Disaster Nursing Competencies

Definition of Competence

• "COMPETENCE" lacks a consistent definition in literature as per Fleming and Holmes in 2005.
• In healthcare, "competence" describes the knowledge enabling a practitioner to perform activities safely and consistently.
• Competence includes knowledge, understanding, judgment, a range of cognitive, technical, psychomotor and interpersonal skills, and personal attributes and attitudes.
• ICN defines competence as a performance level demonstrating effective application of knowledge, skill, and judgment.
• Performing to standards is gained through work experience, education, mentors, and training.
• Competencies are the applied skills and knowledge that enable people to do their work.

Impetus for Developing Disaster Nursing Competencies

• The ICN identifies factors that influence the need for disaster nursing competencies.
• There is a need for nurses worldwide to be actively involved in disaster management, with clearly defined roles.
• Important factors include the addressing knowledge gaps, overcoming barriers, and resolving dilemmas in disaster nursing education.

Importance of Competencies

• Competencies are crucial to ensure a prepared global nursing workforce for disasters.
• Competencies help to facilitate the global deployment of nurses and create consistency in care.
• Facilitation of communication and building of confidence are enabled through competencies.
• A more professional approach is facilitated with shared aims and a unified strategy.
• This enhances nurses' ability to work effectively within the organizational structure.
• Nurses can function successfully as multidisciplinary team members because of competencies.

ICN Disaster Nursing Competencies Development

• Competencies are developed by analyzing existing competency frameworks in public health, mental health, health care workers, emergency managers, nursing, and disaster nursing.
• Two key documents in its development include:
  • Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents (Stanley, 2003).
  • Core Competencies Required for Disaster Nursing (Yamamoto, 2004).
• An organizing structure was identified to make sure all aspects of disaster nursing were included in the competencies.
• The "disaster management continuum" was selected as the organizational structure.
• The reasons for "disaster management continuum" were that:
  • It is recognized worldwide.
  • Nursing roles are integrated.
  • It provides a consistent way to organize the competencies.
  • It enhances the ability to develop the educational curriculum.

The Disaster Management Continuum

• A refined approach developed over the last 30 years to effectively manage disasters.
• Defined as the policy and administrative decisions, plus operational activities for all disaster stages.
• The Disaster Management Continuum is an integrated, continuous process spanning each disaster phase.
• This involves a continuous activity chain of mitigation/prevention, preparedness, response, and recovery/rehabilitation.

Prevention/Mitigation Phase

• Designed to prevent or minimize disaster-related risks.
• Risk identification and appropriate actions can avert or reduce disaster effects.
• Activities encompass reducing loss of life and property.
• Lessons from incidents, training, and exercises aid action plans to reduce long-term risks to human life and the safeguarding of the community or potential effects.
• Nurses collaborates on plans for housing and interventions to reduce vulnerability.
• Risk reduction activities in healthcare settings and identification of alternative care sites require nurse expertise.
• Partnership with healthcare providers and community leaders is needed to plan the evacuation and relocation if needed.
• A nurse's role begins with identifying risks at community and individual levels.
• Nurses work with other professionals to determine disease risks, plans to lower those risks, and surveillance systems for outbreaks.
• Community needs assessments determine disease prevalence, facility susceptibility, and vulnerable populations (chronic disease, mental health, and disability factors).
• Community understanding and pre-existing conditions offer data for the disaster plan.
• Shaping public policy to lessen disaster effects is vital because of a nurse's comprehension of the community and vulnerability areas.
• Nurses work with policy-makers to recognize hazards, population risks, and health infrastructure.
• Ongoing community education related to safety risks, identification and elimination are vital nursing roles.

Preparedness Phase

• Possibly the most crucial phase.
• Focus on preparedness has been proven inadequate in current events.
• The need for planning is underscored by recent events.
• Inadequate disaster planning leads to chaotic response, and increased survivor suffering/loss of life.
• Nursing input creates policies related to response and recovery
• Policies related to unlicensed volunteer personnel use or altered care standards.
• Nurses provide health and medical care focused community needs and resources assessment which enables planning.
• Nursing expertise is key in planning activities such as communication, coordination & collaboration, equipment/supply needs, training, sheltering, first aid stations, and emergency transport.
• Capacity building through recruiting/maintaining a disaster nursing workforce is an aspect of nursing's role.
• The role of nursing involves participating in leadership, planning, participation, and evaluating community readiness exercises which assure the community, and the workforce itself is prepared.
• Nurses develop/provide training to other nurses/health professionals/community.
• Collaboration between planners, relief organizations, agencies, health care, and community is vital.

Response Phase

• Includes the immediate action taken when facing a disaster.
• Includes responder mobilization to the disaster area.
• Objectives are saving as many lives as possible, meeting immediate survivor needs, and minimizing long-term disaster health impacts.
• The phase may extend from days to weeks depending on the disaster's severity.
• The role of nursing is to provide physical and mental health care support.
• Care is provided in challenging settings and conditions, requiring a knowledgeable, skilled, and creative workforce.
• Management of limited resources, coordinating care, altered standards of care, triage, assessments, infection control and evaluation are few nurse skills used during the phase.
• Post-Traumatic Stress Disorder, depression, and anxiety are common post-disaster effects.
• Monitoring survivors is vital.
• Roles include advocacy, education, leadership, and management.
• Monitoring responders and onsite training are important nursing actions.
• The action includes assistance through a healthcare team, and collaboration, to as many survivors as possible.
• Epidemiology-related skills are used to identify patterns that detect potential diseases.
• Gathering data of post disaster illnesses are captured for analysis.

