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The United States needs a national health care and public health workforce with the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. This requires that all of our nation's nurses and health care providers have unrestrained access to high-quality, evidence-based, competency-driven education and training programs. Programs of study for disaster readiness in both the academic and service sectors are limited in number. Those that do exist may be based upon consensus rather than competency and be price prohibitive. They may fail to fully capitalize on existing educational technologies and may not be accessible to all providers. Nurse leaders are ideally positioned to recognize, advocate, and support the need for a broad array of learning options to strengthen the readiness of the health care workforce for disaster response. This article reviews current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.
Content may be subject to copyright.
Nurs Admin Q
Vol. 41, No. 2, pp. 118–127
Copyright c
2017 Wolters Kluwer Health, Inc. All rights reserved.
Education for Developing and
Sustaining a Health Care
Workforce for Disaster
Joanne C. Langan, PhD, RN, CNE;
Roberta Lavin, PhD, FNP-BC, FAAN;
Kelly A. Wolgast, DNP, RN, FACHE, FAAN;
Tener Goodwin Veenema, PhD, MPH, MS, RN, FAAN
The United States needs a national health care and public health workforce with the knowledge,
skills, and abilities to respond to any disaster or public health emergency in a timely and ap-
propriate manner. This requires that all of our nation’s nurses and health care providers have
unrestrained access to high-quality, evidence-based, competency-driven education and training
programs. Programs of study for disaster readiness in both the academic and service sectors are
limited in number. Those that do exist may be based upon consensus rather than competency and
be price prohibitive. They may fail to fully capitalize on existing educational technologies and may
not be accessible to all providers. Nurse leaders are ideally positioned to recognize, advocate, and
support the need for a broad array of learning options to strengthen the readiness of the health
care workforce for disaster response. This article reviews current challenges and opportunities
for the expansion of evidence-based education and training opportunities for health care work-
force disaster readiness. Key words: competencies, disaster nursing, education, nurse leaders,
workforce readiness
THE IMPACTS of climate change, global
terrorism, and growing domestic civil
unrest, along with the emergence of new
infectious disease epidemics, suggest that the
Author Affiliations: Saint Louis University School
of Nursing, St. Louis, Missouri (Dr Langan);
University of Missouri—St. Louis (Dr Lavin); Online
Education and Outreach, Penn State University
College of Nursing, University Park, Pennsylvania
and COL (R), US Army (Dr Wolgast); and Johns
Hopkins University School of Nursing, Department
Community and Public Health Johns Hopkins School
of Nursing, Center for Humanitarian Health, Johns
Hopkins Bloomberg School of Public Health,
Baltimore, Maryland (Dr Veenema).
The authors declare no conflict of interest.
Correspondence: Joanne C. Langan, PhD, RN, CNE,
Saint Louis University School of Nursing, 3525 Caroline
St, St. Louis, MO 63104 (
DOI: 10.1097/NAQ.0000000000000225
burden of caring for victims of disasters will
continue to increase for health care systems.
Unfortunately, many health care providers
lack the knowledge, skills, and abilities they
will need to respond to a disaster event.
Studies have shown that many nurses are
inexperienced with disaster situations and are
inadequately prepared to respond to the com-
plex demands of a disaster environment.1,2
While some progress has been made in devel-
oping and maintaining the workforce needed
during emergency events, there is much
more preparation that needs to be done.3
Health system readiness is now mandated by
The Joint Commission,4as a condition for
continued eligibility to receive Medicare and
Medicaid funding and is a critical component
of the National Health Security Strategy.5
Nurse leaders have a responsibility to ensure
that nurses, advanced practice nurses, and
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Developing and Sustaining Disaster Readiness Education 119
allied health care workers are adequately
prepared to respond to a disaster event.
The role of nurses during all phases of a dis-
aster has a significant potential impact6on the
welfare of individuals and communities. The
nursing team’s disaster competence is critical
to the attainment of the best possible popu-
lation outcomes.7,8 A collective vision for the
future of disaster preparedness for health care
and public health providers9suggests that US
health care providers should possess disaster
and public health emergency (PHE) prepared-
ness skills in order to either respond directly
or to provide indirect support (such as shift
coverage for those who are deployed, or criti-
cal data collection). In addition, US nurses and
other health care providers should promote
preparedness among their families, commu-
nities, and the organizations they represent.
This dedication to professional preparedness
can be demonstrated by participating in disas-
ter planning, drills, and exercises within and
beyond their specialty environment.9This vi-
sion is deeply grounded in the belief that the
broader the range of leadership, skills, and
abilities that all licensed health care providers
bring to disaster planning and response, the
greater the chance of positive health out-
comes for more people.
