Nursing in times of disaster
Joakim Bengs, BSc student Nursing
Anita Wikberg, Supervisor, RN, RM, PhD, Senior Lecturer, Novia UAS
In the beginning of the year 2020, the world faced a rapid spreading of a novel Coronavirus (COVID-19), resulting in a global pandemic.
Nursing preparedness, especially at the moment, is a very relevant topic that needs to be addressed and further explored, since it directly affects the overall response and recovery from situations that we are currently living.
In this article, recently published scholarly articles and news reports were used to form a current overview of the level of preparedness that nurses have, the challenges they face and ways to overcome these challenges.
The different types of disasters were addressed, with a focus on the importance of spreading information and distinguishing from misinformation.
The literature shows that there is an overall lacking, or low level, of disaster preparedness in nursing, actions need to be taken on a governmental level to allocate resources for the furthering of disaster preparedness in health care.
Working as a nurse in times of local and/or global disaster can be challenging if an individual is not properly informed and prepared; there are many aspects that one needs to be aware of in times of disaster, and every individual (working or not) should have some basic knowledge in disaster preparedness, this facilitates the local recovery process greatly (American Nurses Association, 2020).
What are disasters? What type of disasters are there?
Disasters can be defined as a certain event that causes significant infrastructural damage, economic distress and/or endangerment of human life, also leading to loss of human life, thus needing to deploy an overwhelming amount of special services (Seyedin et. al, 2011).
The different types of disasters are many, but can be summarized in the following categories:
- Environmental/Natural (Hurricanes, tsunamis, tornadoes, earthquakes, tropical storms, avalanches etc.) Recent event: Hurricane Dorian 2019 (The Guardian, 2020)
- Chemical (or industrial): an uncontrolled release of a toxic substance leading to harm in public health and/or the environment. These are typically caused by a natural/environmental event but can also be caused by human error. Oil spills also are included in this category. (WHO, 2020) Recent event: Visakhapatnam gas leak in India. (Associated press, 2020)
- Biological (including pandemic influenza’s): global or local (endemic) spreading of infectious diseases. Recent event: 2020 coronavirus (COVID-19) pandemic.
- Radiological/Nuclear: Uncontrolled release of a radioactive substance. These can be caused by natural/environmental events, and human error. Recent event: Fukushima Daiichi March 11 2011. (UCS, 2013)
- Explosive: uncontrolled explosions. Recent event: Beirut harbor explosion. (BBC, 2020)
Nurses roles in disaster events
Recent trends have demonstrated a significant global increase in disastrous events.
The most affected professions during disastrous events are law enforcement, emergency response units (firefighters, first responders) and any healthcare workers ,this is due to an increased amount of people that require healthcare, causing a rise in patients at most healthcare facilities (Brand, 2016).
Nurses have historically always been a part of disaster preparedness and response. From wars to natural events there has always been a need for administration of healthcare in the disaster setting (Magnaye et. al, 2011).
Disastrous events typically occur in four main stages: Mitigation, preparation, response and recovery. Nurses play a significant role in all four stages (Brand, 2016).
Disastrous event stages
Nurses Role (in hospital setting)
Strengthen facility resilience. (making sure that materials are not lacking and properly refilled)
-Conduct hazard vulnerability assessments.
- Develop emergency plans.
- Educate other staff.
- Conduct drills.
- Evacuate, triage, and treat patients.
-Manage staff incident command centers and shelters.
- Manage staff and volunteers.
- Public communication and providing information updates.
- Deliver urgent care as needed.
-Screen survivors for behavioral health and psychological needs in the context of a disrupted social and physical environment.
-Refer patients to mental health services.
-Help survivors reintegrate and understand what has happened, promoting recovery.
-Conduct formal evaluations of drills and real-life responses.
- Review emergency response plans and recommend changes as needed.
Table 1: Nurses role in the main stages of disastrous events (Brand, 2016).
Nurses play a key role in the event of any disastrous events, especially natural or environmental events like earthquakes, tsunamis, hurricanes and tropical floods: they are routinely assigned with triage and health screening; the health nurse also plays an important role because they can view the event not only from the individual patients perspective, but also from the community-wide perspective, identifying needs for temporary housing and shelter and providing these needs; they play also a key role in disease outbreak events, in tracking and tracing the spreading of the disease within the community (Magnaye et. al, 2011; Brand, 2016).
