The Competencies of Disaster Nursing on a Scope of Emergency Department Essay

Introduction

The human kind tends to believe that it is the strongest on the planet. We create megalopolises, build factories, power plants, and dams, subjugate animals, and so on and so forth. Actually, we can control and predict many things. Nevertheless, that is only a huge illusion. There will always be one thing that is hard to predict and impossible to control. That is the nature. And a large number of disasters that regularly occur throughout the world is the greatest proof. Floods, hurricanes, tornados, earthquakes, volcanic eruptions, tsunamis – they always happen unexpectedly, and all that remains for us to do is to recover from the consequences. In addition to natural disasters, there also are manmade ones. If floods or hurricanes can be predicted at least for some time before they happen, terrorist attacks, for example, are much less predictable (Gebbie & Qureshi, 2002, p. 49). As a result, they are harder to prepare for. According to a study conducted by Markenson, DiMaggio, and Redlener (2005), the majority of the health care workers who participated in it admitted that they felt more prepared for natural disasters than for terrorism (p. 518).

It is hard to define a disaster, and probably there is no “single agreed-upon definition” of it, but all definitions address the events that cause the widespread destruction, lead to “human, material, economic or environmental losses” and make people unable to respond adequately using their own resources (World Health Organization and International Council of Nurses, 2009, p. 3). So, no matter if it is a natural disaster or a manmade one, it does have irreparable consequences. The most disturbing fact is that disasters happen more often presently. According to Birnbaum (2002), during the last fifty years, their number has been steadily increasing, and the biggest rise has happened in the last decade. In confirmation of this, World Disasters Report states that there have been 60% more disasters in the world in the last decade in comparison with the previous one (World Health Organization and International Council of Nurses, 2009, p. 3). The same report said that the number of victims increased by 20 percent, and the number of death almost doubled (World Health Organization and International Council of Nurses, 2009, p. 3).

All of this confirms the need to have a well-prepared and skilled workforce that will be able to respond effectively when a disaster comes. And out of all health care workers, “nurses are often the first medical personnel on site after disaster strikes” (World Health Organization and International Council of Nurses, 2009, p. 4). They assist in providing first aid to sufferers, rescue lives, and help people to overcome both physical and psychological issues. They are the first responders, and that is especially true about the nurses of emergency department since EDs are overloaded with victims in times of disasters. That is why nurses should be aware of how to act at any stage of disaster management, starting with preparedness and ending with a recovery phase (Gebbie & Qureshi, 2002, p. 47). This paper examines the core competencies of disaster nursing, including competing issues in this matter, discusses those on a scope of an emergency department, talks about ethical practice and nurses’ ability to response and finally gives a conclusion with my own perspective on the problem.

Competencies and Competing Issues

Competencies in General

The term competency refers to the behavior of an individual who performs a specific role in a certain situation (Loke & Fung, 2014, p. 3290). In other words, it can be defined as “a combination of the knowledge, skills, abilities and behavior needed to carry out a job or special task” (Loke & Fung, 2014, p. 3290).

In their article, Gebbie & Qureshi (2002) identify several core competencies to be followed by nurses and their departments. First of all, a health care center, a department or a unit should decide what tactic to choose when a disaster strikes. In other words, it is necessary to determine if the range of provided services will change or if a unit will function as usual. For instance, when a disaster happens, nurses can either stay at the hospitals and perform their routine services or go to the hotspots, evacuate people and provide first aid. Secondly, “well-orchestrated teamwork” is necessary (Gebbie & Qureshi, 2002, p. 48). Everyone should know their role and place and be aware of the planning and logistics. Otherwise, it will be impossible to respond quickly and efficiently. Thirdly, every nurse should be familiar with the concepts of a disaster response plan and know where it can be found. Apparently, they should know all of the core aspects before a disaster happens.

The next step to think about is the gap between knowledge and practice. Nurses should not only be taught what to do if a disaster arises – they should be taught that in practice. A disaster response plan has to be tested. For example, there is an issue of equipment. All nurses are already well familiar with the equipment, which they use from day to day, but in the case of a disaster they will probably be required to use another, unfamiliar one. To avoid the mistakes connected with this, nurses should be taught how to use it in advance.