Nurses comprise the largest group of US
health care professionals.10 During disaster
situations, nurses may volunteer to respond
on their own volition, be asked to respond, or
may work nonscheduled shifts at their usual
place of work to assist in disaster relief ef-
forts. Frequently, nurses are responsible for
the supervision of volunteers in a disaster re-
sponse. Many nurses, however, may not know
how to respond effectively or what is ex-
pected of them as part of the health care team
The preparation for major PHE and disas-
ter events begins in the academic setting. The
literature supports access to evidence-based,
competency-driven disaster education for
health care and public health providers.12-15
The American Association of Colleges of Nurs-
ing includes disaster-related content as a re-
quirement within its published essentials for
doctoral, master’s, and baccalaureate educa-
tion (Table 1).14-16 However, there is little
guidance as to what, where, and when it
should be integrated into the curriculum. Pro-
fessional nursing organizations can advocate
for, and contribute content toward, nurse
preparedness. Most frequently, disaster con-
tent is embedded in public health courses in
schools of nursing. Some schools offer elec-
tive courses that address emergency response
for nurses, while others grant certificates or
continuing education modules that cover a
myriad of related topic areas.
Because nurses practice in a variety of set-
tings, education must be geared to the specific
areas or populations they serve. For example,
nurse leaders in both service and academic
settings need to know the essential disaster-
related content that their nurses or faculty
need in order to meet standards of regulatory
agencies or accrediting bodies. Faculty should
provide lessons on crisis nursing that will pre-
pare nursing students for state boards as well
as graduate nursing practice.
If a mass casualty event is imminent or
threatening, all nurses will be asked to use
their expertise in the response and recov-
ery efforts. To prepare for this, nurses need
to study and be cognizant of the needs of
vulnerable populations. For example, disas-
ter survivors who are in compromised health
will require specialized care and instructions
when typical care patterns and routine re-
sources are not available. Nurses with spe-
cialized training, such as those with infection
control, emergency, and critical care skills,
will probably be in great demand. The nature
of the disaster or emergency will dictate the
most needed specialties.
All nurses can be of great help in mass ca-
sualty situations, whether or not they have
experience in these specialty areas. Student
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Table 1. AACN Essentials Applicable to Disaster Preparedness14-16
BSN Essentials MSN Essentials DNP Essentials
Essential VI: Interprofessional
Communication and
Collaboration for Improving
Patient Health Outcomes
(Sample content:
Participatory decision-
making—Critical to
delivering high-quality and
safe patient care in rapid
Essential III: Quality
Improvement and Safety
Sample content: Simulation
training in a variety of
settings (eg, disasters, codes,
and other high-risk clinical
Essential VII: Clinical
Prevention and Population
Health (Sample content:
Health promotion and
disease prevention through
preparedness education to
minimize health
consequences of
emergencies including mass
casualty disasters.)
Essential VIII: Clinical
Prevention and Population
Health for Improving Health
Essential VII: Clinical
Prevention and Population
Health for Improving the
Nation’s Health
Essential VIII: Professionalism
and Professional Values
(Sample content: Value of
human dignity and social
justice in the allocation of
scarce resources at times of
disasters; accountability for
one’s self and nursing
practice through lifelong
Sample content: Disaster
preparedness and
Essential IX: Master’s Level
Nursing Practice
Clinical Practice Learning
Expectations: Simulated
mass casualty events
Emerging knowledge regarding
infectious diseases,
preparedness, and
intervention frame DNP
graduates’ knowledge of
clinical prevention and
population health
nurses may also be called upon to assist in
triaging victims in acute care or community
settings. Dispensing medications for mass pro-
phylaxis is a task that students, faculty, and
practicing nurses may all be asked to com-
plete. Inactive nurses might find themselves
called upon to help in community prepara-
tion or relief efforts. All nurses are much more
likely to respond to disasters if they and their
families are prepared and if they have the ed-
ucation and preparedness training to respond
with confidence.11 It can be complicated for
nurse leaders and educators to know what
content to teach that is evidence-based and
competency driven. This is just one of the
challenges in preparing for potential natural
disasters and man-made crises.
Lack of national standards
What needs to be done to ensure the
provision of evidence-based, competency-
driven high-quality content in academic and
lifelong learning programs? Clear, concrete,
and widely shared guidance for the provi-
sion of disaster education would establish a
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Developing and Sustaining Disaster Readiness Education 121
foundation for educational programming, but
these are currently not in place. Current ed-
ucational programs vary greatly, and many
are not evidence-based.17 The absence of a
clearly articulated national framework for dis-
aster education is not without consequences.
