Ready or not here I come: how prepared are we as nurses, when disaster call
During the last few years we have witnessed a dramatic surge in the number of large-scale catastrophic disaster occurrence and mass casualties coupled with the prevalent threats of man-made attacks. This phenomenon has illuminated the recognition of the nursing role when it comes to catastrophic disasters management and how to respond to it. The enhancement of the nursing capacities to respond to disasters and similar health emergencies will surely demand and require a workforce of nurses who are not just clinically experienced, but also possess the skills and the technical know-how, which are necessary for any nurse to confidently respond with authority to any disaster. Although nurses act predominately as care givers during any disaster response, but a large chunk still lack the personal preparedness required to confidently respond to a call during a given disaster situation. This article highlights how graduate nurses, nurses, first responders and volunteers get on with addressing the obstacles and challenges regarding emergency preparedness needed if disaster comes calling.
Over the years, disasters have always been an occurring issue. Always imminent but unsure when to deliver its catastrophic shocks, from the horrific Katrina in 2005, to the Japanese nuclear leaks of 2011, not forgetting the numerous wild fires in Europe, American and Australia and the man-made terrorist attacks like the September 11, 2001 attack on the US soil, and various parts of the world and just recently the corona virus pandemic and the Lebanese explosion in 2020. These are all events that has tested the human resolve and resources and preparedness before, during and after such events. Disasters worldwide have been known to cause a major interruption in delivery of healthcare, infrastructural destructions suffering and injuries and very importantly the incommensurable loss of innocent life and properties (WHO, 2015). There is actually no single definition that covers the meaning of “disaster “, the World health organization (WHO) and the International council of nurses (ICN) puts disaster as a calamity that is sudden and with a very serious disruptive effect of the total dynamics of a community or society resulting in economical, human, material and environmental losses that overwhelms these societies abilities to cope and control the situation using their own resources (WHO/ICN, 2009, p.3). Humans have been tested in all these events, particularly for nurses and first responders who are usually called to act. What are the levels of nurses preparedness in all these catastrophes?
Disaster preparedness in nursing according to WHO/ICN, 2009 will encompass a very comprehensive skills, knowledge and abilities to care, and prevent disabilities and diseases and also the promotion of individual, family and community health especially when resources are scarce. Disaster preparedness can be seen in two aspects, the professional and personal preparedness. Professional preparation is instantiated by receiving training and education on disaster prevention, mitigation, management and recovery to prioritize, assess and to be able to function effectively and efficiently in a disaster scenario (ANA, 2015), while personal preparedness is depicted by the ability to posses an emergency supply kit and a family disaster plan and always maintaining awareness (American Red Cross 2015).
The world is changing every minute with the threats of both man-made and natural disasters, pandemics and recent rise in terrorism, its much evident and likely that nurses of all specialities are in great demand or called to action during these periods of disasters. It is no longer a news that nurses make up a larger chunk of the healthcare workforce globally (Halpern & Chaffee 2005). According to the Finnish Red cross, “they are constantly complementing its personnel reserve with professionals from different fields, especially doctors and nurses” (Finnish Red Cross, 2020). Nursing knowledge about disaster is increasingly becoming important. Presently, the knowledge base for nurses as regards to disaster and being prepared to tackle it head on is to some extent limited, both in clinical sites and in terms of educational preparedness.
Before now, events and circumstances that people and even nurses used to think or attribute only to emergency nurses in the emergency wards or for agencies like the Red cross now requires the involvement of nurses of all fields with a specialized knowledge on infectious diseases, paediatrics, acute care, obstetrics, perioperative, psychiatrics, advance clinical expert and leadership and management. Nurses share a responsibility to themselves and the general public to be prepared and to get educated about preparedness (Smith, 2006).
