Part one of this series provided an overview of the impact of a disaster and the role of the bedside nurse. Part two focused on data handling and the stress response of staff and survivors.
Part three includes an overview of disaster preparedness resources that nurses can turn to for more information to ensure optimal care within the defined scope of practice at the scene.
There are numerous online resources to aid nurses interested in learning more about disaster preparedness, including federal and state agencies, state boards of nursing, and webpages maintained by professional and relief organizations. (Several resources are listed at the end of this article.)
Preparing for Disaster through Education
Disaster preparedness took on a new meaning after the events of Sept. 11, 2001, and several natural disasters that followed. And in the past 12 years, the level of preparedness has improved.
However, a recent report by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) noted that cuts in monies for public health and preparedness and inadequate planning leave the current level of preparation below where it should be (Levi, et al, 2012; Preidt, et al, 2012).1,2
Resources on disaster preparedness are needed because content on disaster preparedness in U.S. nursing programs remains limited (Ruder, 2012).3
Organizations that accredit schools of nursing do require content on disaster preparedness but many practicing nurses graduated before this requirement was imposed or have never worked under disaster conditions.
Either way, many nurses could be left feeling unprepared to function in a disaster situation, particularly one that occurs outside the walls of a hospital or their normal work environment.
The first step in disaster preparedness is education (Kirwin, 2011).4
A major part of nursing education focuses on the development of critical thinking, assessment and technical skills, and communication. All are core competencies needed for dealing with mass casualty incidents.
The next step is to arm oneself with knowledge that can make a difference when disaster strikes in your environment.
Prioritizing Responsibilities During a Disaster
The Institute of Medicine (IOM) report, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response addressed the need to create a framework to enable an efficient response in the event of disaster.5
While the report focused largely on local and state governments, emergency medical services and various types of healthcare systems, it notes that nurses play a critical role both in disaster preparedness planning and relief efforts through both their planning and care.
The top priority for nurses is the safety and well-being of their patients, members of the community - and themselves.
Other priorities during a disaster are documentation of services and protecting and preserving medical records and the information that they contain. When there is no access to documentation systems or forms, nurses should implement a process that works for them - whether that process utilizes a paper binder or a tablet.
Nurses should not jeopardize themselves or others to retrieve or preserve records. They may consider noting the location of records and reporting them to authorities.
Electronic equipment and paper records subjected to water damage should be left for disaster recovery experts, both for the best chance of recovery and to prevent electronic shock or exposure to mold, bacteria, chemicals or other potential threats. Dry, undamaged paper records are best left alone if secure.
Responding to a Disaster Outside of the Healthcare Setting
Nurses who want to render disaster assistance outside the confines of their work setting should consider that state and federal law may provide insufficient legal protection for volunteers.
Acquaint yourself with the American Nurses Association's Nursing: Scope and Standards of Practice and Code of Ethics for Nurses, as well as relevant state board of nursing practice acts and local laws to ensure that your actions are within the professional scope of practice and law. It is also important to follow appropriate procedure for expedited licensure recognition when the affected area lies in another state.
Nurses who want to join disaster relief efforts in their community should explore organized efforts through relief agencies. The advantage of this approach is that efforts are coordinated and a registry of volunteers is maintained, so your contacts can locate you during your relief assistance.
The International Council of Nurses (ICN) maintains a Disaster Response Network webpage with useful links to resource documents such as the ICN Framework of Disaster Nursing Competencies, reports on relief efforts, and links to relief agencies such as the Red Cross and International Association for Disaster Preparedness and Response (DERA).
Before you join a disaster relief effort outside of your workplace, it is important to consider the following questions:
- Will your employer hold your job for you?
- Are additional immunizations or boosters required?
- What are the risks to your health and personal safety?
- And for international efforts is your passport up-to-date and is a visa required?
Resources for the Bedside Nurse
Below is an extensive list of recommended disaster preparedness resources for bedside nurses:
ANA Brief. Who will be there? Ethics, the law, and a nurse's duty to respond in a disaster. A nurse's duty to respond in a disaster
Provides information about the ANA stance related to the issues of legal, ethical, and professional considerations of disaster medical response. These remain a challenge, and could hamper the ability of nurses to respond.
