Introduction
The role of nurses is changing in the healthcare facilities. According to Stangeland (2010), nurses were traditionally regarded as assistants to medical doctors who were expected to follow instructions on how to handle patients in different settings. However, this role is changing as nurses find themselves in situations where they have to make critical decisions to save lives of their patients. The emergency department is one of the areas where nurses are increasingly getting engaged, especially due to the increasing number of patients that has already overwhelmed doctors in many hospitals within the country. Nurses are now expected to offer specialized care to the patients at the emergency departments to reduce pressure on the doctors. Yamamoto (2013) says that nurses can only be effective at the emergency departments if they have some core competencies in disaster nursing. They must have the right skills and knowledge on how to respond to different emergency cases and save the lives of patients in critical conditions at different stages.
Nurses may be expected to offer care to patients before they can be transferred to other departments to receive specialized care from the doctors. In other cases they are assigned the role of caring for patients who have just received specialized care but still need close monitoring to ensure that their conditions improve. That is why Australian Nursing Council Canberra came up with core competencies that all nurses working in the emergency departments are expected to have (Loke & Fung, 2014). The scholar notes that sometimes core competencies may vary depending on whether a nurse is practicing at a local, regional, or national level within Australia. In this paper, the researcher will review the relevant literatures to explain the competing issues of competencies, expanded scope of practice, ethical practices, and ability of the nurses to respond effectively in such demanding environments.
Competing Issues of Competencies
The changing role of nurses has forced the scholars and practitioners to engage in extensive researches in order to help explain the new position that nurses currently hold in hospitals and how their competencies can be enhanced to ensure that they can deliver quality service to the clients. Kako and Migani (2010) say that nurses at the emergency department always find themselves under pressure to deliver quality services within the shortest time possible. Their ability to make the right decisions at the right time may mean life or death to their patients. They always find themselves under pressure to deliver quality service to their patients as fast as possible and in the most precise manner. That is why scholars have engaged in massive research to help explain some of the core competencies of nurses within this department. Jose (2010) says that nurses are ethically required to respond to any emergency medical need that may occur from time to time. When defining the core competencies for disaster management, nurses are expected to explore almost all the critical issues in the emergency department because it is never known which form of disaster may strike (Loke & Fung, 2014).
In the recent past, some parts in Australia experienced flashfloods due to excessive rainfall. The September 11, 2001 terrorist attack in the United States was another serious disaster that needed emergency attention of the nurses. In 2012, Sierra Leone had a major cholera outbreak, which was a major disaster in the country. After a couple of years, Ebola hit the country and other neighboring states such as Nigeria (Baack & Alfred, 2013). A major outbreak of any disease, including lifestyle diseases, should always be considered a disaster that calls for efficient response from the medical practitioners. This means that the term disaster management in the field of nursing cannot be narrowed to a specific issue such as accidents. It has to be viewed from a broad perspective where the medical teams within a given healthcare facility are forced to address a sudden surge of patients who need emergency care to save their lives. In this section, the researcher will look at the core competencies that modern nurses are expected to have in order to work in the emergency departments.
Managing patients’ health in cases of emergency
According to Wynia (2007), nurses at the emergency department are expected to manage the illness status of their patients before they can be taken for specialized treatment. The nurse will collect the primary information about the patient such as determining the health needs by taking account of the disease history and conducting basic screening. Some of the patients may need basic physiological and psychological care as soon as they are brought at the emergency department. Desimone (2009) says that in many cases, the critically injured patients may need some form of psychotherapy before they can start specialized treatments. They may need the assurance that they will actually make it through all the stages. This is one of the most important roles of nurses at the emergency care. As they offer basic care while preparing the patients for specialized treatment, they should identify the fears of the patients and address them so that they can have psychological strength to undergo various specialized processes. Sometimes the nurse may need to address all the concerns of the family members, especially those that have accompanied the patient to the hospital. They may be worried about the condition of their patient and this may affect the psychological stability of the patient. Ensuring that they are comfortable will enable them to cheer their patient as he or she is prepared to undergo various corrective medications.
Nursing Education and competencies
Disaster preparedness needs sufficient training for the nurses to equip them with the necessary skills and core competencies. According to Adams and Berry (2012), disaster management is different from other normal tasks done at a healthcare clinic. Nurses working at the emergency department during cases of disaster will need special skills to ensure that their speed and precision is very high. Speed is necessary to ensure that maximum number of patients can be attended to within the shortest time possible. Precision is needed to ensure that tasks done by these nurses when handling patients are within the set standards. It also avoids cases where their tasks have to be redone by other experts because this will not only cause more pain to the patient, but also waste resources that should be used on another patient. According to Jakeway, Larosa, Cary and Schoen¢sch (2008), ICN framework is one of the major steps needed towards improving the core competencies of the nurses to work in emergency departments during cases of disaster. This should be introduced in the nursing curriculum to prepare nurses to work such demanding environment. It enables the nurses to understand the working environment when responding to the disaster.
