Travel health nursing

Travel health nursing is an emerging nursing specialty that promotes the health and safety of national and international travellers.[1] Similar to travel medicine, it is an interdisciplinary practice which draws from the knowledge bases of vaccines, epidemiology, tropical medicine, public health and health education. Throughout the recent years, it has become an emerging profession, increasing high in demand, due to the evolution of travel medicine in the last two decades[2]. The significance of a travel health nurse was recognised in 1996, hence additional education and training was provided to them in order to develop their service[3][2]. Moreover, travel health nurses are seen working in ‘private practice, hospital outpatient units, universities, the government, and the military’[2][1]. Since, the importance of travel health has been acknowledged, travel health nurses have more opportunities consisting leading roles, within the health care sector practices[4][2]. However, travel health nurses tend to face a number of conflicts amongst the GPs and patients in healthcare settings[5][6].

History

Travel medicine was developed over the two decades[5][3]. Its aim was to prevent all disease and illness during travelling and to provide ultimate care to travellers who are prone to risk[5]. It is now been evolving over the 30 years[5]. Overall it has been more acknowledged after it was seen being practiced in other healthcare settings such as ‘occupational health, college health clinics emergency departments, pharmacies and supermarkets’[5]. Moreover, along with the acknowledgment of travel medicine over several years, the importance of establishing travel medicine clinics has also been recognised in the healthcare department; considering prevention methods to improve morbidity and mortality[7]. Travel health nursing has been widely acknowledged in the United States throughout recent years[6]. In 1996, an international study confirmed that nurses play a significant role in providing health education to travellers[6].

However, they were not qualified and educated enough to fully succeed their roles. Hence, nurses demanded for more training order to be able to deliver a better service[3]. In 2004, when travel medicine got more recognised amongst 91 general practices, 97% of the health advisers were nurses, and 75% nurses worked while receiving higher level education and training[6].

Profession

Travel health nurses primarily work in travel health clinics, the military, the government, and some large ambulatory care practices[1]. Their work covers pre-travel care, with a focus on disease prevention and health promotion while patients are away from their home[2][8]. Travel health nurses assess the potential traveler's health and their destination risks in order to implement a plan of preventive care that can include immunisations and travel medications and supplies[1]. These nurses offer health counselling and education for prospective travellers along with education regarding how to manage their chronic conditions while away from home[1][6]. Often, referrals for care during travel is provided either for anticipated needs or in case of a health emergency[2][1][8].

Their Role

Health issues that are accompanied by travelling require more consideration, as they can be highly prevalent and bring detrimental consequences, causing further global issues[6][7]. Consequently, as a profession, travel health nursing has been emerged throughout the years and the need for more nurses in travel health clinics have increased rapidly[7][8]. In America, nurses who provide travel health care have been in demand and the number of nurses progressively increased[2][8].

Pre travel care

A pre travel care is required for which the nurses have to go through an evaluation for the health and safety hazards, along with constructing a customised plan of care, which covers ‘immunisations, travel medications and supplies, self-care counselling, and referrals’[2] [6]. Nurses start a pre travel assessment (phase 1) which includes all details of their travel health history (of a six-month period)[2][6] [9].These details include;

  • ‘Demographics: the client’s age, gender, country of birth’[2][9]
  • ‘Medications: prescription drugs, over the counter medicines, herbal medications’[2][9]
  • ‘Medical history: chronic health issues (heart disease, diabetes), pregnancy, surgeries, mental or psychiatric problems'[2][9]
  • ‘Allergies: vaccines, foods, medications, environmental triggers, anaphylaxis history'[2][9]
  • ‘Immunisation: documentation, vaccination dates, any adverse reactions’[2][9]
  • ‘Travel illness: any experience with trip illness or injury, experience with healthcare in other countries, first aid knowledge and experience using travel medications.’  [2][9]

Collecting this information can be a challenging task for a nurse, as most of the travellers come unprepared and are unaware about their health details[2]. After health history information is gathered, the nurse then completes information about the trip itself[2][9]. This information includes; .

  • ‘Destination: Every destination, including stops.’[2][9]
  • 'Duration of travel:  dates of departure and arrival as well how long the individual stayed at a particular destination’[9][2]
  • 'Type of travel: urban/rural, work related, backpacking, group, family holiday, or individual trip'[2][9]
  • 'Transportation: type of transportation and accommodation; hotel, camping houses, or hostel'[2]
  • 'Type of activities planned over trip:work or leisure, activities including water, contact with people and animals, and sexual activity.'[9][2]

After this, nurses have to go through the phase 2 of the pre travel health care, which is the trip planning. This phase includes research and risk identification. Using their expertise, nurses identify all the health risks that can be associated to this particular trip for the specific traveller. This is done by looking at all the primary factors that can be associated with risk such as; [2][9]