The roles for nurses
From all indications, every nurse would have a particular role to play in time of a disaster. These roles include creating a triage and treatment of injuries and illnesses, counselling and providing guidance and the distribution and management of available resources for people of all ages and special population (Smith, 2006). Since the September 11, 2001 attack on the US soil, preparation and response to disaster both in the US and elsewhere has seen a significant attention, scrutiny and resources (Peterson, 2006). Although there are many aspects to how disaster is responded to, such as transportation, security and reconstruction, medical response and nursing care will directly affect these people impacted by this disaster. There are uncertainties and challenges as regarding the provision of nursing care, such as the physical environment, the unavailability of materials and resources, individual risk as well as patient vulnerability in such situation. As usual, nurses and physicians are in the front lines, in conjunction with the state, local and federal government agencies, emergency services centres, hospitals, police, fire service, military as well as rescue personnel both local and international (Smith, 2006).
As nurses are getting prepared for any possible disaster and the roles, he/she will be playing during this situation, the priority for each and every of these nurses is his/her safety during this disaster situations and as well as the safety of their immediate family (Smith, 2006). The nursing profession is dominated by female, many of which are saddled with personal commitments which exists beyond their profession and includes taking care of the children, elderly and pets , which might act as a barrier in responding to a call during a disaster (Goodhue et al., 2012; Grimes & Mendias, 2010).
A very important premise of successful response to any emergency is to be prepared ahead of time also known as pre-planning. All nurses must have a personal and professional preparedness plan for times of disaster. Preplanning is an essential necessity for preparing for an imminent disaster at home and as well as responding to a disaster within one’s own region or even an international response (Peterson, 2006). A visit to the Finnish Red Cross (FRC) page will grant you an access to the guidelines and key components on how to be prepared, and be informed about what is happening, creation of a disaster plan for your own family as well as assembling a disaster kit and getting trainings and practicing and maintaining your plan. As a nurse, it will be difficult to respond to any emergency or disaster sites of employment or caring for casualties, when there is any feeling of insecurity or unsafety of their own families (FRC, 2020, Smith, 2006). A professional plan will address issues concerning the employment of a nurse. It is particularly important for a nurse with intentions to serve as a disaster nurse or responder to reach an agreement with his/her employer with regard to how volunteering decisions will be made before a call to duty occurs. In countries like the US, the American Nurses Association (ANA), has created a two positional statement addressing issues related to disaster, volunteering and employment. The first, is a nurse’s right and responsibilities as it relates work release during a disaster, while the second position provides a similar guideline and a companion statement and a work release during a disaster. This information is meant toward the employer and the laid down policies and procedures when a disaster happens.
Getting educated and informed
It is no longer news that nurses make-up a larger chunk of healthcare professionals, but the inability to efficiently manage and handle disasters has proven to be a major obstacle. In the aftermath of numerous disasters globally, nurses have shown eagerness to assist in these vulnerable times, but many lacks the adequate training and skills as regards communication with the team of disaster management and as well as the victims and their families (Veenema, 2006).
Nurses should be actively educated and informed and should be ready to get involved in acquiring the know how and technicalities regarding a disaster plan in any given institution or the primary place of employment (Smith, 2006). Plans for disasters are usually designed to set up the required actions and plans needed to be taken in an event of a serious occurrence with multiple causalities. Every plan is unique to every establishment or institution, it is the responsibility of nurses to familiarize themselves with these plans and also be aware of the expectations of the establishment with regards to work attendance and schedules, as work-schedules might include working in teams of rotating shifts. Again, the nurse should know in advance the plan of communications just in case there is a loss in mobile network or phone signals.
Additionally, for nurses to be better prepared in managing disasters preparedness, nurses must get a disaster educational training. Resources are already on ground to help nurses build on their knowledge base as regards disaster management and preparedness, which are currently running in the nursing educational curriculum as undergraduates and which are also available as courses online which can be found on web pages of the International Federation of Red Cross and Red crescent society, Finnish Red Cross and several emergency management agencies like FEMA ( Federal Emergency Management Authority) in the United States (Smith, 2006 & Veenema, 2006). The essence of this courses or educational training known as “IMPACT” by the Red Cross including the Finnish Red Cross, is to broaden the nurses/volunteer knowledge and bring clarity regarding the various terms and acronyms of communications during a disaster management missions, which are not familiar terms for nurses or a volunteer prior to this course. Certifications can be granted to an interested nursing/volunteer candidate after the completion of such course online and a physical presence class which are also conducted by the same body. Again, at completion of this course, which usually take couple of weeks to complete, such nurse/volunteer is then registered and verified into an emergency system for advance registration of volunteer health professionals. This certification will also cover such nurse/volunteer legally in case any liability is incurred in the line of delivery services during these missions (FRC, 2020).