Developing a positive attitude at workplace
According to a research by Adams and Berry (2012), nurses working in disaster management areas always face stressful situations that they have to deal with when delivering their service. Sometimes the patients or their family members may fail to appreciate the pressure under which these nurses are working. They may become excessively demanding or sometimes even abusing. Nurses need a strong will power to overcome such stressful conditions. If they fail to manage their anger, then they can easily fall apart and engage in unethical practices that do not befit their profession. That is why they need to develop a positive attitude that can keep them motivated even when things do not work as per their expectations. In some cases, these nurses may be expected to work for extra hours depending on the nature of the disaster. As Jose (2010) says, it is the ethical responsibility of the nurses to serve clients who need emergency services even if this means working for extra hours. The need to work for longer hours is unavoidable for these nurses, but they need a positive attitude towards their work to do this.
The need for nursing experience in disaster management
Core competencies for nurses responding to cases of disaster may go beyond training. New nurses working in clinics have the opportunity to work as a team without much pressure, making it easy to learn concepts in a practical setting. In the clinics, these new nurses can consult with their experienced colleagues in cases where they are not sure about what they should do. Nurses working in emergency department in response to a disaster do not have this luxury. According to Adams and Berry (2012), disaster management requires experienced individuals who can work with almost no supervision. Almost all the staff members are always engaged during such situation. This means that everyone must know what should be done based on some years of experience. That is why nurses sent to the emergency department to respond to cases of emergency must be experienced. They must know what should be done and how it should be done to save lives of patients.
According to Jakeway, Larosa, Cary, and Schoen¢sch (2008), experience may not necessarily mean several years of working with the emergency department or responding to disaster cases. Proper training and regular exposure to disaster management cases during training may be of great help. It is rare for nurses who are in training to be sent to help in response to a disaster. Most often, they are sent to clinics and other settings where there is little pressure at work. This limits their experience when it comes to dealing with cases of emergency. It is important to start exposing nurses to these stressful environments as early as possible, most preferably when they are still in college. This way, they will have some knowledge of what should be done in cases of disaster response. Jose (2010) says that such trainees may be send to undertake unspecialized tasks, working very closely with the nurses. This will equip them with the knowledge about disaster response.
Nurses ability to respond to specific emergency issues
According to Wynia (2007), many scholars have considered chest and abdominal problems as one of the most common issues during disaster management. A good example is the Chernobyl Disaster when poisonous gas was released from a nuclear reactant. When patients suffering from chest and abdominal problems are brought to the emergency department, nurses are expected to undertake some basic measures that may help ease their pain and save their lives before they can be allowed to see the doctor. Needle thoracostomy is one of the most common tasks that nurses would perform for patients having life-threatening medical conditions. Desimone (2009) says that for a long time, needle thoracostomy was considered a specialized task that was performed by surgeons and physicians in the emergency department. However, the changing role of nurses in the modern society has seen this activity become one of their major roles at the emergency departments when managing pneumothorax. Powers (2007) notes that this is a specialized task meant to drain blood, air, or any form of fluids that have accumulated within the pleural cavity. In absence of a surgeon or a physician, a nurse with the right skills and experience may be allowed to perform the task based on the strict guidelines from the relevant authorities within the department. Nurses working in the emergency department are also expected to have the capacity to replace gastronomy tubes without causing unnecessary pain to the patient or damage to the tissues. For patients suffering from cardiac arrest, the nurses should have the capacity to perform various tasks that would ease their pain as they are prepared for specialized treatment by the cardiologists.
When disasters such as major road accident or a collapse of a building occurs, survivors always sustain major injuries in their spine, back, or neck that may require a specialized medical attention. Nurses at the emergency department will be expected to receive these patients and perform basic tasks that are meant to relieve them of their acute pain. The first step that a nurse is expected to do is clinical assessment and management of the spine. The nurse may assess the level of damage of the spine and determine the appropriate management action that would be necessary. If the spine has not sustained any damage other than strain, Yamamoto (2013) says that a nurse can prescribe an appropriate physiotherapy, medication and a future date with orthopedists, most preferably after the disaster has been successfully addressed. In case the damage is serious, then the nurse can prepare the patient for a specialized task to address the condition. Nurses are also expected to perform lumber puncture. According to Dorasamy, Raman, Marimuthu and Kaliannan (2013), this is major medical process that was previously done by specialists. However, these specialists are always overwhelmed in cases of emergency, making it necessary for the nurses to step in and help. To undertake this task successfully, a nurse will need some specialized training in this field. Mistakes when carrying out the task can have life-changing impacts on the patient.
