Dyson College of Arts and Sciences

As we talk about resilience in health care we can broach the topic from various perspectives: patient, provider, policymaker. In all of the frameworks and tools for disaster preparedness and resilience the perspective is the ecological perspective and the effect of individuals is often lost or rather the potential mass impact that an individual situation can have is undermined. Vulnerable or underserved populations often do not live in geographically isolated areas or in communities. This dispersion is yet another issue that is not addressed by current thinking. Recommendations: According to a study done in Sweden investigating migrants, findings indicate that trust in others, social participation and social determinants and social capital all had a positive or protective effect of risk factors on this population. Social capitol has been shown to promote resilience to factors impacting the mental health of this migrant population. This is an important strategy to incorporate into the planning for man-made or natural disasters (Lecerof, Stafström et al. 2015). The lessons learned in high-performing hospitals can also inform disaster/resilience planning. For example, by focusing on the following attributes that were found to be associated with the functioning of high-performance hospitals and are critical to preparing for the needs of persons of vulnerable/underserved populations: maintaining a proficient workforce, effective leaders across the organization, expertise-driven practice, and interdisciplinary teamwork (Taylor, Clay-Williams et al. 2015). The Role of the Nurse: Community and Public Health nurses (PHN) are in a unique position as their education, training, and professional experience inherently affords them the access to persons of vulnerable-underserved populations on a regular basis. Moreover, PHNs are familiar with both official and unofficial resources, facilities and services that provide care and access to health care for these populations. PHNs are also intimately familiar with both the in-patient and community-based clinical settings. Thus, the PHN is excellently poised to be an agent in the resilience of vulnerable/underserved populations. In Israel, nurses and other community based care providers receive roles that they are trained to fulfill in the case of an emergency or disaster. Their roles are not place dependent and they are based on their professional roles. The participation of health care providers in the case of emergency is mandatory. Assigning responsibilities and roles to active providers pre-disaster/emergency allows providers time to prepare and become familiar with populations and their needs. This also allows the members of a population to identify their point of access for direction during a time of great confusion as is inherent in any emergency or disaster. An example of the role of a PHN could have taken on is post Hurricane Sandy. During the days and weeks after the initial storm the pharmacies in many neighborhoods were closed. Persons who were on Methadone treatment were not able to access their prescriptions and subsequently sought illicit drugs to meet their need. This would not have been necessary had they had a PHN with whom they had had regular contact and knew that they could contact in the case of an emergency. 55

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