Disaster Nursing And Emergency Preparedness By Veenema Pdf

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Join NursingCenter to get uninterrupted access to this Article. Nurses and other healthcare professionals are ready to handle just about any type of individual patient medical emergency, but, when faced with several hundreds or thousands of contaminated causalities that could be generated from a "weapons of mass destruction" WMD event, these same professionals may not be as ready as needed.

Disaster Nursing and Emergency Preparedness - Springer Publishing

Because of their diverse education, experience, and practice settings, nurses are uniquely qualified to be first receivers, care givers, and leaders in any large-scale public health emergency.

Many nurses, however, continue to feel inadequately prepared to function effectively in these types of situations. Great strides have been made since , but much work remains to be accomplished. This article focuses on newer approaches used to teach nurses the principles of disaster preparedness.

It also addresses the need to incorporate mass casualty care and disaster management skills into undergraduate curricula, continuing nurse education, and advanced degree programs for nurses in the United States. The potential for a high-impact incident resulting in mass casualties remains a specter plaguing the health care system. The increasing frequency of natural disasters and world-wide terrorist events has emphasized the need for adequate preparation of health care providers in the event that such an incident occurs.

Nurses comprise a large percentage of the health care workforce, so that adequate educational preparation for nurses is essential. Yet recent studies [1] , [2] indicate that nurses remain unprepared to adequately respond to a high-impact event. Immediately after the attacks on the World Trade Center in New York and the anthrax exposures in the eastern United States, there was an explosion of courses focused on the elements of chemical, biological, radiological, and nuclear terrorism, collectively known as weapons of mass destruction.

Emerging infections eg, severe acute respiratory syndrome [SARS] , the threat of pandemic viral influenza eg, Avian influenza , and the frequent occurrence of natural disasters, however, have emphasized the fact that these events may result in an influx of the sick or injured equaling or exceeding the number associated with weapons of mass destruction. Consequently, many educational programs for health care professionals now use the all-hazards approach.

Education for nurses, built on the all-hazards approach, provides the framework for college nursing program curricula, and for continuing education CE and just-in-time instruction. Before , few nurses received any formal education in the areas of emergency preparedness or disaster response.

Nurses who did possess some rudimentary knowledge likely served in the military, worked as prehospital providers, were employed in a hospital emergency department, or participated in humanitarian disaster relief work. Consequently, most nurses graduating from schools before have wide gaps in their knowledge of disaster care.

It is accepted that any event resulting in mass illness or injury will exceed the number of health care workers able to supply care. Nurses comprise the largest number of health care workers, but many nurses are unprepared to respond because of lack of knowledge or skills. These existing deficits create a nursing workforce requiring additional hours of formal instruction to be able to respond effectively in the event of a high-impact incident resulting in mass casualties.

It is accepted that all practicing nurses should possess a basic understanding and skill set to be able to provide care in the event of a mass casualty event [3]. These educational demands are staggering, particularly in a health care environment already operating at or above capacity. Innovative ways to educate nurses and other health professionals are being instituted. At least three national CE courses targeting physicians, dentists, paramedics, and nurses were created and are now offered nationally under the sponsorship of the American Medical Association [4].

These programs, however, may be unavailable in more rural locations. Additionally, they can be costly, and many nurses cannot get paid time off work to attend the courses. Computer-based training, a strategy used in many fields of study, is another newer alternative for practicing nurses to augment their disaster training. On-line training has been purported to be more efficacious, more convenient and more flexible, because it can be completed at the learner's own time and pace [5].

These electronic resources typically include on-line, learn at one's own pace modules [5] , and many are offered free of charge. Upon completion of many of these computer modules, the learner can print a certificate to show proof of training. Although numerous computer-based training modules for health professionals exist, most of these on-line educational offerings do not specifically target nurses.

With funding from the Agency for Healthcare and Quality AHRQ , Elizabeth Weiner was one of the first individuals to spearhead the development of six disaster education modules specific for nurses [5]. These free modules are nearing completion, and it is anticipated that they will be available on-line in the near future.

Another innovative CE program of study can be accessed on-line at St. Completion of this nurse-focused CE program provides a certificate in disaster preparedness. Nurses desiring to obtain a certificate are required to pay a fee and must complete six required and four elective modules from a list of Although the need to educate nurses in the fundamentals of disaster care is recognized, and great strides have been made, nursing school curriculum in the United States for the most part remains inadequate [6].

