Since the time Florence Nightingale walked the wards of Scutari, nurses have used their assessment skills and clinical insights to improve outcomes for patients in emergency situations. This OJIN topic on Emergency Preparedness reviews nursing’s history of responding to disasters and aiding individuals and communities in their recovery process. Stopping the spread of infectious disease, managing mass immunization clinics, and providing counsel and care to citizens affected by raging flood waters are examples of situations to which nurses respond on a regular basis.
After the tragic events of September 11th, nurses from all specialties recognized the need to become better prepared to respond to disasters that may occur naturally, accidentally, or by those who would choose to do us harm. The challenge faced by today’s nurse is to ascertain ways in which discipline-specific expertise can be utilized appropriately in an emergency response effort. Pioneers in the field of emergency preparedness for nurses have prepared the groundwork for developing a curriculum and establishing competencies to guide us as we sharpen existing skills and develop the new skills needed to respond effectively to emergency events. As nurses develop their skills, and their confidence in using these skills, it is essential that they also appreciate the unique talents and the specific roles of each nurse on the response team and work to integrate their efforts into the team effort.
This OJIN topic offers the reader five introductory articles on emergency preparedness which illustrate emergency response efforts from various perspectives. The authors, each in their own way, increase our awareness of the importance of the role of the nurse in disaster response. The perspectives presented address the historical role nurses have played during times of disaster, the importance of competency-based education and volunteer registries in emergency preparedness, the benefits of using the knowledge base of military disaster nursing as a foundation for civilian disaster nursing, and finally the importance of addressing nutrition disaster situations.
"A Historical Challenge: Nurses and Emergencies" by Gebbie and Qureshi, provides a historical perspective, stating that "nurses have been a part of emergency response as long as nurses have existed." Beginning with Miss Nightingale’s service in the Crimea, the authors lead us through the roles of the nurse during war years and into the mid-twentieth century. A reference to the Emergency Nurses Association (ENA) is a clear reminder that nurses can influence policy development. Although September 11th has raised awareness as to the importance of being prepared, Gebbie and Qureshi point out that the development of incident command systems and competencies for effective response were well underway by that fateful day, and they assure the public-at-large that nurses have and always will be there to respond in a disaster.
In "Emergency System for Advanced Registration of Volunteer Health Professionals," Peterson highlights the importance of developing a mechanism to increase surge capacity capability of health care professionals in times of disaster. Noting that nurses are often the largest contingent of professionals on hand at a disaster, she suggests that now is the time to take advantage of this "response power" to clarify the effective and appropriate use of those nurses who respond during a disaster. To illustrate the importance of proper management of the response workforce, Peterson points out that spontaneous volunteers, well intentioned though they may be, may not be skilled in a specific area of need; or worse, they may have appropriate skill sets but these skills may be difficulty to incorporate into a group response team. Volunteer registries are identified as helpful tools to maximize volunteer skill sets. The often overlooked issue of professional and personal liability is thoughtfully presented along with helpful suggestions on how to access information that may impact a nurse’s decision to volunteer in an emergency response effort.
The article by Weiner, "Preparing Nurses Internationally for Emergency Planning and Response," spotlights the challenge nurses face today in responding to disasters. The author notes that although disaster response is included in the National Council of Licensure Examination (NCLEX), this content is barely touched upon in the classroom. Weiner identifies the resources available to increase competency in disaster preparedness. These resources include online learning modules, marketed materials, electronic journals, and the Centers for Disease Control and Prevention-funded Centers for Public Health Preparedness (CPHP). Dovetailing nicely with Peterson’s article, this article emphasizes the need to prepare volunteer nurses to function in emergency response settings and to develop a centralized resource center to prepare for both global as well as local emergencies.
"A Proposed Model for Military Disaster Nursing" by Wynd recognizes that we live in a global society in which there is no such thing as an isolated event. She delineates the three phases of a disaster, thus providing insight into the wide spectrum of response efforts, and identifies the need to develop a model as a framework for disaster preparedness and response for nurses. Peterson proposes using the military disaster nursing process as a foundation for such a model. To provide background for such a model, Wynd offers a historical review of military nursing and disaster response, along with a literature review of research findings which illustrate the variety of responses by nurses in both natural and deliberate disasters. Conditions experienced by our military colleagues, such as sleep deprivation, suffering, and bare bones living conditions, are similar to those an on-site nurse responder may face in a disaster event. Hence, the military model may serve well as a jumping off point for local and regional planning and preparedness education.
Wright and Vesala address disasters that may be considered "chronic" in that they have been ongoing for a period of time. Often chronic disasters are not recognized as the disasters they really are. In this article, "Nutrition and Disaster Preparedness: Focusing on Vulnerability, Building Capacities," vulnerable populations affected by long term disasters are considered in the context of food shortages and subsequent malnutrition. The author uses an example of such disasters as they persist in the African nation of Kenya. This article clearly illustrates that, as Wynd also noted, no disaster is only a local event. This article will help the nurse planner to better address those silent disasters that may evolve over time from a natural or accidental event.
Remarkably, this selection of articles on emergency planning and preparedness provides the reader with a complimentary yet unified selection of nursing perspectives on the role of the nurse in a response effort. The consistent reference to the need to sharpen clinical skills and response competencies is at the heart of every article, as is the importance of being personally prepared to respond. This is as important for silent disasters as it is for overt emergencies. Every author also refers to the need to add to the body of knowledge regarding emergency preparedness through data collection and analysis. In my opinion, the references cited in these articles offer new and exciting insights into the on-going development of emergency preparedness for nurses. The long history of public trust that we enjoy as a profession, coupled with our desire to care for those in need, should encourage nurses to be proactive in preparing now for emergencies yet to come. These insights from our colleagues already in the field will go a long way toward building a practice model that will put nurses in their rightful place as leaders in the response effort.
The journal editors invite you to share your response to this OJIN topic addressing Emergency Preparedness either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.
Joy Spellman, MSN, RN
Joy Spellman, MSN, RN, is Director of the Center for Public Health Preparedness at Burlington County College in New Jersey. Designated as a specialty center by the Centers for Disease Control and Prevention, this center conducts emergency response training through the use of simulation technology. Joy serves as the nursing representative on the New Jersey Advisory Council on Preparedness, and has received a citation from the U.S. Attorney General’s Office for "dedication to duty and exceptional professionalism in helping establish emergency preparedness procedures..." in response to New Jersey’s anthrax incidents, 2001. She has published and presented papers on the topic of disaster preparedness. Ms. Spellman holds a BSN degree from Seton Hall University and a MSN in Public Health Nursing from the University of Pennsylvania.