  • 'Unstable medical conditions: such as cardiovascular and respiratory issues, musculoskeletal problems, and mental health or psychiatric issues'[2]
  • 'Traveller age: younger and older travellers who are prone to disease more'[2][9]
  • 'Pregnancy: increases trip risk, first and third trimester are most prone to risk'[2][9]
  • 'Medication and drug use: certain medications (diuretics can increase risk). Alcohol use and illegal drugs are a threat to health and safety during travel'[2][9]
  • 'Destination: travelling to remote, rural, and underdeveloped destinations; travelling to destinations with lack of health and safety services'[2][9]
  • 'Trip duration: Longer trips associate with more risk'[2][9]
  • 'Season of travel: rainy and, dry seasons can be a risk for infectious diseases'[2][9]
  • 'Overseas work assignments: can result in occupational risks'[2][9]
  • 'Contact with local individuals: interaction with local residents, especially children, refugees, and ill individuals, increases the risk for infectious disease'[2][9]
  • 'Leisure activities: such as rafting, caving, mountain climbing, riding motorcycles, and scuba diving can increase the risk for trauma and accidental death'[2][9]

Finally, nurses start the phase three which is a pharmacological intervention[2].After phase two, the nurse is required to form a prevention plan for the traveller, which includes pharmacological and non-pharmacological measures that helps reduce risk[2] [9].This prevention plan consists of precautions to be consumed before after and during the trip, in order to prevent risk to the traveller’s health and safety[2] [9].During the process of recommending vaccines, the travel health nurse needs to take in account of the client’s medical history, immunisation history, age, pregnancy, allergies as well as date of departure, and trip duration[2] [9].The nurse also must evaluate the individual toughly before deciding on the schedule of dose requirements to minimise further risk and adverse effects.[2]

After this phase, the travel health nurse needs to cover phase four which is the final phase[2]. The fourth phase focuses on health education and health counselling[2]. Most travel health issues are not preventable by vaccines, therefore, with the use of statistics and educations nurses help travellers reduce risk while travelling. The nurses utilise different teaching methods (handouts, audio visuals, role play) which are practical and effective and helps them communicate with the traveller on a greater level[2]. Alongside teaching 10 different topics, the nurses focus on vehicle safety and air travel hazards[2] .Tourists tend to have major risk on the road than a local individual.[2] Poor road safety laws in foreign countries and signs in foreign language and drink driving can increase risk for car accidents and injuries[2].Moreover, air travel hazards are health conditions which a traveller experiences due to the duration of a long flight[2]. These include jet lag, travel thrombosis aeortitis, airborne illnesses and air rage[2].

Post travel care

Furthermore, nurses bound to take care of the traveller post travel as well[2] [9].Travellers who return from their trip with an injury or illness, are taken care of with a post travel treatment and diagnosis offered by the nurses[2] [9].In this phase, the travel health nurses are required to work with a team of specialists in infectious disease, dermatology, trauma, and gastrointestinal illnesses[2] [9]. Additionally, nurses also provide the traveller with trip support and professional development and management[2][9].

Scope of activities

Many travellers are at a risk for disease, which depends on the factors such as destination, season of travel, prevention measures used[2]. Chronic illness patients, people disabilities and pregnant women also travel, hence they are more at a risk of disease and illness while travelling. The travellers experience many health problems including jet lag, sleep disruption and other sleep related disorders. This is due to travel in between different time zones[10]. Other illness associated to travelling can be diarrhoea, food poisoning and other vector borne illnesses which can be a high risk; especially for people who are travelling in fatal conditions[10].Hence throughout the years, as travel health got more importance, travel health nurses got recognised more. They now have a leading role in hospitals, travel health clinics, occupational health departments and general practices.[4] Furthermore, there has been a global need for the expansion and growth for travel clinics. Establishment of numerous travel health clinics, alongside with employing travel health nurses, who are professionally trained and consistently supervised with a high level of expertise can result in successful travel clinic operations[7]. Therefore, travel health nurses are high in demand as they are needed to provide medical and health advice to patients post or pre travelling. In United States. travel health programs consisting with pre travel services. Advanced nurses also contribute to these services, as well as managing their own practices[2]. Moreover the availability of educational programs for travel health nursing is expanding and the services are developing as well[2]. Moreover, with travel health nurses working locally and regionally, the future of this profession is promising[2].

Prescribing medication

Although, pharmacology is an important component to study in order to achieve scope in a travel health nurses career, 95% or more travel health nurses have educational needs and are required to seek further education, in order to prescribe medicine[4][11]. Many travel health nurses desire to prescribe medicine to patients, although travel medicine is a complicated yet, growing area of medicine, therefore there are legal and occupational requirements for this process which causes occupational hazards[12] .These requirements include; travel health staff must be competent and qualified in immunisation, travel health and prescribing[11].

They are expected to have appropriate training, including all professional development in their personal development plan[7]. They must seek all their information from reliable, latest and recognised sources. They should understand the restrictions associated with prescriptions, patient group directions (PGDs) and patient specific directions (PSDs)[7]. They should be able to comprehend the principles of risk assessment and know how to apply them to the traveller[7].

Additionally, practitioners are under full responsibility whilst recommending, administrating or even prescribing vaccines/medicine, hence they have to be fully aware about the implications associated at all times[11].

