Travel health nursing

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].

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 with 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].

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].

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].