Académique Documents
Professionnel Documents
Culture Documents
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ICN Framework
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ISBN 978-92-95065-79-6
2009 World Health Organization and International Council of Nurses
All rights, including translation into other languages, reserved. No part of this publication
may be reproduced in print, by photostatic means or in any other manner, or stored in a
retrieval system, or transmitted in any form, or sold without the express written permission
of the International Council of Nurses. Short excerpts (under 300 words) may be reproduced
without authorization, on condition that the source is indicated.
Requests for permission to reproduce, in part or in whole, or to translate them whether
for sale or for noncommercial distribution should be addressed to Publications Coordinator,
International Council of Nurses (ICN), 3 place Jean Marteau, 1201 Geneva Switzerland,
Tel.: +41 22 908 0100; Fax: +41 22 908 0101; Email: turin@icn.ch.
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Table of Contents
Forward
iv
Acknowledgements
v
Chapter One: Background
1
Chapter Two: Impetus for the Development of the Framework of
Disaster Nursing Competencies
9
11
15
19
25
26
28
33
34
35
36
37
39
41
42
44
45
47
50
51
52
53
54
55
56
58
58
59
61
67
International Efforts
The Role of Nurses
Impact of Gaps in Knowledge
Issues of Ethics and Cultural Competency
Barriers to Nurse Involvement
Disaster Nursing Education
iii
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Forward
Disasters occur daily throughout the world, posing severe public health
threats and resulting in tremendous impact in terms of deaths, injuries,
infrastructure and facility damage and destruction, suffering, and loss
of livelihoods. Developing nations and lesser-resourced countries and
communities are particularly vulnerable to the impact of disasters on health
systems and health care and overall social and economic functioning.
Nurses, as the largest group of committed health personnel, often
working in difficult situations with limited resources, play vital roles when
disasters strike, serving as first responders, triage officers and care providers,
coordinators of care and services, providers of information or education,
and counsellors. However, health systems and health care delivery in disaster
situations are only successful when nurses have the fundamental disaster
competencies or abilities to rapidly and effectively respond.
The International Council of Nurses and the World Health Organization,
in support of Member States and nurses, recognize the urgent need for
acceleration of efforts to build capacities of nurses at all levels to safeguard
populations, limit injuries and deaths, and maintain health system functioning
and community well-being, in the midst of continued health threats and disasters.
This publication signifies continued partnerships between the International
Council of Nurses, the World Health Organization and the populations we serve in
strengthening the essential capacities of nurses to deliver disaster and emergency
Forward
services within an ever-changing world with ongoing health threats and disasters.
Dr Hiroko Minami
Dr Shin Young-soo
iv
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Acknowledgements
This publication was prepared by Donna M Dorsey, MS, RN, FAAN, for
the International Council of Nurses (ICN). Special acknowledgement is due
to the ICN and its President, Dr Hiroko Minami, for their leadership in the
development of the Disaster Nursing Competencies. Creating competencies
that support the education and role of nurses in disasters will guide the building
of a nursing workforce better prepared to respond and provide humanitarian
aid in the event of a disaster.