Stress management in disasters. Pan American Health Organization http://www.paho.org/english/ped/stressmgn.pdf This workbook was developed in 2001 by Cyralene P. Bryce, PhD, for the Stress Management in Disasters in the Caribbean (SMID) course. It is intended to be used in conjunction with the Insights into the Concept of Stress workbook. It is not intended to be a complete text on the subject of stress. (Bryce, C.P., 2001).6
Disaster preparedness for health professionals
This is a four-part video series from University of California Television and the California Preparedness Education Network. You will hear from noted health care providers and disaster response experts from around California, a state with a well-tested emergency response system that can serve as a model for the rest of the country.
Heartland Centers for public health and Community Capacity development. Introduction to emergency preparedness for all nurses
Heartland Center for Public Health Preparedness and Heartland Public Health Education and Training Center now offers archived versions of our popular Webinar Series.
The National Nurse Emergency Preparedness Initiative (NNEPI)
Free courses sponsored by The George Washington University School of Nursing
CDC Emergency Preparedness & Response web site
The CDC Emergency Preparedness and Response website is CDC's primary source of information and resources for preparing for and responding to public health emergencies. This site continues to keep the public informed about public health emergencies and provides the information needed to protect and save lives.
Responding to a Crisis: Managing Emotions and Stress
Free online course from the Iowa Department of Public Health. This course introduces users to the principles of Psychological First Aid and self-care. Throughout the scenario, the user makes decisions about how to best respond to disaster victims who are experiencing a range of emotional responses.
This government website for consumers provides information about some of the basic protective actions for multiple disasters. For example, safety is necessary when experiencing all hazards, whether this means sheltering or evacuating depends on the specific emergency. Developing a family communications plan or making an emergency supply kit are the same for accidental emergencies, natural disasters and also terrorism. However, there are important differences among potential emergencies that should impact the decisions you make and the actions you take. Many of the ideas can be translated into actions that can be taken in the healthcare setting.
The National Center for Disaster Preparedness.
The National Center for Disaster Preparedness at Columbia University was established following the domestic attacks of 2001, in response to the urgent need for a knowledge-based approach to disaster preparedness. NCDP develops research that helps us prepare for, respond to, and recover from large-scale disasters (including hurricanes, earthquakes, industrial accidents, pandemic flu's, or terrorist attacks). NCDP's approach combines on-the-ground analysis, policy work, education, and high level advocacy to ensure that the best thinking, and best practices, become part of our national disaster preparedness and recovery work.
CDC - PHPR - Planning Resources by Setting.
CDC has provided a list of resources below to help healthcare facilities plan for possible public health emergencies. These tools are intended for healthcare planners within the specified settings like hospitals, urgent care and long-term care who are tasked with ensuring their facility is prepared to respond to a public health emergency.
Disaster Preparedness & Response
American Nurses Association NursingWorld webpage providing useful links to information on working with culturally diverse populations, nurse obligations, and altered standards of care in disaster and information for volunteers.
Culturally Competent Disaster Nursing
Minority Nurse article by Luis Clemens detailing lessons learned after Hurricane Katrina.
Hospital Preparedness Program (HPP)
Program available through the Office of the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services that provides leadership and funding to improve public health preparedness for emergencies. Links to reports and guidelines are provided.
ICN Framework of disaster nursing competencies
International Council of Nurses document. International Council of Nurses (ICN). (2011). Disaster Response Network webpage: http://www.icn.ch/networks/disaster-response-network/
Guidelines for Planning Disaster Preparedness, Recovery, and Relief Projects
2011 National Student Nurses' Association, Inc. project.
Integrating Emergency Preparedness and Response into Undergraduate Nursing Curricula.
2008 World Health Organization.resource.
Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards.
This book's mission is to help our nation's nurses develop the knowledge and skills needed to efficiently and effectively respond to disasters. As the nation's largest health care workforce, it is essential to ensure that all nurses understand the implications of natural and man-made disasters, so they are prepared to respond if required. This edition expands focus on human services, the mental health aspects of disasters, and the needs of those who are most vulnerable during disasters, such as children. It also includes more of an international focus (Veenema, T.G., (ed.) 2012).7
References for this article can be accessed here.
Charlene Romer and Toni Hebda both are professors in the MSN Degree Program at Chamberlain College of Nursing.