A disaster response program is only effective when the involved parties are properly prepared and educated. No one knows when a disaster will hit, so the level of preparedness has a direct effect on the whole recovery process (Brand, 2016).
The idea of disaster preparedness stems from the belief that a society should be, as adequately as possible, prepared for any types of disasters that may occur; this is to be certain that the right resources, procedures and systems are used to give fast and correct help to victims of disaster, including actions taken before any disasters allowing for the smooth working of disaster relief (Magnaye et. al, 2011).
A form of disaster preparedness has also taken form into society in the recent months, with the corona virus outbreak in March 2020 it has become the norm in the healthcare setting to track various movements and symptoms, a system that has been used previously during other disease outbreaks (Brand, 2016).
These measures include:
- “Screening patients at all entry points, including primary care venues;
- Communicating travel histories to team members;
- Establishing systems of community-wide coordination.” (Brand, pg 2 2016)
Nurses need a high level of preparedness to be able to respond effectively to different disasters, and a governing body that provides the correct education and courses for the nurses will see a large increase in the effectivity of disaster response; this is not always put into place, so adaptation and reforms should also be taken to ensure that the healthcare professionals are receiving the appropriate training (Brand, 2016).
Importance of nursing education
As stated previously, the importance of nursing education and planning in events of disaster is critical to a good response to the events, nurses should be involved already at the initial emergency planning process, this leading to a more effective care plan (Strangeland, 2010).
Nurses have stated that in their involvement in events of large numbers of casualties they used teamwork to enhance their use of basic skills, but they felt that if they would have been more prepared they could have used more complicated skills, thus providing a better care for the victims (Strangeland, 2010).
Within these preparedness programs, skills can be taught to the nurses, for example the ability to recognize the potential for disasters, when a disaster has occurred, how to protect individuals around as well as be able to protect yourself, while also recognizing self-potential (Strangeland, 2010).
An important role of the nurse in disaster events, that can be seen also during the novel Coronavirus pandemic in 2020, is the providing of factual and, most importantly, true information regarding the whole situation, being a global pandemic or a disastrous natural event (Gerwin, 2012).
During the outbreak of the swine flue (H1N1) in 2009, misinformation was a big problem that the healthcare providers faced: for example, news agencies and governmental agencies made minor errors of judgement, especially regarding the production and provision of vaccines, and these errors distorted views in media, politics and how individuals interpreted the agencies (Gerwin, 2012).
Individuals also used these occasions to distort and warp the view of trustworthiness that governmental healthcare agencies have, instilling mistrust and providing misleading information to affect the public’s perceptions, memories and actions that took place during the events (Gerwin, 2012).
Not every individual believed in the misleading information that was provided, none the less the public’s opinion and perception of governmental agencies worsened, especially in the United States (Gerwin, 2012).
There is always a sense of uncertainty in information being provided during times of disaster, especially having to do with microbial endemics/pandemics and events that are not at all foreseen (Gerwin, 2012).
This in itself creates a sort of public mistrust in governmental agencies, but with the use of the Internet and mass corporate media agencies there is a challenge to provide correct factual information when that is drowned out by sensation news, used to incite fear and doubt (Gerwin, 2012).
During the second wave of swine flu various potential effective non-pharmacological measures were shared, but that information was drowned out by the continuous use of the fact that the number of vaccines were lacking to overshadow the measures provided (Gerwin, 2012).
Another problem faced would be that the measures shared were shared only on the health sections of news agencies, being excluded from the front page (Gerwin, 2012).
These uncertainties in information created an information gap, allowing for individuals that have no education or involvement in health care providing wrong or just untrue information, while also criticizing governmental agencies’ actions (Gerwin, 2012).
We can take example from the events of the H1N1 swine flu outbreak in 2009 and work for providing a better information system, but seeing the situation now during the outbreak of the novel Coronavirus in 2020 we can see that we are far from being able to provide quick, accurate and factual information (Gerwin, 2012).