The publication was made possible by the following persons who
contributed time and suggestions in reviewing the publication drafts: Geoff
Annals, Chief Executive, New Zealand Nursing Organisation; Professor
Paul Arbon, Chair of Nursing, School of Midwifery, Flinders University,
Adelaide, Australia; Elizabeth Berryman, Emergency Health Advisor, Save
the Children, London, England; Lisa Conlon, Lecturer, Faculty of Nursing,
University of Technology, Sydney, Australia; Carl Magnum, PhD, RN,
Emergency Preparedness and Response Specialist, University of Mississippi,
Professor, Disaster Nursing, Red Cross College of Nursing, Seoul, Republic
of Korea; Barbara Russell, MPH, RN, Director Infection Control, Baptist
Health Services, Miami, Florida; Daad Shokeh, Secretary General,
Jordanian Nursing Council; Bente Sivertsen, Policy Adviser, Nursing and
Midwifery Programme, WHO Regional Office for Europe; Pearl Stoker, MN,
RN; Willama T Stuart, RN; Ron Thompson, Consultant in Public Health,
Waterloo, Merseyside; Tomiko Toda, Department of International Affairs,
Japanese Nursing Association; Teresa Yin, PhD, RN, Director of Nursing,
Taipei Veterans General Hospital, Taipei City, Taiwan (China); Richard
Garfield, Project Manager, World Health Organization/Health Action in
Crises; and Kathleen Fritsch, Regional Adviser in Nursing, WHO Regional
Office for the Western Pacific. Their knowledge of disaster nursing, insight
and thorough review were exceptionally valuable in ensuring that the
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Acknowledgements
vi
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Chapter One:
Background
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Chapter One:
Background
Disasters occur every day somewhere in the world with dramatic impact
on individuals, families and communities. Whether the disaster is a singlefamily house fire or a tsunami that devastates a community, the quality of
life is threatened. World Disasters Report 2007 reported a 60% increase in
disasters in the last decade (19972006) over the previous decade (1987
1996). Additionally, the number of reported deaths grew from 600 000 to
over 1.2 million. At the same time, the number of people affected rose from
230 million to 270 million, a 17% increase (Klyman, Kouppari & Mukheir,
2007).
Developing nations are particularly vulnerable due to the lack of funding for
disaster preparedness and the impact of disasters on the health care, economic
and social infrastructure of the affected region and subsequently, the country.
Disasters can change the face of a developing nation in seconds, wiping out
years of development. Nations with greater resources are usually able to move
more quickly to restore the infrastructure and economy. However, no matter
where the disaster happens, the impact on the population and community can
be devastating, leaving no nation, region or community immune.
According to the United Nations Bureau of Crisis Prevention and
Recovery, some 75 percent of the worlds population live in areas that have
been affected at least once by either an earthquake, a tropical cyclone,
flooding or drought between 1980 and 2000 (IRIN, 2007, p. 3). Natural
disasters have been increasing over the last 50 years, with the greatest
increase in the last decade (Birnbaum, 2002). On average during 2000
2006, 116.3 countries were hit by disasters each year, but in 2007 it was
133 (Scheuren et al., 2008, p. 6). As in 2006, Asia was most affected by
disasters in both the number of deaths and the number of disasters in 2007
(Hoyois, Schauren, Below & Guha-Sapir, 2007; Scheuren et al., 2008). These
statistics amplify the importance of sound disaster planning and mitigation
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resources.
Disasters take a physical and psychological toll on individuals. Experience
has demonstrated that rapid intervention is necessary to address physical
and psychological issues. Failure to intervene can lead to long-term physical
conditions or mental health problems. Some individualspeople with preexisting health conditions, medical disabilities, mental health or psychological
problems as well as the frail, women, older people and the very youngare
more vulnerable and at risk. Moreover, an individuals ability to cope with
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a disaster and the recovery process are directly affected by the individuals
culture, the support system available and the persons gender, experience with
disaster, education and psychological status. The process of intervention can
be difficult, requiring a delicate balance of assistance and encouragement in
the face of incomprehensible losses. However, the lack of sufficient numbers
of health personnel and facilities make dealing with these immediate needs
difficult. Assisting the survivors to rebuild their lives is critical to a nations
recovery.
The need for qualified individuals ready to respond to disasters and to
participate in preparedness and disaster recovery activities is well documented.
However, training is often fragmented or not available. Over the last several
years, organizations and groups have begun to address the issue by developing
competencies to describe the role of the responders and by developing
specialized education and training programmes. Competencies have been
developed for public health workers, health care workers, emergency workers,
largest group of health care providers, nurses need to develop competence in
disaster response and recovery. Therefore, disaster education for all nurses is
vital.