An unprepared health care workforce has the
potential to limit the effectiveness of local,
state, and federal response plans; limit organi-
zational surge capacity; and negatively impact
health outcomes in populations impacted by
disasters.1While some government agencies,
schools, and professional organizations have
developed disaster preparedness programs,
formal systems are not in place to provide
pre- and postlicensure nurses with consis-
tent and comprehensive education and train-
ing in emergency preparedness and disaster
Competing sets of disaster competencies
Nursing still lacks a research-based set of
workforce educational competencies specific
to disaster response, even though it has been
15 years since the tragedy of 9/11. Compet-
ing lists of disaster competencies for health
care providers have been published. Unfor-
tunately, these have resulted in confusion for
nurse leaders.18 These have been developed
primarily by consensus, and there is little ev-
idence that they have contributed to health
care workforce preparedness (Table 2).18
For the purposes of this article, a nursing
disaster competency is defined as a charac-
teristic of a nurse that enables an individual
professional to effectively perform the role of
nurse specific to a disaster situation. There
remains no consensus or empirical validation
of the majority of competencies.19 However,
researchers have identified 2 validated tools
that have undergone rigorous testing: the Dis-
aster Preparedness Evaluation Tool; and the
Emergency Preparedness Information Ques-
tionnaire. The Disaster Nursing Core Com-
petencies Scale was developed and tested
through utilization of these tools.
While the work of researchers on
these tools is helpful, the terminology
around competencies remains imprecise and
inconsistent.19, 20 The most common core
competencies referred to by various authors
are the detection of and response to an event,
the role of a nurse in incident command
[centers], triage, epidemiology and surveil-
lance, isolation, quarantine and decontami-
nation, communication, psychological issues
and care of special populations, accessing crit-
ical resources, reportage, and ethics.19
Academic and staff development adminis-
trators must ensure that a consistent and ap-
propriate set of competencies are identified
and then used to develop and revise curric-
ula. A starting point for this could include
those competencies that have a basic level
of evidence, such as those based on the ICN
Framework for Disaster Nursing Competen-
cies, built on generalist nursing competen-
cies. (It should be noted that these do not ad-
dress nurses in advanced practice.)21 Only the
Competencies for Clinical Nurse Specialists in
Emergency Care have validating research be-
yond the consensus work of expert panels.
Need for multiple portals to educational
Disaster and large-scale PHEs are low-
frequency high-impact events. From an edu-
cator’s perspective, this creates a unique chal-
lenge for both students and lifelong learners
regarding learning transfer and retention of
content. Students must master the core con-
cepts and competencies for disaster response,
retain this information, retrieve it at the appro-
priate time, and utilize it in a manner that pro-
motes optimal health outcomes for victims.
Ideally, students should be able to access real-
time content and decision support wherever
and whenever they need it. For this reason,
nurse leaders should advocate for multiple
options where their staff can access quality
disaster education and training.
Need for greater emphasis on
psychiatric/mental health
Many disaster survivors experience psy-
chosocial symptoms such as stress, grief,
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Table 2. Table of Competencies Adapted From Disaster Education and the APRNa18
Documents Author Intended Audience
Method of
Development and
Competencies for
Registered Nurses
Responding to
Mass Casualty
International Nursing
Coalition for Mass
Casualty Education
Registered nurse
Consensus based
APRN Education for
Preparedness and
All Hazards
Resources and
Suggested Content
National Panel for
APRN Emergency
Preparedness and
All Hazards
Nurse practitioner
Consensus based
ICN Framework of
Disaster Nursing
World Health
Organization and
Council of Nurses
Generalist nurse Focus group
Written inquiry (Loke
and Fung) 11
Core Competencies
Required for
Disaster Nursing
University of Hyogo,
Graduate School of
Nurse educators Training followed by
Competencies for
National Library of
competencies for a
wide variety of
health professions
Primarily consensus
based, some
supported by
research of various
The Contribution of
Nursing and
Midwifery in
World Health
Midwives Consensus based
Competencies for
Clinical Nurse
Specialists in
Emergency Care
Emergency Nurses
Clinical Nurse
Expert panel/
validation study
questionnaire to
national sample
Guidelines Regarding
CRNA in Mass
Casualty Incident
Preparedness and
American Association
of Nurse
Certified Registered
Nurse Anesthetists
Consensus based
Basic Essential
Curricular Content
for Public Health
Nursing Emergency
Association of
Health Nursing
Health Nurse
Consensus based
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Developing and Sustaining Disaster Readiness Education 123
Table 2. Table of Competencies Adapted From Disaster Education and the APRNa18
Documents Author Intended Audience
Method of
Development and
Public Health Nursing
Competencies for
Surge Events (PHN,
25(2) 159-165.
DOI: 10.1111/j.
Polivka, Stanley,
Gordon, Tolbee,
Kieffer, and
Public Health Nursing Delphi study
Preparedness and
Response Core
Competency Set
for Perinatal and
Neonatal Nurses
(Obstet Gynecol
Neonatal Nurs.
