this is the right thing to do—maybe this action will decentralize the shooter’s thought process enough to stop the carnage. But like so many reported Active Shooter Events, it may be that nothing stops the shooting and killing until and unless the shooter stops or is stopped,” explains McRoberts. “A nurse may believe he/she can reason with an active shooter, but attempting this may be a tactical mistake; interacting/talking with a person who has already decided to shoot, injure, and kill others is too risky. Begging for compassion from a shooter—including begging for their own life or the life of another—needs to be supplanted with fighting for their own life and the lives of others.”
Keeping a Clear Head
Unless you prepare before an Active Shooter Event occurs, it can be nearly impossible to keep a clear head. “Each of the previous skill developments build one upon the other to create a foundation of action items that give nurses the best chance to survive. With that as underlying support, the next step is practicing ‘stress inoculation’—not the clinical variety, but the very practical application of understanding our limitations as humans and what happens to us physiologically when we are under extreme stress,” says McRoberts.
“Tachypsychia, auditory exclusion, and fine motor skill erosion occur in everyone and diminish our abilities to function under stress. However, we can mitigate these negative effects and develop the ability to function through the high stress of an Active Shooter Event. In its most basic form, stress inoculation is the practice of very specific actions, movements, and functions. Consider what we would need to do in a high-stress event: see clearly what is happening; speak clearly to communicate; walk or run; dial a phone; etc. To complete tasks under stress, nurses need to practice them while under manufactured stress,” says McRoberts. “For example, a common situation in an Active Shooter Event might be finding and climbing stairs, and then dialing your cell phone and telling someone out loud your exact location. Nurses can practice speaking into a phone clearly and in a controlled manner while breathing at an accelerated rate from a brisk walk, run, or stair climb; they can test and challenge each other with random quizzing by unexpectedly asking a colleague exactly where they are located; and they can follow that up with asking them where they would move to for the greatest level of safety. These seem like extremely simple things, but it is practicing them in advance that is the secret to making them ‘simple.’ Once you know you can do these things, it creates a positive cascading effect of believing in yourself and your ability to complete these tasks under stress. Like anything else, the more we practice something, the better we get at it.”
McRoberts give these final tips to give nurses guidance as to what they should and shouldn’t do in an Active Shooter Event:
- Look for the threat and then react to it; don’t panic and freeze.
- Remember that this event will happen quickly and will only take about two minutes, but you will perceive it to be very long and protracted.
- Rely upon your new mindset, knowing that you can function through this event.
- Know exactly where you are (your surroundings) and where you must move to for safety.
- Know what to say to communicate to others, including what may be required by pre-established agency/facility protocols.
- Know that you may have to move more than once.
- Don’t try to negotiate or plead with an active shooter; you are better fighting for your life, not begging for your life.
- Know in advance that you may have to move away from patients temporarily to survive so you can be there to help them later.
- Know that when law enforcement gets to the scene, they will move quickly past everyone and everything to get to the shooter and stop them; this may mean moving past injured people, patients, colleagues, and you.