The fundamental attributes of nursing practice consist of providing nursing
care to the injured and ill, assisting individuals and families to deal with
physical and emotional issues, and working to improve communities. As stated
by Dr Eric Laroche, WHO Assistant Director General for Health Action in
Crises (WHO, 2008):
Nurses are often the first medical personnel on site after
disaster strikes. In these situations where resources are scarce,
nurses are called upon to take roles as first responder, direct care
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populations.
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Chapter Two:
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This chapter considers some of the factors that have influenced the need
for disaster nursing competencies. It discusses the need for nurses, worldwide,
to be actively involved in the disaster management continuum; the roles of
nurses; the gaps in knowledge; the barriers; and the dilemmas in disaster
nursing education.
Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
10
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International Efforts
Worldwide efforts through the leadership of the United Nations and the
World Health Organization (WHO) have begun to address issues of disaster
mitigation and preparedness. In January 2005, 168 governments adopted the
Hyogo Framework for Action, which is a 10-year blueprint for disaster risk
reduction. The goal is to reduce not only the lives lost in a disaster, but also the
damage to economic, social and environmental resources of the community.
Included in the five priorities is the need to strengthen disaster preparedness
for effective response (ProVention Consortium, 2007). An effective response
includes well-trained personnel with appropriate skills who understand their
roles as well as the roles of others.
To enhance the implementation of the Hyogo Framework, the United
Nations created the Global Platform for Disaster Risk Reduction to serve as
a forum for all parties involved in disaster risk reduction. The Global Platform
United Nations agencies to include the private sector, scientific and academic
communities, international financial institutions and other groups involved in
disaster. The intent is to increase the recognition that solutions to disaster risk
reduction are multifaceted and the business of everyone. Governments retain
the principal responsibility for risk reduction, albeit supported by a network of
stakeholders. Without a multi-stakeholder approach, progress on the Hyogo
Framework will be slow. The Global Platform also provides for information
sharing and the provision of practical guidance to reduce disaster risk (Global
Platform for Disaster Risk Reduction, 2001).
WHO, as the lead agency for addressing the health aspects of emergency
preparedness and response, plays a pivotal role in meeting the humanitarian
challenges of emergencies, crises and disasters. Subsequent to the extreme
11
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Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
(2)
(3)
(4)
12
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13
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14
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was adequate and lives were saved; however, it is estimated that at least 215
people lost their lives in nursing homes and hospitals during the hurricane as
a result of failed health facility evacuation plans in Louisiana. In addition, the
number of health personnel on the ground, initially, was inadequate to meet
the needs.
Disasters can pose serious public health threats to any nation. Death,
trauma, injuries, worsening of chronic diseases, infections, spread of disease
and mental health problems are just a few of the potential public health
consequences of a disaster. Health care must be available if risks to life are
going to be reduced. A nations capacity to respond to a disaster event
successfully depends in part on the ability of the health care professionals to
rapidly assess, communicate and manage effectively during an event (Cox and
Briggs, 2004). The preparation of nurses and other health professionals must
be a priority.
15
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16
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affected area, and the degree to which the health infrastructure is developed
and available. With an understanding of the epidemiology of disasters, nurses
can anticipate certain health consequences and delivery issues depending on
the type of disaster event. For example, with earthquakes, one can expect
many deaths and severe injuries as well as damaged and destroyed health
facilities. On the other hand, a slow rising flood will produce far fewer deaths
and injuries with less damage to the health infrastructure (Pan American
Health Organization, 1999). Using data from epidemiologic studies of
disasters, nurses are better prepared to address the challenges of providing
care in different types of disasters and under different conditions.
Preparedness and mitigation activities have become a worldwide priority
(Prevention Web, 2008). These activities reduce the risk and impact of
disasters on the population and community and therefore save lives. Nurses
who have an understanding of health issues in the community play a major
role in disaster planning, programme development, mitigation, training and
knowledge of community resources, populations at risk, vulnerable individuals,
workforce issues, supply needs and nursing roles and practices are crucial
contributions to disaster planning.