465, quiz
Jorgensen, Mendoza,
and Henderson
Obstetrical and
Neonatal Nurses
Consensus based
aAdapted with permission. CThe Honor Society of Nursing, Sigma Theta Tau International.
depression, and anxiety. Because the disrup-
tion caused by the disaster may continue for
many weeks or months, chronic psychologi-
cal conditions such as posttraumatic stress dis-
order, substance abuse, and major depression
may require long-term management. Triage
for physical injuries is often implemented in
the early stages of disaster response. Less vis-
ible adverse mental health effects of disas-
ters need identification and triage as well. As-
pects of psychological treatment that need
implementation include psychological first
aid, psychological debriefing, crisis counsel-
ing, and psychoeducation for individuals with
distress.22 Nurse leaders can be strong voices
for the inclusion of mental health content in
disaster education programs. This education
can help prepare the workforce to anticipate
and respond to the psychiatric and mental
health needs of individuals and families im-
pacted by disasters.
Victims who have suffered debilitating in-
juries and loss are not the only individuals
in need of mental health care. Those who
have witnessed the effects of disaster events,
such as friends, families, community mem-
bers, first responders, and the health care
workers themselves need assessment and may
need nursing intervention. Education is a key
to preparing health care providers for this
type of readiness and response. Debriefings
and care for the health care providers should
be a nurse leader’s priority as he or she plans
to try to return a health care system to some
type of normalcy. Counselors, mental health
nurses, social workers, chaplains, or other
grief counselors may be needed to support
those efforts.
Nurse leaders are in a powerful position
to advocate for, lead, and support institu-
tional initiatives designed to improve nurs-
ing and other health care provider disaster
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readiness. Nurse leaders can work with their
state and local office of emergency prepared-
ness as well as their organization’s emergency
management committees to increase aware-
ness among hospital administration and staff
of the importance of disaster education. They
can craft policies that provide staff with time,
funding, and incentives to access disaster ed-
ucation. Administrators can support training
exercises of all types to ensure that compe-
tence is established and sustained. They can
also form academic practice partnerships in
which training is planned together.
In early 2016, the American Organiza-
tion of Nurse Executives published a guid-
ing principle related to crisis management
as an exemplar of lessons learned from re-
cent disasters and the threat associated with
Ebola transmission. The principle addresses
the need for nurse leaders to be effective
communicators; critical thinkers; and col-
laborative members of the leadership team,
while being comfortable with uncertainty;
savvy in media relations; and able to demon-
strate empathy (“calm, confidence and au-
thority in all situations”).23 American Orga-
nization of Nurse Executives also advocates
that nurse leaders at all levels possess com-
petencies in developing and implementing
bioterrorist, biohazard, and disaster readiness
In 2013, a policy position statement on
health care executives’ roles in emergency
preparedness was published. The statement
provides relevant information while guiding
health care leaders to maintain a current disas-
ter plan, assess resource availability, develop
an incident command system, develop pro-
tocols and policies for patient and employee
safety, develop communication plans, and en-
sure ongoing surveillance programs for the
most likely disaster scenarios. Frequent or-
ganization drills, which include community
involvement to test disaster plans, are one
way for leaders to assess effectiveness of the
plans.24 The expectation is clearly established
for nurse leaders and health care leadership
teams to be proactive in addressing disaster
J. Englebright, PhD, a chief nurse executive
As a large system, all HCA facilities benefit from the
after action reports from each disaster response.
For instance, in our latest hospital evacuation,
we learned that our quarterly drills did not have
enough emphasis on command and communica-
tion protocols. We plan to use this information to
design future drills for all hospitals, to evaluate dif-
ferent communication technology options, and to
develop specific training modules. My primary con-
cern is that disaster preparedness is often skimmed
over in the business of the clinical work environ-
ment. Training can be concentrated on specific
roles such as ED or perinatal staff, leaving much
of the nursing workforce unprepared. (E-mail com-
munication, September 2016.)
Nurses across a broad array of settings will
play a variety of roles before, during, and af-
ter disasters. Prior to a disaster or PHE, nurses
can work on efforts to increase prepared-
ness and resilience in schools, churches, and
other community organizations. The empha-
sis on interprofessional learning is an impor-
tant element in disaster preparedness educa-
tion because preparation and response efforts
require the assistance of a number of profes-
sions. Nurse leaders are urged to support a
collegial approach to learning with other dis-
ciplines and experts. As with any initiative,
evaluation is a key aspect in the cycle of as-
sessment, planning, implementation, and im-
proving the approach. Evaluation is also key
in choosing the types of disaster content and
programs to choose.
The cost of disaster programming must be
considered in designing curriculum to ensure
disaster competencies. Two major consider-
ations are as follows: (1) What content and
practices are essential at each level of nursing
education for nurses to respond adequately
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Developing and Sustaining Disaster Readiness Education 125
during a disaster? (2) How do faculty and
nurse leaders make allocation decisions re-
garding education with available funding?