Perspective of nurses on competencies in disaster nursing
Finally, it is important to look at the perspective of nurses about the issue of competencies in disaster nursing. According to Jakeway, Larosa, Cary and Schoen¢sch (2008), the concept of disaster nursing is relatively new, though the practice has been in existence for so many years. Until recently, little focus has been put in ensuring that nurses are adequately equipped to respond to cases of disaster. However, it has become evident that this is an area that can no longer be ignored. When coming up with the competencies that these nurses should have, it will be very important to take into consideration their views about this issue. Some of these nurses have worked under such circumstances for some time, and therefore, know what is expected of them. Their views may help in developing a comprehensive curriculum for the nurses to ensure that they are better equipped to respond to cases of disaster.
Expanded Scope of Practice
The discussion above clearly reveals that the scope of nursing practice has expanded considerably, especially when they are working in the emergency department. In this department, nurses may be forced to perform tasks that were traditionally considered responsibilities of specialists. According to Yamamoto (2013), the role of nurses is changing, and in many cases, they are forced to make decisions that can save the lives of their patients. However, it is important to ensure that the expanding scope of nursing practice is accompanied by acquisition of core competencies that can make them efficient when undertaking their new duties. The traditional nursing curriculum that has been used in the recent past can no longer be effective for nurses in their new roles. They now need a new curriculum that focuses on their changing responsibilities. According to Grimaldi (2007), nursing can no longer be considered a general practice where one can work in almost any department within the hospital. Just like doctors, nurses have to specialize on specific areas of their interest, and acquire specialized knowledge that can be applied in their specialized practices. For instance, nurses working with the cardiologists must have specialized in this area in their colleges. Although these nurses may have the knowledge about other departments, the main specialty must be in a specific field. This specialization would help ensure that such nurses can work very closely with doctors to address specialized conditions. In the absence of doctors, the nurses can make informed decisions on how to address a given problem without fear of making fatal mistakes (Giarratano, Orlando, & Savage, 2008).
Ethical Practice
Disaster management within the emergency department can pose a serious challenge to the medical staff. Nurses are always the most affected by such disasters. They are always expected to respond to the situation and provide sustainable care to the patients as they wait for specialized treatments from the medical doctors. Such stressful environments require ethics and commitment among the nurses. Ethical practices may be manifested in many ways. Attitude is the first manifestation of ethics. Nurses are expected to maintain a positive attitude when handling patients, even in circumstances when they work under pressure. They should avoid any time wastage at the emergency department because lives of others depend on their efficiency and reliability in delivering services. Desimone (2009) notes that, nurses should be sure of their actions. Any mistake during such delicate processes may end the life of a patient. Finally, nurses should avoid equating their services to financial gains. Their tasks can never be equated with money because they are granting people the opportunity to continue living. Issues such as industrial action should not be common among the nurses, especially when there is a disaster.
Ability to Respond
The ability of nurses to respond effectively to cases of disaster largely depends on their training, their attitude, and the nature of relationship between them and their employers. Nurses, just like other professionals, need proper training to be able to respond to specific medical issues during emergencies (Good & Calif, 2008). When they lack these specialized skills, then they can offer very little service when a disaster strikes. They also need to feel that they are valued and respected by their employers. The positive relationship between the nurses and their employers always defines their attitude, especially in cases where they are called upon to respond to extraordinary circumstances. They should be provided with the necessary skills and then motivated in order to enhance their capacity to respond to emergencies (Adams & Berry, 2012).
Conclusion
During disaster management, emergency departments in hospitals always find themselves under pressure to operate beyond their normal capacity. Under such extraordinary conditions, nurses may be expected to perform functions that are otherwise considered areas of specialty. It is clear from the discussion that positive attitude and morale alone cannot enable these nurses to perform specialized operations during disaster management. They also need to be equipped with core competencies that can enable them respond appropriately to the situation facing them. They cannot afford to make trial and error when trying to save lives of patients. That is why they need specialized education that will enable them to carry out these specialized tasks.
From my personal perspective, I think nurses need to specialize in two or three related fields other than having a generalized nursing knowledge when they are in college. At the time when they are getting admitted into institutions of healthcare, they should have specific areas where their knowledge goes beyond simple care for the patients. I also believe that they should work within their area of specialty to increase their knowledge other than working in various departments within the hospital.
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