Shri Anil Sinha, Head of the India National Centre for Disaster
Management, told the Trained Nurses Association of India that nurses can
contribute significantly in educating and creating awareness in the community
on disaster preparedness (Seda, 2002, p. 1). Nurses play an important role
in disaster preparedness by: educating the community on disasters; working
to reduce hazards in the workplace, homes and communities; contributing to
the development, implementation and evaluation of community readiness;
participating in and evaluating disaster drills; and coordinating and working
with community organizations. In the workplace, where disaster planning
17
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18
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19
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Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
20
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21
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nurses and other responders. The ability to be flexible was hampered by a lack
of understanding of the situation. Communicating was frustrating because of
language issues and the lack of communication tools. Teamwork was hindered
by the lack of understanding of the various roles of responders. In addition,
nurses often made personal sacrifices to assist in the disasters, which adversely
impacted the disaster operation, as well as the nurse. Failure to understand the
Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
22
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were ill-prepared. Nurses arriving first at the scene of the disaster expressed
23
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completed a basic disaster nursing course, Suserud (2003) found that the
students failed to recognize the need to address mental health issues and
focused only on the physical injuries. Still today, too many nurses respond
to disasters expecting that their role will be focused on the physical injuries
and illnesses of the survivors. While mental health issues are a major
concern, many nurses lack sufficient knowledge to recognize the potential
for mental health consequences in a disaster. Failure to identify normal stress
reactions to a disaster, failure to provide appropriate psychological care and
failure to recognize the need for additional mental health care may delay or
complicate an individuals recovery. All nurses must be competent to provide
psychological support and possess the knowledge necessary to address mental
health issues.
Physical and psychological needs are also experienced by disaster relief
workers. As with disaster survivors, mental health needs are often overlooked.
Many of the workers have never been exposed to the suffering and devastation
of a disaster. They tend to work long hours and get little rest. They may also
be dealing with an unfamiliar culture and political tensions. All of these factors
put them at risk for injury, illness or psychological problems. Psychological
problems are often first observed as behaviour changes, which impact not
only on the individual but also on the relief operation. Nurses must be able to
identify psychological needs and implement supportive nursing interventions
to assure the well-being of health workers by meeting their basic human needs
during such stressful times.
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need to choose between two patients requiring surgery, one critically injured
25
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checks had not been cashed because the evacuees did not have checking
accounts or that they used the money to buy items considered nonessential
by the staff. Failure to understand the culture and norms of the population
created a sense that the staff did not care about the evacuees. The cultural gap
created a very difficult helping environment (Clemens, 2006).
Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
26
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factors that will help to ensure that nurses are willing to respond.
Understanding the factors that influence the ability and willingness to
report to work in a disaster is vital in order to ensure an adequate workforce.
A number of studies have investigated the ability and willingness of health care
workers to report to work in an emergency or disaster situation. Dr Kristine
Qureshi and others (2005) found that factors influencing ones ability to report
during a disaster included: transportation issues, personal health concerns,
child care, elder care responsibilities, and pet care. Factors impacting the
willingness to work in a disaster event included: fear and concern for self and
family, personal health problems, child care and elder care.
One survey of 1500 employees revealed that caregiver responsibilities
were a major predictor of a health care workers willingness to report in
a disaster (Rosenfeld et al., 2007). A study of Japanese nurses asked to
respond to the Great Hanshin-Awaji Earthquake of 1995 found that home
for the disaster (Mitani, Kuboyama and Shirakawa, 2003). Lack of disaster
knowledge was also found to be a deterrent for recruiting nurses.
The type of disaster also impacts on the willingness to work. Fear and
concern are higher in disasters involving chemical, biological, radiological
nuclear agents and those related to disease and illness. A review of the
literature on willingness to work in disaster response completed by Erin Smith
(2007) found that threats of infection dramatically impacted on the response
to a disaster. In addition, she noted that the literature suggests that the longer
an event lasts, the harder it is to sustain the workforce.