Finally, nurses/volunteers should be ready to answer to these questions:
- In response to any disaster calls, how involved do they want to be.
- Do they want to be called up on in a major national emergency or at every emergency/disaster period?
- Is the interest towards an extensive training so they can be opportune to being deployed frequently?
- Will the family responsibilities be too important that, it will hinder the ability to be deployed to a different part of the country?
- Is renumeration important in order to be deployed?
- Is the insurance covering the deployment or the system deploying going to provide such insurance for deployment?
- Is there an agreement with an employer in case of deployments? Was there a prior discussion and understanding regarding availability during a deployment.
In response to the answers to all these questions, a nurse/volunteer may have to consider the available programs through which to get registered, receive education and then be trained and deployed (Peterson, 2006).
Now is the time for all registered nurses/volunteers to use this opportunity and play a role as a disaster nurse/volunteer/responder. Being ready and prepared entails addressing the aspects of both personal and professional planning that has to do with disaster deployments (Peterson, 2006).
Qualifications to participate and practice in multiple roles in the events of a disaster or mass casualty is a uniqueness for nurses and nursing students (Stanley, 2005). But nurses lack all the necessary knowledge when it comes to disaster management and disaster nursing. It is now a responsibility for nurses/volunteers to acquire and become knowledgeable in the area of disaster nursing and management even if its only relating to caring for their clinical practice and that of their own family (Smith, 2006)
Author: Emeka R. Nnadiekwe, nursing student Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD och Senior Lecturer, Health Care, Novia UAS
America Nurses Association (ANA). 2015. Disaster preparedness & response http://www.nursingworld. org/MainMenuCategories/Workplace Safety/DPR, https://www.nursingworld.org (online accessed 26.08.20)
American Red Cross. 2015. Prepare your home and family. http:// www.redcross.org/prepare/location/ home-family (online accessed 26.08.20)
Goodhue, C.J., Burke, R.V., Ferrer, R.R., Chokshi, N.K., Dorey, F., & Upperman, J.S. 2012. Willingness to respond in a disaster: A paediatric nurse practitioner national survey. Journal of paediatric healthcare 26(4), doi: 10.1016/j.pedhc.2010.11.003
Grimes, D., & Mendias, E. 2010. Nurses intentions to respond to bioterrorism and other infections diseases emergencies. Nursing outlook, 58(1), 10-16. Doi: 10.1016/j.outlook.2009.07.002
Halpern, J, S., & Chaffee, M, W. 2005. Preface: Disaster management and response. Nursing Clinics of North America. 40 (3) 13-15
The Finnish Red Cross (FRC). https://www.redcross.fi/get-involved/join-aid-workers-abroad ( online accessed 21.08.20).
Peterson, A, Cheryl. 2006. Be safe, be prepared: emergency system for advance registration of volunteer health professionals in disaster response. Journal of issues in nursing. 11(3): 9p-9p.(1p)
Smith, S, Janice. 2006. Disaster knowledge and preparedness affects all nurses: How can nurses prepare. Virginia nurse today
Stanley, J.M. 2005. Disaster competency development and integration in nursing education. Nursing clinics of North America. 40 (3), 453-467.
World Health Organization (WHO). (2015). Disaster and emergencies. http://www.who.int/surgery/challenges/esc_disasters_emergencies/en ( online 26.08.20).
World Health Organization and International Council of Nurses WHO/ICN. 2009. ICN Framework of disaster nursing competencies. http://www.wpro.who.int/hrh/documents/icn_framework/en/ (online 26.08.20).
Veenema, T, Goodwin. 2006. Expanding educational opportunities in disaster response and emergency preparedness for nurses. Nursing Education Perspectives. Vol.27.no2.p96