Particular attention should be paid to communication equipment. Communication failures are crucial, and they have already made the consequences of many disasters even more complicated. The prime example is Hurricane Katrina. The communication systems failed, which is why local and state governments could not deliver the resources to the places where those were needed: for example, they had buses to evacuate people, they just did not have those in the right places. As a result, many people were not evacuated in time, and that caused more injuries and deaths. Another example is a terrorist attack on September 11, 2001. The evacuation orders were sent to both police and firefighters; police heard the order, but the equipment the firefighters used could not receive it (Peha, 2007, p. 61). Consequently, although they had enough time to evacuate (nearly half an hour after the first order was transmitted), they did not, and 121 lives were lost (Peha, 2007, p. 61). Communication failures cause a slow reaction, higher levels of stress, loss of critical thinking skills, an inadequacy of decision-making, and, as a result, the mistakes, which a person would have never made in other circumstances. An emergency department operates just like any other organization, and poor communication affects it as well. However, in this case, it will cost more people’s lives. Not all nurses are familiar with the communication equipment, which is why all of them should be taught how to use it beforehand.

Finally, no matter how well you are prepared and how well you know a disaster response plan, many things will go out of control, and many ethical issues will arise. That is why the most important competencies in the case of a disaster are the problem-solving skills and critical but flexible thinking. For instance, if communication systems have already failed, all that remains to do is to try to find the alternatives, up to use a runner to send a message.

Competing Issues of Competencies

Considering all of this, two most important competing issues of competencies can be identified. Those are the education of nurses and their experience in managing disasters. Both of them are equally important.

Education

Since presently there are no accepted standards of how to teach students to handle disaster management, the first competing issue is education (Hsu et al., 2006, p. 2). Firstly, some nursing schools simply do not have such an option. As the research conducted by Usher and Mayner (2011) revealed, very few Australian schools that took part in the survey included the disaster nursing content in their curricula. Besides, even those that did include it focused more on the theory, not practice. Hsu et al. (2006) state the same – they say that the majority of the currently taught practices in this area are “neither evidence-based nor standardized” (p. 1). Weiner, Irwin, Trangenstein, and Gordon (2006) proved with their study that the number of hours that educational establishments offered on the topic of disaster preparedness and management actually did not change over the years, despite “the accelerated pattern of worldwide terrorism” and “the magnitude of recent natural disasters” (p. 338). They also identify several reasons for that to happen. First of all, nursing school curricula is already overloaded (Weiner et al., 2006, p. 338). And secondly, there still is a deficiency of literature in the area of disaster management, which can be proven by the fact that almost the half of the study participants say that they get the information on the websites, and 44% say that they read journal articles; only 37% use books (Weiner et al., 2006, p. 338). However, nurses definitely should be provided with appropriate training programs, since otherwise it will be impossible for them to respond to disasters quickly and efficiently.

Experience

Although education is crucial, it is still not enough. As Saifan, AbuRuz, and Masa’deh (2015) write, there is always “a clear gap between what is taught in the classroom and what the student nurses experience in the clinical area” (p. 20). To preserve critical thinking, resist stress and be able to make right decisions during a disaster, an experience is essential. According to the survey conducted by Loke and Fung (2014), more than 80% of nurses who took part in their study admitted that they had zero experience in disaster management and response (Loke & Fung, 2014, p. 3290). In addition to this statistic, the authors also revealed the competencies that turned out to be the most neglected in this case. The majority of nurses did not know their particular roles in disaster management, were not aware of their task to prepare people for disaster and did not prepare for it correctly by themselves (Loke & Fung, 2014, p. 3301). They also did not understand the nature of a disaster, did not train their communication skills and could neither identify vulnerable populations nor help them psychologically (Loke & Fung, 2014, p. 3301). And this list can be greatly expanded. However, the most important reason why untrained nurses are not prepared for working during a disaster is that they are not ready for it physiologically by themselves. Lia, Turalec, Stoned, and Petrinia (2015) described the experience of fifteen unprepared register nurses providing the health care after Wenchuan Earthquake. As the authors stated, they were “certainly naive about what to expect after a large earthquake” (Lia et al., 2015, p. 47). They had to deal with ethical issues, sometimes even decide who should and who should not receive the health care, work in resource-limited settings, critically and quickly make hard decisions. Even when the participants were interviewed five years after their experience of the Wenchuan Earthquake, they still were very emotional about it.