The results of these studies highlight the need for adequate disaster
education and preparedness. Nurses must be able to analyse the risk and make
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28
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29
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of the West Indies are examples of schools that have incorporated disaster
education in their curricula. Overall, however, too few programmes are
preparing new nurses for disaster situations. In Japan, 60% of the nursing
education programmes had no disaster nursing course and had no intention of
adding a course in the future (Yamamoto and Watanabe, 2006).
Chapter Two: Impetus for the Development of the Framework of Disaster Nursing Competencies
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programmes are needed to fill the knowledge gap and increase the willingness
of nurses to respond.
It is important to note that continuing education in disaster preparedness
and response is not required in many countries and what is available varies
greatly. Although nurses have demonstrated an interest in disaster education,
their level of interest generally drops as the time following an emergency event
increases. Offerings are needed both in the classroom and online to assure
access to disaster education. Standard competences are required to support
programmes that will address the basic requirements for the role of the nurse
in disasters.
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Chapter Three:
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This chapter focuses on the process used to develop the ICN Disaster
Nursing Competencies for the Generalist Nurse. The process included
identifying an organizing structure for the competencies, determining the
advantages and limitations of the competencies, obtaining input from experts,
and reviewing current literature.
||
||
34
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to do their work. They are the descriptive statements that are observable
and allow for measurement of competence. Competencies are valuable
to describe the expected activities of the profession when carrying out a
specific job. Nursing competencies are used to describe general nursing
practice, specialized roles (such as disaster nursing) and specialty practice
(Hird, 1995).
Competencies:
||
||
||
facilitate communication;
||
build confidence;
||
||
||
||
||
essential.
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Literature Review
To assure a broad assessment of information related to disaster, nursing
and competence, an initial search of the literature was performed by using key
databases, namely ERIC, PubMed, MEDLINE, and CINAHL. Internet search
enginesGoogle, Yahoo, AltaVista and Excitewere used for additional
searches.
Key words used to search resources included: disaster, disasters,
nursing, public health, competencies, competence, ethics,
nursing role, training, education, disaster management, disaster
organization, disaster statistics, World Health Organization, United
Nations, international disaster relief, International Red Cross, Red
36
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Key Documents
37
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of practice area. The competencies are divided into three categories: (1)
professional, ethical and legal practice; (2) care provision and management;
and (3) professional development. The ICN Disaster Nursing Competencies
are a subset of the ICN Competencies, reflecting the specialized role and
activities of nurses in disaster. It is expected that nurses will demonstrate the
basic nursing competencies as well as the disaster nursing competencies when
working in disaster situations.
The Educational Competencies for Registered Nurses Responding to Mass
Casualty Incidents (Stanley, 2003), developed by the Nursing Emergency
Preparedness Education Coalition, was one of the first set of competencies
developed for disaster nurses. The competencies focus on knowledge and skills
38
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39
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Prevention/
Mitigation
Preparedness
Incident
Response
Post- Incident
Recovery
Reconstruction/
Rehabilitation
40
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Prevention/Mitigation
Prevention/mitigation is the process designed to prevent or minimize
the risks related to disaster. Identifying risk and taking appropriate action
may prevent a disaster altogether or reduce the effects of the disaster. It
encompasses a variety of activities to reduce the loss of life and property.
Lessons learnt from actual incidents, training and exercises contribute to the
development of action plans that describe what actions should be taken to
reduce or eliminate long-term risks to human life and safeguard the community
41
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for care or identifying alternative sites for care following a disaster is another
activity that requires the expertise of the nurse. Working in partnership with
other health care providers and community leaders, the nurse helps to plan for
the evacuation of health facilities and relocation of patients as required.
