Working as a nurse in a Disaster Area – Challenges of disaster nursing
Author: Lily Gebremariam, Degree Programme: BSc nursing student, Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD, Senior lecturer, Novia UAS
Nurses are the front-line volunteers in catastrophic events globally, yet disaster nursing and emergency management needs a special training and competence. Nurses could be assigned in different duties, from triaging a patient to be a leader in managing workforce on the site. Tackling catastrophic events requires planning for phases of prevention, preparedness, response, and management of the disaster. This article reviews the role of nurses and the competence required by nurses according to “The international council of nurses” (ICN) in terms of the four phases of disaster response. Most importantly the article discusses, the challenges faced by nurses in the preparedness phases of disaster management and planning process. The lack of knowledge in ethical and legal consideration, experience, personal threats, and behaviour could be a cause of challenge in emergency management for nurses.
The term disaster refers to both natural and unnatural ones that occur due to man made errors. Despite the type of disaster, nurses have an important role to help and support victims in devastating situation. The disaster could range from floods, drought, fire, war, hurricane or working in vulnerable areas where a certain disease outbreaks. Though the nurses could be a great help, is being a registered nurse enough qualification to volunteer and act in disastrous events?
Every disaster needs a specific skill or training to tackle it. Disaster situations are frightening and dangerous not only for the victim but also for the helpers. The respondent needs to protect him- or herself, be competent and prepared when, what and how to act. The nurse who wishes to participate in disastrous areas should get well acquainted and be trained in advance before the occurrence of the situation.
International council of nurses has developed the ICN framework to educate general nurses in reaching a competence for managing disaster. According to ICN framework, there are four disaster management kits for every stage of disaster. The framework emphasises and educates nurses on how to prevent, prepare, response and recovery from the challenges of a disasters. The framework is constructed in accordance with the competences of different health care sectors as, emergency nurses, public health and mental health. According to the framework, with the competency of addressing disaster, the professional will have a knowledge, skill, motivation and be able to tackle the disaster.
Red Cross is one of the organizations where volunteers and nurses could get training by participating in the “Red Cross disaster services human resource system”. According to Red Cross, there are 20 000 nursing students and nurses volunteering to participate in disaster areas (WHO, 2019).
Role of nurses in disaster areas
Nurses’ role in disaster areas could be limitless, the nature of nursing profession has a reflective advantage where nurses could take both physical as well as psychological responsibilities in the four different stages of disaster.
Nurses could have a responsibility of giving care in the response stage of a disaster: by assessing, giving first aid for wounded victims, give care for mental health needs in cases of traumas, prevention of illness and outbreaks before the occurrence of crisis situations and managing epidemics, triaging victims, and giving vaccination. Nurses could also work with the role as leaders, managing other caregivers, and allocating resources and organizing shelters and health stations in the areas.
Phases of disaster management
The first phase in addressing disaster is prevention or mitigation. It is the process to lessen the risks that come along with the disaster, to minimize the dangers of the disaster. In mitigation phase, nurses have a role in teaching the community about disaster, work to remove hazards, evaluate the community if they are ready or not. The phase is an ongoing one, where there could be a change in manpower, environment, or information. This phase is necessary to avoid the consequences coming from hazard. Well preparation, helps to recover from the disaster in a short period of time and vulnerability (Ejeta, Ardalan & Paton, 2015).
Preparedness is the second phase; it is all about making a plan to concur the damage and give support to the recovered ones. In this phase making an emergency management plan is the main goal for the disaster occurred and for those unexpected ones. Identifying the roles of the volunteers and communication means are also part of this phase. Preparedness for the need for isolation, vaccine, infection control could be where the nurses’ skills are needed more importantly in this phase. Preparedness includes understanding the capacity of staff's skills and equipment needed in advance of the event occurrence and making an action plan (WHO, 2019).
In the third stage, response stage of disaster, the objective is to help and keep as many lives as possible of those who are in danger from the catastrophic event. The stage commences with gathering volunteers and emergency respondents, nurses to the danger area. Nurses’ role in the response stage, varies from acting as a leader in managing other respondents, assessing victims’ physical condition, triage, infection control, caring for post traumatic disorders, giving first aid, emergency care and palliative care. According to the ICN framework, nurses should have the competencies to check for the victims with mental status, anxiety after disasters and continually monitoring (Rokkas, Cornell & Steenkamp, 2014).
The last stage is recovery; it is a demanding process that might take days to months. After the immediate response ends, the recovery process commences. The process encompasses repair, rebuilding, and starting from scratch (Coppola, 2021). The aim is to return the victims to their normal life. The role of nurses in the after-crisis comes in hand with organizing life support systems, psychological support, and restoring physical damages of properties. The recovery stage has two phases: short-term and long-term recovery.
