To work as a nurse in disaster and vulnerable areas
Author: Dona Philip, BSc Nursing student, Novia UAS.
Supervisor: Anita Wikberg, RN,RM,PhD, Senior lecturer Novia UAS.
Introduction
According to WHO (2017), a disaster can be referred as a calamitous situation which can impact directly into the peoples living by causes suffering, disrupts freedom, hinders daily activities, health issues and moreover it results in scarcity of food, shelter, medical aid and other factors which are necessary for peoples living. Disasters can be classified into natural such as earthquakes, tsunami, landslides, different types of heavy storms, flooding and severe drought. Meanwhile, biological disasters are outbreaks of epidemic diseases or pest infestations. Similarly, chemical hazards, presence of radiological substances, crashes and social disasters, such as war, conflicts or act of terrorism. Disasters often result in greater impact on public health, when it predisposes traumatic agony, grief, helplessness, disabilities, loss of assets, collapse of essential services, mental or social problems. Disaster management is one of the prime strategies of every country and in which medical professionals such as nurses, doctors, paramedics and rescue workers play an integral role.
According to United Nations office for disaster risk reduction, UNDRR (2012) a disaster could be a significant misfunctioning or disruption of a society in which people’s life, economy, assets, health and environment are in threat or eventually damaged. This is beyond the control of people and they get victimised despite of all coping strategies and natural resources to protect themselves in this situation. Definition of disaster depends upon the characteristics and causes of the phenomenon. Generally, it is classified as natural or manmade and further into direct exposure to a hazard or inclination to the disaster vulnerability.
Health and social implications of disaster
According to Boruf et al. (2013), the most certain after effect of a disaster in loss of lives, disability and injuries. According to Australian agency for disaster management each year around 300 natural and manmade disaster occur globally and many millions of people suffer directly or indirectly of it. Communicable disease, for instance cholera and dengue fever incidence increased in south India after the flood. These kind of communicable disease outbreaks eventually happens associated with the disaster. Certain disaster causes acute illnesses, for example, coccidioidomycosis is one of the major diseases in Latin American countries after the occurrence of earthquake. Hypothermia, frostbites, parasitic diseases are also evident after the flood calamity. Also, it has been reported chronic coronary diseases, and the prevalence has been proven after the lives get desperate after the disaster, also the diabetes conditions are increased since the stress is a predisposing factor. Post-traumatic stress disorders are also increasingly seen after disaster areas. In addition, lethargy, disrupted cognitive abilities, depression, extreme grief response, anorexia and poor mental capabilities are also the after effect of a disaster. Confused and disoriented state is also common among victims after the incidence of any disaster. Similarly, in the socio-psychologic perspective anxiety disorders are very common in people after the occurrence of disasters.
What is disaster management and emergency preparedness
The main strategies include:
Emergency preparedness -> Mitigation -> Response -> Recovery -> Preventive measures
According to WHO (2017), on disasters and emergency preparedness, the base of the disaster management process depends on the effectiveness of risk assessment. It includes, observing and monitoring the potential hazards to health as a part of emergency preparedness, for example, identifying the vulnerable areas, performing vulnerability analysis and giving public awareness regarding it. The mitigation is about giving relief care on the basis of different rescue policies, priorities like age group and severity of disabilities. Response is
according to the health risk assessment and vulnerable population. The recovery phase can be achieved through a well organised set of actions in disaster occurrence. Preventive measures are generated in prior or after the history of a disaster according to the severity and level of after effects.
Nurses responsibility in disaster management
Wolanski (2014) states that, being an integral member in the healthcare team, a nurse has to play a vital role in disaster management. The skills are evolving from the student period itself by encountering numerous vulnerable areas, unfamiliar and demanding situations. The community nursing work practices during the nursing studies, gives a lot of ideas about, how nurses are performing in real situation to alleviate suffering, giving a public awareness about the hazards. These experiences are preparing a future nurse to confront any disaster. When tsunami ravaged in India, numerous numbers of student nurses were deployed to for the rescue and disaster relief work and it was a remarkable aid work in association with other health sectors and volunteering organizations.