Occupational Hazards

Travel health nurses have to face many challenges throughout their profession[7][2]. Travel health nurses from UK, japan and Australia were asked about their challenging times during their job[6]. Most of them stated that time was one of the main and most challenging difficulty encountered during their practice[6]. These ‘time issues’ were specifically, appointment timing, allocated times with the traveller, moreover the length of meeting administrative requirements was an issue as well[6].

Another challenge that is mostly face by travel health nurses is lack of educational opportunities, and accredited training programs takes additional fees including travel expenses[6][2]. Training and education also took time and was a challenge faced by the nurses[6]. The main barriers to further education for nurses was time, time off work and costs[6]. Practice nurses are expected to deliver care, yet they lack travel health training experience [6].Another occupational hazard nurses face daily, is problem patients[6]. Some patients fail to understand the seriousness of some situations that could result in poor consequences, if their advice is ignored or not followed[6]. Even worse ramifications can take place when these are vulnerable patients (chronically ill patients, pregnant women, infants or elderly)[6]. This disrupts the quality of health care[6]. Lack of financial support from employers is also seen as a barrier[6].Nurses usually have to work under a certain budget in order to meet standards of care, hence extra effort and hard work is required from the nurses[6][10]. Conflicts may occur between GPS and nurses coming across the knowledge and understanding of travel medicine in general.[6] Moreover, legislation issues are experienced during the need to prescribe medicine or vaccination[6].

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gollark: The power output is, really, very disappointing, though.
gollark: I have an excess of deuterium, though, and nothing to do with it.
gollark: Seems to be the case, according to my testing by moving a wire.
gollark: The power appears to be vanishing into the void. I suspect that the reactor is pushing into cables which aren't connected but are adjacent.

References
  1. "ATHNA: Travel Health Nursing Fact Sheet". www.athna.org. Retrieved 2 August 2018.
  2. Rosselot, Gail; Wachs, Joy E. (January 2004). "Travel Health Nursing". AAOHN Journal. 52 (1): 28–43. doi:10.1177/216507990405200110. ISSN 0891-0162.
  3. Steffen, Robert; DuPont, Herbert; Annelies, Wilder-Smith (2006-03-08). "Manual of Travel Medicine and Health". Journal of Travel Medicine. 11 (5): 337. doi:10.2310/7060.2004.19112. ISSN 1195-1982.
  4. Overbosch, Femke W.; Koeman, Susan C.; van den Hoek, Anneke; Sonder, Gerard J.B. (2012-10-01). "Dutch Travel Health Nurses: Prepared to Prescribe?". Journal of Travel Medicine. 19 (6): 361–365. doi:10.1111/j.1708-8305.2012.00660.x. ISSN 1195-1982. PMID 23379706.
  5. Barry, Michele; Blackburn, Brian (November 2009). "Travel Medicine, 2nd Edition Travel Medicine, 2nd Edition Edited by Jay S. Keystone , Phyllis E. Kozarsky , David O. Freedman , Hans O. Nothdurft , Bradley A. Connor Philadelphia, PA: Mosby Elsevier, 2008. 640 pp $169.00 (hardcover)". Clinical Infectious Diseases. 49 (9): 1461. doi:10.1086/630202. ISSN 1058-4838.
  6. Bauer, Irmgard; Hall, Sheila; Sato, Nahoko (July 2013). "Providing travel health care – the nurses' role: An international comparison". Travel Medicine and Infectious Disease. 11 (4): 214–224. doi:10.1016/j.tmaid.2013.04.004. ISSN 1477-8939. PMID 23702427.
  7. Sofarelli, Theresa A.; Ricks, Jane H.; Anand, Rahul; Hale, DeVon C. (2011-01-01). "Standardized Training in Nurse Model Travel Clinics". Journal of Travel Medicine. 18 (1): 39–43. doi:10.1111/j.1708-8305.2010.00478.x. ISSN 1195-1982. PMID 21199141.
  8. "Why Should I See a Travel Health Nurse? | Passport Health". www.passporthealthglobal.com. Retrieved 2020-05-29.
  9. The pre-travel consultation. (2020). Retrieved 29 May 2020, from https://www.racgp.org.au/afpbackissues/2007/200705/200705gherardin.pdf
  10. Sato, Atsushi (2019-10-02). "Travel Health Knowledge, Attitudes, and Practices Among Community Pharmacists in Japan". doi:10.20944/preprints201910.0015.v1. Cite journal requires |journal= (help)
  11. Umeed, Margaret (April 2010). "Prescribing vaccines in a travel health consultation". Nurse Prescribing. 8 (4): 161–168. doi:10.12968/npre.2010.8.4.47409. ISSN 1479-9189.
  12. Willcox, Adrienne; Ellis, Mike; Allen, Jackie (April 2006). "Travel health: a practical approach to post-travel consultations". Primary Health Care. 16 (3): 43–50. doi:10.7748/phc2006.04.16.3.43.c603. ISSN 0264-5033.
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