The short-term recovery takes place while an emergency response is in effect; it focuses on restabilizing victims with utmost necessities. The aim is to support suffering people or patients to get vital life needs, alleviate physical pain and allocate them to a safe place and prepare them for long-term recovery (Coppola, 2021). Long-term recovery is to regain damaged properties and support people who experience or are at risk of post-traumatic trauma. To assist People who undergo overwhelming feelings and get demotivated to function as normal after disaster events (Assid, 2014).
Nurses have a great role in the rehabilitation process; in terms of the psychological and physical care of victims (Chan et al., 2010). They assess and counsel people in the community who needs psychological help, work with other professionals to support people get legal, economic, and psycho-social needs, make settlements, and provide counselling and documentation (Assid, 2014).
Challenges of nurses to work in disaster area
Working in a disaster area might be challenging and stressful in many ways. Often working on catastrophic areas requires to systematically use materials and manpower, due to the shortage of the resources available to reach out to the situations. Nurses as a leader need to be organized enough to allocate resources smartly and motivate people to work in chaotic situation. For example, on war areas, it could be stressful in some situations even to triage a victim and give the necessary care, with limited medical supplies (WHO, 2019).
As a nurse working in disaster situation, there is a lot of adaptation in the nursing practice from being a registered nurse with basic skills and working in a hospital setting. Nurses need to adapt and manage to work with many patients at one time, unlike caring for few patients in normal work. And be able to quickly change the focus of care from public health to emergency care. Nurses should have the capacity to work with many professionals having different characteristics in a stressful situation.
Working globally in a different culture, it could be a challenge for the nurse to know the norms and respect the dignity of the victims. Due to the circumstances of the situation, it could be difficult to be competent in delivery care, considering the cultural norms and religious values of the victims.
The other challenge is to face safety threats and violence while working as a respondent in emergency. For example, to give first aid for victims of floods (hurricane) or participate in areas where infectious diseases spread out, mental preparation is needed to face risks of getting a disease and thinking of potential physical safety and security for oneself. In the occurrence of new disasters like an infectious disease outbreak, Nurses’ willingness to respond is in question. Due to a lack of prior information and knowledge, nurses face the fear of caring for patients, doubting their skills, and fear of contagious infections (Jennison, 2021). Working in an area where the physical environment is uncontrollable, as flood not only disturb the reach out plans and materials, shelters but also the respondents’ life could be in danger in every instance. (WHO, 2019)
In some cases, it is more difficult for the nurse to balance professional responsibilities with family obligations, besides thinking about safety. The nurses could have family needs to meet and it might require longer time to serve, reach out and solve the chaos. Moreover, it is sometimes difficult to make ethical decisions as a nursing professional, while being in a life and death situation.
While volunteering as a nurse in catastrophic events, nurses could come across different challenges which they might not face in everyday work in the health care centres or hospitals. Commonly in response to disaster, there is a short period of time to distribute help or make a quick decision due to, shortage of resource, manpower or the nature of the hectic situation. Even though practicing ethical, legal considerations and respecting patient autonomy is the theme of nursing profession, maintaining standards in disaster situations could be a challenge (Aliakbari, Hammad, Bahrami & Aein, 2014).
Making ethical considerations with the availability of limited resources is a difficult notion. For example, a nurse could decide between triaging a patient with critical injury and insignificant chance to be alive and another victim with heavy injury but have a high chance of survival with a limited source of surgery. Critical ill patient is given priority in normal hospital setting but in a disaster site, priority is given to the heavily injured victim. To whom to give priority in limited source of vaccine or medicine is not always easy either (WHO, 2019).
Catastrophic events can happen anywhere in the world, and it is unpredictable. Emergency nursing in a disaster demands good effort to work along other professionals. Addressing disastrous events require, having a good skill of leadership and competence and preparation. According to ICN, taking the necessary training as an emergency nursing is the paramount to address the events. However, challenges faced by nurses could be minimized but not curtailed at all levels. Considering ethical and legal practices in the nursing profession is important, the competence training for emergency preparation within the ICN should give more emphasis on making ethical decisions on chaotic situation. Even if as a good nurse, practicing ethics in everyday work, nurses should be aware and be taught in advance as it is a challenge to address this in disaster events.
Nursing education should incorporate training in emergency or disaster management. The training should focus more on areas where nurses face challenges and doubt. Some areas include overcoming legal issues, ethical consideration, care for the injured children, justice and equality, built-in authorization, and patient self-determination, and keeping patient autonomy and consent.
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