Helping to shape public policy that will decrease the consequences or
potential effects of a disaster is an important role because of the nurses
knowledge of the community and the areas of vulnerability. Working with
policy-makers to identify hazards, the risk such hazards pose to the population,
and health infrastructure to develop solutions that reduce the risk are all part
of nursings role. Ongoing community education related to identification and
elimination of health and safety risks in the home or community is another
area where nurses bring expertise.
Preparedness
Preparedness is perhaps the most critical phase in the disaster
management continuum. Current events have demonstrated that the focus on
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and collaboration, equipment and supply needs, training, sheltering, first aid
43
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stations, and emergency transport all require nursing expertise. Nurses develop
and provide training to other nurses and health professionals, as well as the
community. Capacity-building through recruitment and maintenance of a ready
disaster nursing workforce is also part of nursings role. In addition, nurses
are involved in leadership roles, planning, participating in, and evaluation of
readiness exercises to assure that the community, and the nursing workforce
itself, is prepared in the time of an emergency or disaster. Collaboration with
planners, organizations involved in disaster relief, government agencies, health
care professionals and community groups to develop the preparedness plan is
vital.
Response
The response phase encompasses the immediate action taken in the face
of a disaster. It includes the mobilization of responders to the disaster area. In
the response phase, the objective is to save as many lives as possible, provide
for meeting the immediate needs of the survivors and reduce the longer-term
health impact of the disaster. This phase may last a few days to several weeks
depending on the magnitude of the disaster.
The role of nurses in the response phase is providing both physical and
mental health care. Care is provided in a variety of settings under challenging
conditions that require a knowledgeable, skilled and creative workforce.
Managing scarce resources, coordinating care, determining if standards of care
must be altered, making appropriate referrals, triage, assessment, infection
control and evaluation are just a few of the skills a nurse uses in the response
phase. Identifying individuals with chronic disease or disability is a critical
responsibility. With health care access and mobility limited, these individuals
are at great risk because of heat, humidity and cold issues, and difficulty in
maintaining appropriate diets. Post Traumatic Stress Disorder, depression
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and anxiety are frequently seen in the aftermath of a disaster. The nurse must
continually monitor survivors for signs of mental health issues, must provide
care and must make referrals, as necessary.
Roles include advocacy for patients and survivors, teaching, and leadership
and management. Nurses must monitor responders to assure that mental
health or physical care is not needed. Additionally, nurses provide onsite
training to other nurses and health care workers and volunteers. In this phase,
nurses often work as part of a health care team and collaboratively with other
responders to provide assistance to as many survivors as possible. During the
response, nurses use their skills in epidemiology to identify patterns of illness
to detect any threat of communicable disease or other health hazards. They
also collect data on injuries and illnesses seen during the disaster, which are
later communicated to epidemiologists for analysis.
Once immediate needs are met, the recovery phase can begin. In this
phase, work is concentrated on assisting the community and the affected
population recovers from the impact of the disaster. Recovery includes
restoring vital services, rebuilding infrastructure and housing, and meeting the
needs of the population while assisting them to restore their lives. Recovery
is a long-term process that requires both short-term and long-term goals for
rehabilitation, reconstruction and sustainable development.
Nurses continue in the role of providing care and support to those with
physical and mental health needs. Those injured or ill or those with chronic
disease, mental health illness, or disability must be monitored to reduce the risk
of complications. Referrals must be made to appropriate health care providers,
government or relief agencies for housing, food, medications, medical
Recovery/Rehabilitation
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the recovery phase to assure that all of the needs are being met.
During the recovery and rehabilitation phase the nurse evaluates the
disaster plan and champions required changes to improve the management
of the disaster and the disasters impact on the population. Evaluation is a
critical component in mitigating the effects of future disasters. Nurses have a
responsibility for providing documentation and evaluating the process while
actively participating in follow-up activities that include community planning
and development.