Faculty working in schools of nursing can
begin by using Rescher’s system25 for the al-
location of scarce resources, as adapted in the
Figure. Rescher’s criteria for inclusion and ex-
clusion can be applied in a manner that is
easily understood and fair. Include courses
that meet the desired criteria. Key elements
of this system include the consideration of
population and geographic location served;
greatest likelihood of meeting essential stu-
dent learning outcomes; faculty prepared-
ness based on teaching expertise; and future
Completion of this process will help en-
sure that the courses and/or methods selected
will have the greatest positive impact on so-
ciety and the preparedness of the students.
Rescher’s factors include principles of utili-
tarianism and justice to analyze the value and
benefit of various approaches to teaching dis-
aster content.25 His model allows flexibility
for schools to make decisions that best meet
the needs of their constituency and address
their local risk assessment. The cost/benefit
considerations of adding disaster-specific con-
tent cannot be overlooked as all schools have
limited resources. The best outcome requires
a thoughtful approach based on community
risk assessment, faculty competencies, and
available funding.
All nurses and health care providers, across
all types of health care settings, would ben-
efit by having unrestrained access to high-
quality, evidence-based, competency-driven
education and training programs. The goal
of this would be to improve health care out-
comes for individuals and families impacted
by disaster or major PHEs. Nurse leaders are
well-positioned in both academia and service
settings to advocate for and influence the pro-
cess of selecting, developing, and sustaining
education for a health care workforce. They
have a responsibility to prepare a team that
Figure. Ethical analysis for APRN disaster curriculum inclusion. Copyright Roberta Lavin. Used with
permission from Rescher.25
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is knowledgeable of all aspects of disaster,
response, and recovery. The authors of this
article acknowledge the difficulty in choosing
appropriate curricula and the effort it takes to
sustain readiness. However, evidence-based
content is available in a variety of media to
assist in the development, implementation,
and evaluation of curricula. Opportunities
exist to establish academic and workplace
partnerships to create and share disaster edu-
cation content. The process is dynamic, and
we all need to be vigilant in updating content
and sharing lessons learned. In this way, our
health care workforce will be better prepared
to serve our communities, both now and in
the future.
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... It has also been found that different capacities improved after PFA training, such as the acquisition of knowledge and more insights related to disaster, mental health, self-care in times of disaster, selfefficacy in providing PFA, and attitudes toward and a willingness to provide PFA (Everly et al., 2014). Education on mental health and psychosocial support, including PFA, could help to prepare healthcare providers, particularly nurses, to respond more effectively to the psychosocial needs of those affected from the emotional impact of disasters (Langan et al., 2017). ...
Aim: This study aimed at evaluating the effects of a modified psychological first aid (PFA) training program on nurses' psychological preparedness for emergencies and disasters. Background: Nurses need to be psychologically prepared in order to mitigate the impact of conflicts and disasters. The PFA training could ensure their psychological preparedness in responding to different emergencies and disasters. Design: A nonequivalent controlled group trial was conducted between July 2019 and August 2019. Methods: Nurses working in the trauma units from five hospitals in Palestine were allocated into two arms: a control arm and an intervention arm incorporating a 9-hour modified PFA training program. Both groups were assessed at start (pretest) and upon completion of the program (post test) using a number of validated self-reports. Results: Eighty-four nurses were allocated to each arm, and 75 in each arm completed baseline data (n = 150). The results of generalized estimating equation estimates revealed that PFA training imposed a significant group-by-time effect on psychological preparedness (p = 0.013). The mean scores of psychological preparedness showed greater improvement in the intervention group than in the control group at posttest (37.81 vs. 32.64). Improved group-by-time effect was further identified in relation to optimism (p = 0.009), self-esteem (p = 0.008), and self-efficacy (p = 0.033). The intervention effect was large (Cohen d = 1.41). Conclusion: PFA training may help to build nurses' capacity in being better prepared to respond to psychological issues during and after emergencies and disasters. Implications for nursing and health policy: Nurses should be adequately equipped with knowledge and skills to deal with different emergencies and disasters. Health policy needs to address psychological preparedness for emergencies and disasters of all healthcare workers. Healthcare policymakers and educators could adopt PFA training on a regular basis to consolidate psychological preparedness of nurses.
... Nurses ought to know how to take care of patients with PTSD and other mental trauma due to disasters (Li et al., 2015). Special education and preparation, such as psychological debriefing, counselling and psychological first aid, can help to properly educate nurses (Langan et al., 2017). (Baack & Alfred, 2013). ...