Recovery and Rehabilitation Phase

• Begins after immediate needs are met.
• This phase entails assistance to the community and the recovery from the disaster impact.
• Recovery includes restoring vital needs, rebuilding and meeting the needs, to restore living.
• Recovery is a long process involving short-term and long-term goals for what needs to be restored and/or rehabilitate.
• Nurses continue care and offer supportive measures for those with physical and mental health needs.
• Complications need to be monitored for the injured, the disabled or those with illnesses.
• Referrals are made to ensure provisions that meet care and provide support.
• Nurses conduct follow-ups with survivors to assure needs have been met.
• The role includes contributing in health care infrastructure recovery.
• Temporary medical services turns into permanent facilities.
• Patient care is provided through and with leadership.
• Additional services may be a need due to the disaster.
• Patient's needs are advocates because of a nurse.
• The nurse evaluates the disaster plan and champions required changes to improve the disaster management and impact on the population.
• Providing documentation, while community planning and actively participating in follow-up mitigates future effects.

ICN Framework Application

• The specified three levels of nurses need competency in disaster nursing that increases level of complexity.
• Level I: Any nurse completing a basic and authorized nursing education
• Level II: Nurses with Level I competencies designated responder through an institution/organization.
• Level III: Nurses achieving Levels I & II competencies and preparedness responding to wide range of disaster and to serve a deployable team.

Eight Domains Of ICN Disaster Nursing Competencies

• Preparation and planning: Actions taken apart from an emergency to increase readiness and confidence.
• Communication: Approaches to conveying essential information, and documenting decision making.
• Incident management systems: Disaster/emergency response structure.
• Safety and Security: Assuring nurses, their colleagues, patients do not unsafe practices responses.
• Assessment: Gathering data for which to decide with.
• Intervention: Actions conducted with the individual and their support unit.
• Recovery: Actions that move individuals/families to a higher resumption of services.
• Law and ethics: Legal and ethical framework of disaster/emergency.

Risk Reduction

• The specific disasters on the community regarding risks and effects are evaluated.
• Collaboration between healthcare professionals, community organizations, government, and leaders.
• An participation in planning healthcare needs during a disaster event.
• Vulnerable populations' needs are identified, coordinated to implement appropriate activities.
• Understands the concept of isolation, quarantine, containment, decontamination.
• Working together to assist and build capacity.
• Community education activities with disaster preparedness.
• Assessing the community's current status and medical history/conditions.
• Partnering/planning to promote measure.
• Healthcare system's is improved through and with the public.

Policy Development and Planning

• Terminology involved in disaster nursing and management is understood.
• Describing government role, policy, and plans for community, national and workplace.
• One's role during a work in the workplace event.
• Policy and planning are contributed to through policy engagement and implementation.

Ethical Considerations

• Ethically challenges are identified through collaborations.
• Guidelines for prioritizing, protecting rights, and following cultural expectations.
• Maintaining documentation, confidentiality, and awareness and sensitivity to bias and beliefs.

Legal Considerations

• Obeying all the laws in the respective area, and the implication it may serve for what's to come
• To understanding protocol of volunteer roles and responsibility, and the adaptation safety they must adhere to.

Accountability

• Responsible for own action.
• Delegate through laws, regulation safety.
• Skilled in the limits of the role and the provision.

Communications and Information Sharing

• Chain of commands and the respective role
• Accommodates the needs to diversity.
• The risk is immediately noted as soon as information can be identified.
• Reduction of language barriers from communication
• Sharing health care data.
• Follow the protocol of the health and environmental.

Education and Preparedness

• Retaining competence of current and new knowledge that has a relationship between disaster and nursing.
• Personal emergency needs are maintained in any environment.
• Implementing activities for emergency, and collaborating for needs of capacity and training
• Recognizing that action is conducted to increased readiness.

Care of Communities

• Nursing are required to identify community needs, and health is improved.
• Working with the community for relief and healthcare organization is beneficial.
• Meeting resources needs and working in a multi-disciplined environment.

Care of individuals and families, assessment

• Physical and mental, psychological responses are noted when providing to all age level of communities members.
• Preventative and isolation from any known illness/agents.

Implement

• Following procedure of scientific process to prevent issues.
• Maintaining safeness and all the necessary protocols.

Psyhcological care

• Using the appropriate language and comfort to identify patients with mental and physical disability through their behaviors, cope with resources.

Vulnerability

• Identify groups at risk (children, and high acuity or specific populations, like homeless, etc).
• Accommodating those in independent situation.

Long Term Care Needs

• Creating plans for individuals and family.
• To provide sources for the community's and people to be referred to, but to also engage in a multidisciplinary team for maintain healthcare.

Community Recovery

• To review the results is vital for the future.
• Evaluate the practice improvements when there is aid from agency and health members

Long Term Care Needs

• Creating plans individuals and family
• To provide resources and people to be referred but to also Engage multi-disciplinary team for maintain healthcare.

General Professional Nurse in Disaster Nursing 2.0

• Any nurse completing basic nurse training through the country can support maintain a safe emergency.
• Can participate in emergency drills.
• Are expected to have current and up to date knowledge to handle.

Specialized Nurse In Disaster Nursing 2.0

• Any individual trained for disaster situations.
• Supports implementation and nursing decision, assess, apply infection levels.
• Explains PPE and response chains