Nursing Practice During a Disaster: Some Considerations

Nursing is by nature a profession based on caring compassion and the desire to alleviate suffering and facilitate healing. The nursing profession has and will play a vital role in the response to any disaster. This fact has been acknowledged by the Institute of Medicine(IOM) in their report The Future of Nursing Leading Change and Advancing Health. The IOM has also created the report titled Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations. The nation has coped with disasters such as the 9/11 terrorist, hurricanes, and pandemics. Some disasters require an all out immediate health care response, other disasters require a more planned response over a longer period of time. The IOM has distinguished disasters by calling them pervasive or catastrophic. However, every disaster requires a different allocation of resources, and maximum output of health care personnel. Care decisions are made in a compressed time frame and the standard of care will change. The standard of care that is able to be implemented is known as a crisis standard of care, is executed by the presence of certain circumstances and at present is formally declared by a state government. Preparation before a disaster is essential. There are many questions that nurses would have in deciding how to respond in a disaster. What are a nurse’s professional and personal considerations? Effectiveness means getting the answers beforehand, as almost any nurse will feel a professional obligation to assist in a disaster if needed. This article will pose some questions nurses might have in an attempt to provide tools to help a reader make an informed decision. The IOM has recommended national standards and protocols in any disaster response. Currently only some states have disaster contingency plans. The IOM with input from professional organizations such as the ANA has prepared a report that outlines suggested procedures. The ANA has its own policy paper as well. The Red Cross is also establishing scope of practice for nurses in their disaster response which includes nurse managed shelters. It is called the Disaster Health Services Concept of Operations. The IOM has stated that 5 elements must comprise any national policy on disaster response. They are: That any plan has a firm ethical foundation, and there be community and provider engagement and education that are continual and integrated. There must be assurances on legal authority and environment. Clear triggers, indicators and responsibilities, which employ evidence based decision making processes.are necessary. Here are some of the questions nurses might have about their professional role in a disaster. What capabilities will I need to practice effectively? The Columbia School of Nursing has composed a list of core competencies for clinicians in disaster healthcare. For a health care professional the following is a brief summary of emergency preparedness skills: Responding to the emergency within the incident or emergency management system of the particular organization or entity. The ability to explain one’s role in the disaster response. Initiate patient care according to licensed ability and coordinate referrals to an appropriate agency according to the patient’s condition. Be able to recognize sickness, disease, or injury that is a consequence of a number of agents natural or manmade. The ability to put in place infection control procedures to reduce spread of disease, which will include decontamination and use of protective equipment. Recognize and manage stress and anxiety created by the disaster and refer if necessary. Communication is a large part of several competencies as clinicians will need to both receive and convey information about the disaster, for example to facilitate updates. They will also have to interpret information received and summarize care given to patients and also participate in post event evaluation. What would be my scope of practice? What the legal protection is in place to protect me in my practice? The IOM report stated that professionals need to be clearly protected in order to allow health care professionals to practice without fear of legal action as long as they are acting in good faith and not recklessly. Although comprehensive liability protection is in place medical personnel are protected if they act under an emergency declaration as part of a team, for example. The IOM has recommended that existing liability protection be tied to linked to the declaration of crisis standards of care. An ethical foundation allows for confident provider response and action. Clarification and standardization of protocols will encourage nurses to respond in a disaster. If my present employer doesn’t have a disaster plan response where can I get training in disaster nursing? Be knowledgeable about your employer’s emergency preparedness plan if your medical center has one. Get involved in advocating to your peers the importance of creating a plan. Also be aware of your state’s response protocols are. Nurses can also train with organizations that would respond in a disaster such as the Red Cross, Disaster Medical Teams and the Medical Reserve Corp Standards of care in a disaster will differ from health care on a regular basis. Any crisis standard of care must be applied consistently and with transparency. All this must be contained in a policy that has been developed pre disaster by a disaster medical advisory team using evidence based decision tools and algorithms. In a disaster health care professionals’ goal must be to provide the care for the greater good of a larger number of patients. Nurses must confidently rely on their professional experience to make up for the lack of technology, staff, or support services available. Also utilities and infrastructure to administer health care may be damaged. One point that has been proven in any disaster is that vulnerable groups of society suffer the most both during and after the event. As mentioned earlier, community engagement is necessary in any disaster response plan, both for it to be executed successfully and for the recovery of citizens after. This is where nurses’ professional skill and unique position of trust in the public’s eyes will mean they are the health care professionals best positioned to elicit and maintain constructive productive dialogue with the public before, during, and after a disaster. Policymakers would do well to note the public’s trust in nurses and put them in positions to engage the public in disaster response planning. Sources:

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