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Case Study #1

Gina Marie, RN, worked in the emergency department (ED) of a major hospital system in a large city in the Midwest for almost 1 year when, during her shift in the ED, a multistory downtown office building was bombed in a terrorist attack. As soon as the hospital determined that a major disaster had occurred, the hospital's emergency operations plan was activated. Fortunately, less than 1 month before the bombing occurred, Gina had participated in a large-scale disaster drill conducted by the hospital in partnership with agencies from across the city, including the fire department, the police department, and the city's emergency operations center. Although extremely frightened, Gina knew exactly what to do, and went to work in her assigned role to triage victims who were coming into the ED. Gina knew that the entire hospital staff was more successful in managing the disaster and helping victims because of the well-coordinated emergency operations plan (EOP) that was in place and that all staff thoroughly understood the plan.

 More recently Gina has moved to another state and has accepted a nursing position in the outpatient clinic of a large academic medical center. As part of her orientation Gina asks her supervisor about the facility's EOP and the supervisor replies, "I am sure we have a written plan in the policy manual, but I really don't know much about it. This is a very safe community, so we don't need to worry about anything happening here. And besides, if something did happen, the victims would go to the hospital, and it would not affect us." This response from her supervisor leaves Gina feeling very concerned. After experiencing first-hand the reality of a terrorist attack and witnessing the need for all community agencies to work together in the event of a major disaster, Gina decides to get involved in helping the clinic understand the importance of having a good EOP that is coordinated with the hospital and other community agencies; she also volunteers to help coordinate a community-wide disaster drill to test out the plan. Think about Gina's situation as you consider the following questions:

1.     When might nurses in an ambulatory clinic be considered "first responders"? 

a.     In the event of a shooting at the local school

b.     In the event of a biologic event/ transmission 

c.     In the event of a natural disaster

d.     In the event of a local bombing

Case Study #2

The lack of a community EOP has always been a concern for members of the Greenbrier County Health Department; however, until recently the budget did not support the development and implementation of a community-wide plan. Thanks to funding from the Department of Homeland Security, the health department now is in a position to develop a community-wide EOP. Gary Gage, a nurse at the health department for 8 years, is placed in charge of plan development. Gary is aware of The Joint Commission's (TJC) expansion of its traditional disaster preparedness standards to encompass the entire community and its resources; therefore, Gary decides to begin the planning process with a more thorough examination of TJC recommendations. According to the standards, an EOP requires a community state of readiness, engagement, and cooperation of various federal, state, and community agencies. To determine the community's state of readiness, engagement, and cooperation Gary decides to use the nursing process to establish a plan.

1.     What are the steps of the nursing process that Gary would use?

a.     Diagnosis, planning, assessment, implementation, evaluation

b.     Evaluation, diagnosis, planning, assessment, implementation

c.     Assessment, diagnosis, planning, implementation, evaluation 

d.     Evaluation, assessment, diagnosis, planning, implementation  

Case Study #3

Matt is a new nursing graduate and has just completed a 3-week orientation to a medical-surgical unit in a small rural hospital. After orientation ended, he switched to the night shift as his regular shift, working 7 pm to 7 am. After 1 week on night shift, his assignment is to care for 10 patients because one of the scheduled nurses has called in sick. Matt is concerned about being responsible for this many patients because he has only had 6 patients during orientation with his preceptor. The charge nurse assures him that she will be available to help if he should have questions. In addition to Matt and the charge nurse, the floor is staffed with two unlicensed assistive personnel (UAP) for the census of 20 patients.


Matt receives orders for a patient to receive 2 units of packed red blood cells at 10 pm. The charge nurse has received an admission from the emergency department but helps Matt with the process of checking the blood. While the first unit is infusing, one of Matt's patients is experiencing increased confusion and is calling out loudly. The patient is also trying to get out of bed. The UAP working with Matt is attempting to calm the patient and keep her safe but is having difficulty. Matt administers a PRN sedative for the confused patient, and then obtains the second unit of blood. After starting the second unit of blood at 2 am, Matt makes rounds on his other patients. He finds the UAP assisting the confused patient back to bed after finding her on the floor crying and holding her leg. He calls for the charge nurse, but she responds that she is unable to help at this time. Matt performs an assessment on the patient and asks the UAP to stay with the patient while he calls the health care provider. An x-ray is ordered for the patient, so Matt makes arrangements for this and then checks on his transfusion patient.


When Matt's preceptor arrives for the day shift, he tells her, "This is more than I can handle. I need to rethink nursing because this isn't anything like it was in school. I didn't have any help, and I've never had to care for this many patients. I don't want to work like this. I'm going to try to get my charting done and get out of here. Maybe I need to work somewhere else."

1.     What phase of reality shock is Matt experiencing?

a.     Recovery

b.     Resolution

c.     Rejection

d.     Honeymoon  

2.     Which of the following would Matt be considered?

a.     Rutter

b.     Runaway

c.     Native

d.     Burned out

3.     What strategies would help Matt? (Select all that apply)

a.     Organizational skills 

b.     Assertiveness skills 

c.     Communication skills

d.     All of the above

Case Study #4

You are on a disaster relief team that was immediately sent to the site of a tsunami. Your team is the first one on the ground since the disaster occurred. Debris is everywhere and getting around is difficult. Local help is not available because they cannot access the area where your team was air lifted into.

1.     What stage of a disaster is your team in?

a.     Preparedness

b.     Response

c.     Recovery

d.     Discovery

2.     What is the first action of the team?

a.     Scene assessment 

b.     Triage

c.     Crisis management

d.     Disaster condition

3.     You are working with a small team to check for survivors under the rubble. Your team finds a small child with crushing injuries. The child is carefully moved to the central location where treatment tents have been set up. The doctor assess the child and puts a blue tag on him, indicating that he will not treat him aggressively. What is your response?

a.     Argue with the doctor that he should do everything possible

b.     Take care of the child yourself since the doctor won't

c.     Go back to finding other survivors 

d.     Offer to find supplies elsewhere

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Case Study #1 Gina Marie, RN, worked in the emergency department (ED) of a major hospital system in a large city in the Midwest for almost 1 year...
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