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Chapter Four:
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Chapter Four:
||
||
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||
mitigation/prevention competencies;
||
preparedness competencies;
||
||
recovery/rehabilitation competencies.
Within the four areas, 10 domains were identified: (1) risk reduction, disease
prevention and health promotion; (2) policy development and planning; (3) ethical
practice, legal practice and accountability; (4) communication and information
sharing; (5) education and preparedness; (6) care of the community; (7) care of
individuals and families; (8) psychological care; (9) care of vulnerable populations;
and (10) long-term recovery of individuals, families and communities. Numbering
of the competencies is only for the ease of reading and does not indicate priority.
ICN Framework of
Competencies of the
Generalist Nurse
Prevention/
Mitigation
Competencies
Risk Reduction,
Disease Prevention
and Health
Promotion
Policy
Development
and Planning
Framework of Disaster
Nursing Competencies
Preparedness
Competencies
NEPEC Competencies
COE Competencies
Response
Competencies
Ethical Practice,
Legal Practice and
Accountability
Care of the
Community
Care of
Individuals and
Families
Communication
and Information
Sharing
Recovery/
Rehabilitation
Competencies
Long-term
Individual, Family
and Community
Recovery
Psychological
Care
Education and
Preparedness
Care of Vulnerable
Populations
* COE: Center of Excellence; ICN, International Council of Nurses; NEPEC, Nursing Emergency Preparedness
Education Coalition.
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1.
(1)
(2)
populations.
(3)
(4)
Identifies challenges to the health care system and works with the
multidisciplinary team to mitigate the challenges.
(5)
(6)
(7)
1.2 Health
(1)
Promotion
(2)
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(3)
(4)
(5)
2.
(2)
(3)
(4)
(5)
Recognizes the disaster plan in the workplace and ones role in the
workplace at the time of a disaster.
(6)
(7)
(8)
(9)
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(10) Participates
Practice
(1)
(2)
(3)
(4)
(5)
(6)
(7)
3.2 Legal
(1)
Practice
(2)
(3)
(4)
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Describes the legal and regulatory issues related to issues such as:
yy working as a volunteer;
yy roles and responsibilities of volunteers;
yy abandonment of patients;
yy adaptation of standards of care;
yy role and responsibility to an employer; and
yy delegation.
3.3 Accountability
(1)
(2)
(3)
(5)
4.
Describes the chain of command and the nurses role within the
system.
(2)
(3)
(4)
(4)
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(5)
(6)
(7)
(8)
(9)
(10) Demonstrates
equipment.
Chapter Four: The ICN Framework for Disaster Nursing Competencies
(11) Maintains
required.
(12) Communicates
(2)
(3)
(4)
(5)
(6)
(7)
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(9)
(10) Assists
Care of Communities
(1)
(2)
(3)
Evaluates health needs and available resources in the disasteraffected area to meet basic needs of the population.
(4)
(5)
(6)
(7)
(8)
(9)
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community.
(11) Effectively
7.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
7.2 Implementation
(1)
56
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(2)
(3)
(4)
(5)
(6)
(7)
(8)
(10) Provides
(11) Maintains
disaster
(12) Documents
(13) Provides
(9)
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8.
Psychological Care
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
9.
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(b)
(2)
(3)
(4)
(5)
(6)
10. Long-term
(1)
(2)
(3)
(4)
(5)
(6)
(7)
10.1
Care Needs
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10.2
Community Recovery
(1)
(2)
(3)
(4)
(5)
normal functions.
(6)
(7)
(8)
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Chapter Five:
Recommendations
61
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Chapter Five:
Recommendations
(b)
(c)
(2)
take no action.
62
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(4)
(5)
(6)
(b)
63
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(7)
(c)
(d)
(8)
(9)
64
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(12) Specialty
(15) More
crucial that the voice of nurses is heard when policy is created. The
nurses can play in a disaster. It is important that nurses interpret the
competencies and roles of nurses during the policy development
process.
(16) It
65
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66
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