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Aim: With the rise in frequency and severity of disasters in recent decades, it is essentially important that nurses must be adequately prepared to handle them. This study was aimed to evaluate the levels of disaster core competencies and preparedness of nurses in the emergency department. Design: A cross-sectional survey design was used. Methods: This cross-sectional research was conducted from August 2020 to December 2020 among 271 nurses in the emergency departments of six hospitals in Qazvin, Iran. The participants completed the "Nurses Perceptions of Disaster Core Competencies Scale" (NPDCC) (45 items) and the disaster preparedness (a single-item visual scale). Data were analysed by one-way analysis of variance, independent t-tests and multiple linear regression analysis. Results: The mean scores of disaster preparedness and core competencies of nurses were 6.75 out of 10 (SD = 1.63) and 2.88 out of 5 (SD = 0.80), respectively. "Technical skills" (mean = 3.24, SD = 0.91) were the highest and "communication skills" (mean = 2.57, SD = 0.95) were the lowest across the subscales of the scale. A significant association was found between disaster core competencies and preparedness of nurses (p < .001). Regression analysis results indicated that nursing disaster core competencies were perceived betted by older nurses (B = -0.405) who had experience in the disaster stage (B = 0.228) and nurses with disaster response experience (B = 0.223) and lower professional experience (B = 0.309). Nurses with a postdiploma degree (B = -0.480) and bachelor's degree (B = -0.416) were perceived to have lower disaster core competency than nurses with a master's or PhD degree. Conclusion: There are still gaps in disaster preparedness and core competencies for emergency nurses that need to be addressed. Nursing managers must support an improvement in nursing disaster core competencies. This may be done by conducting sessions for routine disaster scenarios and providing formal disaster preparedness training.
... Xu et al. (2020) stated that social support is one of the most important general resistance resources, which could prompt people to perceive their lives as predictable, controllable, and understandable, thus performing more adaptively in stressful situations. Adequate peers and family support is vital to assist an individual in effectively managing stress-provoking situations such as disaster events, emergency crises, and infectious disease outbreaks (Langan et al., 2017). ...
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The unprecedented COVID-19 pandemic had prompted many governments to enforce lockdown to prevent the virus from spreading. In Malaysia, a series of Movement Control Orders (MCO) were introduced starting March 18, 2020. As a result, many people’s lives were affected, including university students. These affected students had to stay in their campus residential facilities, isolated from family, relatives and friends, which could lead to the feeling of loneliness. This study aims to explore the phenomenon among students stranded on campus during MCO periods. Approximately 243 students from several public universities were surveyed using Google form. Results from the 210 usable responses showed that most of these students experienced moderate loneliness and often used coping approaches like acceptance, positive interpretation, active coping, and active solitude. Friends seemed to be a more immediate source to seek for support in times of isolation. Correlation results suggested that social support availability is negatively associated with student loneliness experience, and positively related with student coping strategies. Specifically, the availability of support from friends and significant others may minimize loneliness experience.
Objective Nurses, who play a key role in disasters, should be sufficiently prepared and have good knowledge in responding to disasters to reduce the negative consequences on the population affected by disasters as disasters increase globally. The study aimed to investigate the results of peer-reviewed publications that measure nurses' level of knowledge and preparedness for disasters. Method The systematic review model was used in this study. Scientific studies on disaster preparedness of nurses in Turkish and English between 2015-and 2019 were systematically examined. Sciencedirect, Ulakbim and Medline/PubMed databases were used for the literature search. In the study, the keywords ‘disaster’, ‘disaster preparedness', ‘disaster competencies', ‘disaster nursing’, ‘disaster information’ and ‘nurse’ was searched. Seventeen (17) research articles conducted with nurses suitable for the study were included and analyzed. Results Studies commonly report that nurses are not sufficiently prepared for disasters and are not confident in responding to disasters effectively. It was seen that the factors that increase the preparedness for disaster response are previous disaster response experience and disaster-related education level. Conclusion The results of this systematic review show that it is necessary to develop better education and training programs to strengthen the knowledge and skills of nurses, especially in disaster preparedness.
Background: Disaster planning is an essential component for nursing students to learn. Problem: Clinical experiences of disasters are typically unavailable for nursing students. Increasing frequency of disaster events around the globe has made disaster planning knowledge and skills a critical component in nursing education and professional practice. Approach: An unfolding tabletop disaster planning exercise was created as a simulation training strategy meant to strengthen essential disaster response skills. The exercise involves 5 realistic scenarios related to a mass casualty event, taking students from the disaster site to the hospital-based disaster response. Outcomes: Implementation of a tabletop disaster planning simulation in one nursing program replaced the traditional lecture-based disaster content. Conclusion: An unfolding tabletop disaster planning simulation is a comprehensive, interactive, sustainable, and low-cost teaching strategy that draws on nursing students' fundamental knowledge. Students had the opportunity to practice clinical skills required during a disaster, such as communication, prioritization, teamwork, and delegation.