Nurses face great challenges during the actual disasters, ranging from infrastructure to cultural challenges, but the major challenges they face are typically in the wake of these disasters, and they are typically in the psychological realm, facing posttraumatic stress disorders after the events. These anxieties may not present themselves straight away but may rather be triggered by certain events which force the individual to relive the traumatic events (Strangeland, 2010).
A major challenge that is discussed also in the role of nurses is the provision of accurate and factual information; this represents a very difficult challenge within itself, as information has become readily available at the fingertips for any individual with an internet connection and a smart phone, and consequentially the amount of untrue, wrong and misleading information has also increased, creating a sea of uncertainty for the individuals seeking for information; nurses should be able to give correct and factual information to their patients or victims of disaster, also to provide a sense of security, since the patient or victim can use the nurse as a source of information (Gerwin, 2012).
Some ethical challenges can also take place during disastrous events, for example, an individual might have the option of choosing between working where they are for a salary, or volunteer for disaster relief (Strangeland, 2010).
We can clearly see that nurses play a vital role in the whole process of disaster, starting from preparation for disasters, later responding to the disasters and providing care in the aftermath of disasters (Magnaye et. al, 2011).
An important role discussed was also the nurse’s role in provision of factual and correct information, this is crucial to the effectiveness of the chain of events when responding to disasters or outbreaks (Magnaye et. al, 2011).
it is also important for the nurse to distinguish between misinformation and real information with evidence, it is easy with the use of the internet to find articles and views that are presented as information but have no actual evidence behind them.
For a more effective approach, what we need to focus on is the preparedness of the healthcare professionals, allocating appropriate resources and education to the workers, without adequate preparedness, there cannot be adequate response (Magnaye et. al, 2011).
- American Nurses Association. “Disaster Preparedness.” ANA, American Nurses Association, 2020, www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness.
- Associated Press. “Indian LG Plant Lacked Environmental Clearance Before Leak.” US News & World Report, U.S. News & World Report, 2020, www.usnews.com/news/business/articles/2020-05-12/indian-lg-plant-lacked-environmental-clearance-before-leak.
- BBC. “What We Know about the Beirut Explosion.” BBC News, 11 Aug. 2020, www.bbc.com/news/world-middle-east-53668493.
- Brand, Rachel. “When Disaster Strikes: Nurse Leadership, Nursing Care, and Teamwork Save Lives.” RWJF, May 2016, www.rwjf.org/en/library/research/2016/05/when-disaster-strikes.html.
- Gerwin, Leslie E. “The Challenge of Providing the Public with Actionable Information during a Pandemic.” The Journal of Law, Medicine & Ethics, vol. 40, no. 3, Oct. 2012, pp. 630–654, 10.1111/j.1748-720x.2012.00695.x.
- Magnaye, Bella, et al. “THE ROLE, PREPAREDNESS AND MANAGEMENT OF NURSES DURING DISASTERS.” Scientific Research Journal, VOLUME -III, vol. 3, no. 4, 2011, pp. 2094–1749, pdfs.semanticscholar.org/82f4/af57dc8e297274327e849431cb314fd4489d.pdf.
- Seyedin, Hesam, et al. “Disaster Management Planning for Health Organizations in a Developing Country.” Journal of Urban Planning and Development, Mar. 2011, 10.1061/(ASCE)UP.1943-.
- Stangeland, Paula A. “Disaster Nursing: A Retrospective Review.” Critical Care Nursing Clinics of North America, vol. 22, no. 4, Dec. 2010, pp. 421–436, europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7135108&blobtype=pdf, 10.1016/j.ccell.2010.09.003.
- The guardian. “Search for Survivors of Hurricane Dorian Continues in Bahamas.” The Guardian, 9 Sept. 2019, www.theguardian.com/world/2019/sep/09/search-for-bodies-and-survivors-continues-after-hurricane-dorian-in-bahamas.
- UCS. “A Brief History of Nuclear Accidents Worldwide.” Union of Concerned Scientists, Union of Concerned Scientists, 1 Oct. 2013, www.ucsusa.org/resources/brief-history-nuclear-accidents-worldwide.
- WHO. “Chemical Incidents.” Www.Who.Int, World Health Organization, 2021, www.who.int/health-topics/chemical-incidents#tab=tab_1.