According to the International Council of Nurses (2006), disaster management relies on multisectoral and multidisciplinary management strategies in order to deliver functional response and action on the basis of prioritizing the needs of disaster victims. The plan of action is based on prioritizing the need of victims for instance first priority is given for the people need immediate intervention like resuscitation and intensive care. The second priority is given to the people need to be given surgical interventions should be taken to the hospital soon. Similarly, the third priority is given for wounded people who require hospital care and the last priority is people who need just first aid to be taken to the relief camps. Nurses are key role performers in these areas and additionally the health risk assessment is carried out through nurses being an integral members in the healthcare team.
On the other hand, according to Boruf et al. (2013), even though the nurses are expected to be the key role takers in disaster relief, a remarkable number of nurses are reluctant to participate in any sort of community preparation, respond or recovery process. The main reason is, they are not trained well to face the disaster care, working in recurrent disaster occurrence and witnessing greater incidence of level of trauma associated with disaster.
The professional attitude towards disaster management should be attained in the student period itself so that a nurse can foresee and be prepared for such happenings in the future. Community health nursing and rural healthcare should be enlisted as an obligatory part in nursing curriculum because it enables functional assessment skills, risk assessment and development of vulnerable areas. For nurses it is equally important to know how to use self-protective measures and specialized instruments. However, nurses remain as a trusted profession for the professional commitment in providing compassionate care in disasters. Wolanski (2014)
Although, Tyer (2019) emphasizes, the leadership skills in resolving an issue is very demanding in order to meet this kind of emergence situations and sustainable emergency preparedness. Appropriate decision-making skills leading others are also much needed competence in this field. Certain personality traits like grit personality are more professionally successful in meeting an emergency situation and in performance to resolve it because to work on disaster area itself gives a burden and psychological stress, not everyone overcome it unless they have deeper understanding and motivation to perform. It requires an ultimate passion, empathy, attitude to confront the challenges which are eventually associated with working in emergency situations.
According to Wolansky (2014) frontline nurses are also essential elements in emergency preparedness because they have the needed qualities like critical thinking, sustainable management skills, assessment experience, analysing skills in performing with limited resources. Nurses with grit personality type functions more efficiently in challenges and obstacles in attaining the goal.
The other qualities like emotional intelligence, critical thinking, leadership initiatives are added advantages in performing those areas. Similarly, the nurses working in community care areas have an integral role to perform in making a disaster response intervention by enabling the public safety, infection control and assessing the targeted people in prevalence of communicable diseases, sanitary material supplies, first aid supplies, hygiene measures in rescue shelters and moreover giving emotional and psychological support to strengthen people in their sufferings. Moreover, giving public awareness regarding biological agents, chances of communicable disease outbreak like malaria and anthrax. Also certain facts like ethical problems are evident in nurses functional areas in disaster since they are performing on limited set of resources and the nurses code of ethics are sometimes compromised like maintaining the dignity, autonomy, quality of the care, appropriate triaging, treatment priorities and privacy of the victims. Similarly, nurses have to be aware of the legislation, governance and obligations to work on a disaster relief area. (Cusak et al. 2013)
The overall responsibilities of nurses include identifying the risks and the management based on proper assessment regarding health hazards like environmental, biological, chemical, radiational hazardous matters detection. Similarly, analysis of the vulnerability, community infrastructure and awareness of limited set of resources to perform the health management task which leads to recovery, restoring the community function. Additionally, reducing the fatality, preventing the communicable disease, sanitation and hygiene are also equally important. (Aliakbari, 2014)
Conclusion
To work in disaster and vulnerable areas demands a multisectoral approach and nurses are the integral component in disaster preparedness, mitigation, reasons or the recovery process. Though the disaster incidence cannot be resisted, the only thing to do is to be well equipped to meet any sort of disaster. During the student period itself nurses have to be trained to confront emergencies, volunteering activities, professional cooperation. The crucial role of a nurse is to be trained initially during the student period and letting students have practice on better communication, occupational safety, leading capacities to face any emergency situations so that a “willingness” can be generated to work like in pandemics.
References
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