Climate change has been labeled one of the most significant threats to patient health. Advanced practice registered nurses must acquire adequate preparatory education to care for patients during climate change. They would benefit from implementing climate change concepts to provide safe and quality care for patients. This article aims to discuss integrating climate change concepts into advanced practice nurses curricula by applying the National Organization of Nurse Practitioner Faculties' competencies.
Background: This study aimed to investigate the influence of COVID-19 stress on the level of smartphone use among soldiers. In addition, it explores the potential moderating effect of social support as a protective factor.Methods: We collected responses from 205 soldiers serving in one military division in Chungcheongbuk-do using cross-sectional online and offline surveys. The data were analyzed with descriptive statistics, Pearson correlations, and hierarchical regression analysis using the SPSS 27.0 program.Results: Controlling for covariates, COVID-19 stress and social support were significant factors influencing the level of smartphone use. The analysis did not identify a moderating effect of social support on the relationship between pandemic stress and smartphone use.Conclusions: Our study results could help military and mental health organizations intervene in problematic smartphone use by creating programs for soldiers at high risk for COVID-19 stress.
Maternity care services were significantly altered with the start of the global pandemic in 2020, challenging the ways care was provided for families during childbirth. This qualitative analysis focuses on maternity care professionals' perceptions of the impact of COVID-19 on maternity care in Michigan early in the pandemic. The question "How has COVID-19 impacted your work?" was embedded into a survey focused on maternity unit culture in process across Michigan. Directed content analysis was applied to the open text responses to identify themes. From April-June 2020, 1071 surveys were completed by nurses, physicians, and midwives; 647 (60%) included responses to the COVID-19 question. Five themes emerged: (1) provider health; (2) patient care impact; (3) burdens of personal protective equipment; (4) decreased support during labor due to visitor restrictions; and (5) ethical challenges and moral distress between concerns for self and carrying out professional roles. Maternity care providers in Michigan experienced a range of complex challenges due to the pandemic, with many experiencing conflicts and questioning their role as a provider amid concerns of the effects of COVID-19 on themselves and their families. Resources are necessary to support providers who experience distress to promote well-being and retention of this essential workforce.
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The beginning of the 21st century has been marked by an increase in attention to the quality of emergency and disaster response, particularly the preparedness of health workers of all kinds. The increase in natural disasters, civil unrest, and dislocation of populations has seen health workers mobilized. These workers are moving, both within countries and across borders, as members of long- organized teams such as the National Disaster Medical System (NDMS), volunteers joining through a nongovernmental organization (NGO) such as a Red Cross/Red Crescent unit, or individuals self-deploying to the scene of the emergency. Postevent evaluations have consistently identified the need for those responding to be able to join in an organized response that includes taking on assigned roles, communication through established channels and minimization of the number of "SUVs" or "spontaneous unrequested volunteers." Although bystanders and self-deployed helpers (some with professional qualifications) are the first at any disastrous event, the subsequent response efforts are expected to be organized, efficient, and effective. This requires advance training of the responders.
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The purpose of this study was to explore Hong Kong nurses' perceptions of competencies required for disaster nursing. Focus group interviews and written inquiry were adopted to solicit nurses' perceived required competencies for disaster care. A total of 15 nurses were interviewed and 30 nurses completed the written inquiry on their perceived competencies related to disaster nursing. The International Council for Nurses' (ICN) framework of disaster nursing competencies, consisting of four themes and ten domains, was used to tabulate the perceived competencies for disaster nursing reported by nurses. The most mentioned required competencies were related to disaster response; with the ethical and legal competencies for disaster nursing were mostly neglected by nurses in Hong Kong. With the complexity nature of disasters, special competencies are required if nurses are to deal with adverse happenings in their serving community. Nurses' perceived disaster nursing competencies reported by nurses were grossly inadequate, demonstrating the needs to develop a comprehensive curriculum for public health. The establishment of a set of tailor-made disaster nursing core competencies for the community they served is the first step in preparing nurses to deal with disastrous situations for the health of the public.
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The type of disaster, individual demographic factors, family factors and workplace factors, have been identified in the international, multidisciplinary literature as factors that influence a person's willingness to attend and assist in their workplace during a disaster. However, it is unknown if these factors are applicable to Australasian emergency nurses. The research aims to determine the extent to which Australasian emergency nurses are willing to attend their workplace in a disaster. This research was exploratory and descriptive study design, using online and paper based surveys as a means of data collection. Australasian emergency nurses from two Australasian emergency nursing colleges and four Australian hospitals were recruited to participate. Data analysis was conducted using both descriptive and inferential statistics. In total, 451 Australasian emergency nurses participated in this research. Participants were more willing to attend their workplace during a conventional disaster (p≤0.001), if they worked full-time (p=0.01), had received formal education pertaining to disasters (p≤0.001), had a family disaster plan (p=0.008), did not have children (p=0.001) and worked in an environment in which they perceived their colleagues, managers and organisation to be prepared. The factors that influenced Australasian emergency nurses to attend their workplace in a disaster were similar to that described in the international multidisciplinary literature. Of particular note, improving disaster knowledge and skills, having a family disaster plan and improving the perceptions of the nurses' workplace preparedness can enhance the nurses' willingness to assist in a disaster.
