NSG 323 Unit 6 disaster preparedness role analysis example

The Public Health Nurse's Role in River Flooding: A Phase-by-Phase Analysis for One Midwestern County

Student Name

Department of Nursing, Herzing University

NSG 323: Community and Public Health Nursing

Instructor Name

February 24, 2026

The Public Health Nurse's Role in River Flooding: A Phase-by-Phase Analysis for One Midwestern County

The Community and Its Hazard

The setting is a composite county of about 85,000 people along a Midwestern river, with one small city and several farm towns. The county emergency management agency's hazard vulnerability assessment ranks riverine flooding first among its hazards, ahead of tornadoes and severe winter storms, based on frequency and on how many residents live in the floodplain. In the most recent major flood, about 1,200 residents were displaced for up to three weeks, two shelters operated for 19 days, and the county's only dialysis center closed for four days. The floodplain includes a mobile home park of about 140 units, a senior apartment building, and an encampment of people experiencing homelessness on the riverbank.

This analysis examines what a public health nurse at the county health department does across the four phases of this hazard: mitigation, preparedness, response, and recovery. Much of the nursing work falls outside the response phase, before the water rises and after it recedes.

What Floods Do to Health

The health effects of flooding extend well beyond drowning. A systematic review of floods and human health found effects including injuries, infections, and mental health problems, with some of these continuing for months or years after the water recedes (Alderman et al., 2012). In this county, the specific concerns from the last flood were interrupted care for people on dialysis and home oxygen, carbon monoxide exposure from generators used indoors, wound infections during cleanup, and anxiety and depression among displaced families, several of whom lived in shelters for the full 19 days.

The Nurse's Work by Phase

The table summarizes nursing contributions in each phase for this hazard specifically.

Where Nursing Sits in the Command Structure

When the county activates its emergency operations center, it uses the Incident Command System, the standard structure that defines who reports to whom in an emergency (Federal Emergency Management Agency [FEMA], 2017). Public health and medical services form one emergency support function, led in this county by the health department. During a flood, the public health nurse is not in command. The nurse is assigned to the shelter health station, which falls under the mass care branch of the operations section, and reports to the shelter manager for shelter matters and to the health department's liaison for clinical matters. Knowing this reporting line in advance matters: in the last flood, shelter nurses described receiving conflicting instructions from the shelter operator and the health department because the line had not been clear.

The Response Phase in Practice: The Shelter Health Station

The response work is concrete and repetitive. As each household arrives at the shelter, a nurse or trained volunteer asks a short set of questions: current medical conditions, medications and whether the person brought them, equipment that needs power, dialysis schedule, pregnancy, and anyone in the household who needs help with daily activities. Residents who need more care than a general shelter can safely provide, such as someone on continuous oxygen without a power source or a person needing help with every transfer, are referred to the county's medical needs shelter at the hospital's conference center. The station keeps a log of every health contact so that the next shift can follow up and so that the health department can see patterns, such as a cluster of diarrheal illness that might signal a water or food problem in the shelter. The nurse also watches the shelter itself: crowding, handwashing supplies, food storage, and how people are coping, since distress among displaced residents often surfaces at the health station before anywhere else.

Vulnerable Groups and What Each Requires

Residents on dialysis, about 60 in the county, need a plan for treatment at another center if the local one closes, and a way to get there; the dialysis center's own emergency plan will be reviewed jointly. Residents on home oxygen or other electricity-dependent equipment need backup power or early evacuation; the health department's list, built from the electric utility's medical priority program and home health agencies, is updated each March. Older adults in the senior apartment building need an evacuation plan that accounts for the building's single elevator. Residents of the mobile home park, many of whom speak Spanish, need warnings in Spanish through channels they use, which the park's residents' association has offered to help identify. People living in the riverside encampment receive no warnings by phone or television, so outreach workers will visit the camp when a flood watch is issued.

Capabilities and Gaps

Existing strengths: a tested shelter plan, a trained volunteer pool of 24 nurses from the local hospital and retirees, and good relationships with the emergency management agency. Gaps identified from the last flood's after-action report: shelter medication supply was inadequate for people who evacuated without their medications; there was no process for obtaining emergency prescription refills on weekends; the Spanish-language warning reached the park late; and no one was assigned to follow up with displaced families after the shelters closed. Nursing preparation for disasters, including knowing one's role and the plan, is a professional expectation, not an optional extra (Veenema, 2018).

Recommendations for the Nurse's Next Year

First, work with the regional pharmacy association on a weekend refill process for sheltered residents before the spring flood season. Second, build the Spanish-language warning pathway with the residents' association and test it in April. Third, add a recovery nursing task, visits to displaced families at two and eight weeks after return, to the plan, with a named lead. Fourth, run a tabletop exercise with shelter volunteers that includes the reporting line. Each of these falls in preparedness and recovery, the phases where nursing work most changes how a flood affects people's health.

References

Alderman, K., Turner, L. R., & Tong, S. (2012). Floods and human health: A systematic review. Environment International, 47, 37-47. https://doi.org/10.1016/j.envint.2012.06.003

Federal Emergency Management Agency. (2017). National incident management system (3rd ed.). U.S. Department of Homeland Security.

Veenema, T. G. (Ed.). (2018). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards (4th ed.). Springer Publishing.