Expanded Scope of Practice

Presently, the idea of the expanded scope of nursing practice becomes more and more attractive. The scope of practice can be defined as a set of actions and roles, which a healthcare practitioner (in this case, a nurse) has the right to undertake; accordingly, an expanded scope of practice refers to a broader range of those roles and actions (Lowe, 2010). By broadening the range of tasks that nurses can perform, emergency departments can increase their productivity, decrease the waiting time for patients, provide more time for doctors to accurately cure acutely ill people, and even improve the patients’ outcomes (Expanding the scope of practice of nurses in emergency departments, n.d., par. 10). This approach can help to deal with an increasing demand for the healthcare, as well as nursing and physician shortages. Additionally, it can be helpful in the case of disasters since those usually require the healthcare practitioners to expand the range of tasks they perform in their day-to-day duties. As the proof, Menon et al. (2012), who are physicians and nurses, describe their experience of responding to the earthquake in Haiti in 2010. They admitted that they had to expand their scope of practice greatly to help those critically injured victims. If nurses train to do this in advance, they will be more prepared and physiologically ready for big loading and critical tasks during a disaster. In such a case, emergency departments will be able to provide their services to sufferers quicker and better, which will save many people’s lives. Gebbie and Qureshi (2002) state that emergency departments are usually better prepared for disasters than other care facilities (p. 46). Particularly, the ED nurses know both the concepts of a disaster response plan and their roles in it. However, even that will not be enough when a disaster strikes, so the programs aimed to expand nurses’ roles beforehand indeed are useful.

Ethical Practice

When a disaster arises, an ethical issue becomes one of the greatest concerns, which is why it should also be addressed in this paper and taken into account when it comes to the core competencies. The point is that during a disaster, nurses should be concerned about the greater good and the well-being of the majority rather than about the benefit of one particular person. Besides, in the view of scarce resources and supplies, an enormous number of sufferers and a very limited number of physicians and nurses who are willing to work in conditions of a disaster, does the American Association of Nurses Code of Ethics still work in the same way? That is doubtful. During a disaster, nurses sometimes have to reuse the supplies, which would have been discarded in other situations, or provide only a partial care to a patient because the resources are scarce. Obviously, any of this actions can be considered as right in other circumstances but “ethics are certainly not black and white, and in a disaster situation, they become even more blurred” (Brewer, 2010, p. 3).

Another significant issue is the following. Nurses, physicians, and other frontline workers manage to save many lives when a disaster strikes. However, they also worry about their own health and the well-being of their families. The question is should the priority of evacuation or treatment be given to the families of those working on the front lines? If nurses do not have to care about the safety of their families, they will be more concentrated on work and will help more people. Besides, that will increase their willingness to help during a disaster. Indeed, as Qureshi et al. (2005) claim, there is a big difference between an ability and willingness to respond to a disaster, and such factors as fear for children, parents or disabled family members significantly reduce the willingness to respond. Schroeter (2008) states that every nurse should decide from the very beginning what level of risk she can possibly accept and under what conditions she is willing to respond to a disaster. For the same reason, they should be involved in the development of disaster response plans since that is how they can suggest their own ideas and be sure that ethical dilemmas they are concerned of are taken into account. Chapman and Arbon (2008) also prove that this will be helpful since according to their findings, Australian nurses are not satisfied with the way how disaster plans are developed and implemented.

Ability to Response

With all of this in mind, it can be concluded that the nurse’s ability to quickly and adequately respond to disasters is determined by three following factors: physical, mental, and physiological readiness for it.

Firstly, nurses should be well-trained and in good physical shape to be ready to deal with a massive influx of wounded and perform their duties as quickly as possible. Secondly, mental characteristics are crucial. This group includes such factors as an education, a level of experience, abilities to think both critically and creatively and be flexible in decision-making. Finally, as the study conducted by Lia et al. (2015) proves, physiological readiness is essential. People who are not physiologically prepared for disasters and their consequences have wrong expectations and can hardly be able to resist stresses or make right decisions. This factor is imperative when it comes to ethical dilemmas – it is very easy to make the wrong choice here, and psychological instability will only contribute to that.

The absence of any of these factors will affect the remaining ones, which is why all of them in the complex are necessary to deal with disasters.

Conclusion

Both natural and manmade disasters have devastating consequences and lead to large-scale environmental, economic, material, and human losses. Disasters are hard to predict and control, and what is even more disturbing, they happen more often presently. During the last fifty years, their number has been increasing, and the biggest rise could be seen in the last decade (Birnbaum, 2002). Since nurses play a significant role in every stage of disaster management, from preparedness to the recovery phase, and since an emergency department is the first place where sufferers are usually taken, the ED nurses should be aware of every core competency of disaster nursing.