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Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health. ( Disaster Med Public Health Preparedness . 2012;6:44–52)
Leaders from the American Organization of Nurse Executives describe the dynamic state of today's healthcare system related to crisis management. Adaptive leadership, driven by strong values and morality, can guide leaders and organizations through the most difficult times.
Purpose: To develop a vision for the future of disaster nursing, identify barriers and facilitators to achieving the vision, and develop recommendations for nursing practice, education, policy, and research. Design and methods: A series of semistructured conference calls were conducted with 14 national subject matter experts to generate relevant concepts regarding national nursing workforce preparedness. An invitational daylong workshop hosted by the Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, was held in December 2014 to expand and refine these concepts. Workshop participants included 70 nurses, emergency managers, and a broad range of public health professionals. Conference call notes and audiotapes of the workshop were transcribed and thematic analysis conducted to outline a vision for the future of nursing in disaster preparedness and response, and to articulate an agenda for nursing practice, education, policy, and research to achieve that vision. Findings: The group developed a vision for the future of disaster nursing, and identified current barriers and opportunities to advance professional disaster nursing. A broad array of recommendations for nursing practice, education, policy, and research, as well as implementation challenges, are summarized in this article. Conclusions: This project represents an important step toward enhancing nurses' roles as leaders, educators, responders, policymakers, and researchers in disaster preparedness and response. Nurses and the health and human service organizations that employ them are encouraged to engage in an expansive national dialogue regarding how to best incorporate the vision and recommendations into their individual lives and the organizations for which they work. Clinical relevance: Nurses comprise the largest healthcare workforce, and opportunities exist to strengthen disaster readiness, enhance national surge capacity, and build community resiliency to disasters.
Background: All nurses must have core competencies in preparing for, responding to and recovering from a disaster. In the Kingdom of Saudi Arabia (KSA), as in many other countries, disaster nursing core competencies are not fully understood and lack reliable, validated tools. Thus, it is imperative to develop a scale for exploring disaster nursing core competencies, roles and barriers in the KSA. Objectives: This study's objective is to develop a valid, reliable scale that identifies and explores core competencies of disaster nursing, nurses' roles in disaster management and barriers to developing disaster nursing in the KSA. Methods: This study developed a new scale testing its validity and reliability. A principal component analysis (PCA) was used to develop and test psychometric properties of the new scale. The PCA used a purposive sample of nurses from emergency departments in two hospitals in the KSA. Participants rated 93 paper-based, self-report questionnaire items from 1 to 10 on a Likert scale. PCA using Varimax rotation was conducted to explore factors emerging from responses. Findings: The study's participants were 132 nurses (66% response rate). PCA of the 93 questionnaire items revealed 49 redundant items (which were deleted) and 3 factors with eigenvalues of >1. The remaining 44 items accounted for 77.3% of the total variance. The overall Cronbach's alpha was 0.96 for all factors: 0.98 for Factor 1, 0.92 for Factor 2 and 0.86 for Factor 3. Conclusions: This study provided a validated, reliable scale for exploring nurses' core competencies, nurses' roles and barriers to developing disaster nursing in the KSA. The new scale has many implications, such as for improving education, planning and curricula.
PURPOSE: This article is a descriptive analysis of rural nurses' perceived readiness to manage disaster situations. DESIGN AND METHODS: The 58-item Disaster Readiness Questionnaire was used to survey hospital-based nurses from rural communities in Texas during the summer of 2011. The data were collected by emailing a link through the various hospital intranet sites, resulting in a sample size of 620 nurses. RESULTS: Findings revealed that most nurses are not confident in their abilities to respond to major disaster events. The nurses who were confident were more likely to have had actual prior experience in disasters or shelters. Self-regulation of behavior (motivation) was a significant predictor of perceived nurse competence to manage disasters only in regard to the nurse's willingness to assume the risk of involvement in a disaster situation. Healthcare climate (job satisfaction) was not a determinant of disaster preparedness. CONCLUSIONS: Global increases in natural and human-induced disasters have called attention to the part that health providers play in mitigation and recovery. Since nurses are involved in planning, mitigation, response, and recovery aspects of disasters, they should actively seek opportunities to participate in actual disaster events, mock drills, and further educational opportunities specific to disaster preparedness. Administrators must support and encourage disaster preparedness education of nurses to promote hospital readiness to provide community care delivery in the event of a disaster situation. CLINICAL RELEVANCE: Nursing comprises the largest healthcare workforce, and yet there is very little research examining nurses' readiness for disaster.
The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event.