Among other things, nurses should know the ED tactic in the case of a disaster and the concepts of a disaster response plan in advance. They should also clearly realize their own roles and do their best to provide “well-orchestrated teamwork” (Gebbie & Qureshi, 2002, p. 48). In addition to knowing their tasks, they should practice those; for example, they should train to use unfamiliar equipment, paying particular attention to communication equipment.

The most important competing issues in preparing for a disaster are the education of nurses and their experience. Presently, not all nursing schools provide enough content regarding disaster management, and even those that do rely more on theory than practice (Hsu et al., 2006, p. 1). In addition, the majority of nurses do not have any experience in this area, which results in wrong expectations and psychological unpreparedness (Lia et al., 2015).

Finally, no matter how good a nurse is educated and prepared, disasters are uncontrolled. They demand nurses to expand their scope of practice and perform duties, which lie outside their usual domain. Ethical issues that inevitably arise in times of disasters are even more complicated. I am deeply convinced that nurses are able to adequately respond to disasters only if they are ready for them physically (in good physical shape, well-trained), mentally (well-educated, have experience, can think critically and find flexible solutions), and psychologically (stress-proof, ready for ethical dilemmas). Additionally, nurses should also be involved in the development of disaster response plans because that will increase their willingness to help during a disaster.

References

Birnbaum, M. L. (2002). Disaster medicine: status, roles, responsibilities, and needs. Prehospital and Disaster Medicine, 17(3), 117–118.

Brewer, K. (2010). Who will be there? Ethics, the law, and a nurse’s duty to respond in a disaster. Web.

Chapman, K., & Arbon, P. (2008). Are nurses ready? Disaster preparedness in the acute setting. Australasian Emergency Nursing Journal, 11(3), 135-144.

Expanding the scope of practice of nurses in emergency departments. (n.d.). Web.

Gebbie, K., & Qureshi, K. (2002). Emergency and Disaster Preparedness: Core Competencies for Nurses. The American Journal of Nursing, 102(1), 46-51.

Hsu, E. B., Thomas, T. L., Bass, E. B., Whyne, D., Kelen, G. D., & Green, G. B. (2006). Healthcare worker competencies for disaster training. BMC Medical Education, 6(19), 1-9.

Lia, Y., Turalec, S., Stoned, T. E., & Petrinia, M. (2015). A grounded theory study of ‘turning into a strong nurse’: Earthquake experiences and perspectives on disaster nursing education. Nurse Education Today, 35(9), 43-49.

Loke, A. Y., & Fung, O. V. M. (2014). Nurses’ Competencies in Disaster Nursing: Implications for Curriculum Development and Public Health. International Journal of Environmental Research and Public Health, 11, 3289-3303.

Lowe, G. (2010). Scope of emergency nurse practitioner practice: where to beyond clinical practice guidelines? Australian Journal of Advanced Nursing, 28(1), 74-82.

Markenson, D., DiMaggio, C., & Redlener, I. (2005). Preparing Health Professions Students for Terrorism, Disaster, and Public Health Emergencies: Core Competencies. Academic Medicine, 80(6), 517-526.

Menon, A. S., Norris, R.L., Racciopi, J., Tilson, H., Gardner, J., McAdoo, G.,…Auerbach, P.S. (2012). The expanded scope of emergency medical practice necessary for initial disaster response: lessons from Haiti. Journal of Special Operations Medicine, 12(1), 31-36.

Peha, J. M. (2007). Improving Public Safety Communications. Issues in Science & Technology, 23(2), 61-68.

Qureshi, K., Gershon, R. R. M., Sherman, M. F., Straub, T., Gebbie, E., McCollum, M.,…Morse, S. S. (2005). Health Care Workers’ Ability and Willingness to Report to Duty During Catastrophic Disasters. Journal of Urban Health, 82(3), 378-388.

Saifan, A., AbuRuz, M. E., & Masa’deh, R. (2015). Theory Practice Gaps in Nursing Education: A Qualitative Perspective. Journal of Social Sciences, 11(1), 20-29.

Schroeter, K. (2008). Nurses, Ethics, and Times of Disaster. Perioperative Nursing Clinics, 3, 245-251.

Usher, K., & Mayner, L. (2011). Disaster nursing: A descriptive survey of Australian undergraduate nursing curricula. Australasian Emergency Nursing Journal, 14(2), 75-80.

Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency Preparedness Curriculum in Nursing Schools in the United States. Nursing Education Perspectives, 26(6), 334-339.

World Health Organization and International Council of Nurses. (2009). ICN Framework of Disaster Nursing Competencies. Web.