Weiner and colleagues [6] showed that as late as , the number of hours focused on the nurse's role in disaster preparedness in American schools of nursing had increased marginally, but continued to be inadequate.

They identified several important obstacles for this including: curricula already heavily content laden, lack of scholarly articles targeted for nurses, inadequately defined and validated fundamental content, and faculty insufficiently prepared to teach the content [5]. Nevertheless, some university-based schools of nursing are attempting to integrate disaster nursing content throughout the curriculum, often as part of community health course content, or as electives for students to choose [7] , [8] , [9].

For example, the Long Island University School of Nursing involves senior nursing students in a 3-hour lecture covering basic disaster management principles and a 1-day symposium as part of their community health experience [10].

Another school, the Texas Tech University Health Sciences Center School of Nursing, had nursing students participate in a simulated mass causality drill to allow students an opportunity to practice skills [11]. The question remains, however, how much and what type of content is sufficient? Jennings-Sanders and colleagues [9] suggest that short lectures do not provide enough time to synthesize disaster nursing principles.

Consequently, they propose that disaster nursing should be a required semester-long course for undergraduate nursing students. This may be very difficult to achieve, because most undergraduate curricula are content-overloaded. Efforts to expand and formalize essential disaster-related content have been hampered by the fact that no consensus exists concerning fundamental elements, how the content is taught best, or how to promote retention of an overwhelming amount of information.

To date, some anecdotal evidence exists to support the efficacy of bioterrorism and disaster preparedness courses [8] , [10] , but a systematic analysis of relevant curricular threads has yet to be completed. This emphasizes that core content for nursing curriculum needs to continue to be delineated and that outcome competencies must be identified and then validated through research.

Creation of such a framework then can guide curriculum organization and design. One of the major impediments in the establishment of such a framework is the fact that essential content for disaster nursing education remains poorly characterized; however, preliminary work on competencies is well underway.

The fundamental content of emergency preparedness curricula remains controversial. When considering emergency preparedness training in the hospital setting for example, Rubin questioned not only the quantity of training, but also the usefulness and realistic nature of existing competencies. Although both the American Nurses Association [12] and the American Association of Colleges of Nursing [13] recommend appropriate basic education and continued education for all nurses in emergency preparedness, neither define content.

So, what is meant by competencies? Core competencies are defined as the knowledge, skills, abilities, and behaviors needed to carry out a job [14]. Articulated by measurable statements, competencies are based on key essential job functions, frequently used job functions and accountabilities, and high-risk job functions and accountabilities that involve actions that could cause harm, death or legal actions to customers, employees, or the organization. Whitcomb [15] emphasized that core competencies delineate the knowledge, skills, and attitudes that learners must acquire to be able to perform within each competency domain at a predetermined level.

Attaining competencies helps to ensure that programs achieve certain outcomes. Several authors suggest the development of formal emergency preparedness educational core competencies [16] , [17] , [18] with competency-based objective evaluation [19]. A second group suggests that emergency preparedness training should be required CE [20] , [21] , [22] or a requisite for medical privileges or licensure [23]. In January , JCAHO introduced new emergency management standards, building on its long-standing disaster preparedness requirements [24].

One specific phase of the new standard includes determination of the priorities for, and means for effectively deploying, the finite resources needed to support response systems, including trained personnel.

In the absence of standardized federal criteria, several groups have attempted independently to develop core competencies for various responder types without any attempts to harmonize them. Those addressing health care include emergency medical technicians, emergency physicians and emergency nurses [25] , emergency response clinicians [26] , hospital workers [27] , and public health workers [27]. Unfortunately, the vision and resulting competency requirements are inconsistent across the groups.

Further, no attempt has been made to validate if these competencies are accurate or address the full spectrum of required skill sets—information that is essential for planning and future training.

According to the White House-commissioned Katrina Report [29] , the required knowledge, skills, and abilities of health care professionals differed from existing competency lists. The White House report stated:. Recently the National Organization of Nurse Practitioner Faculties recognized that curricula development for advanced practice nurses APN is difficult, as most educators are unfamiliar with emergency preparedness content [30] , [31] , and curricula are already full.

As a result, the group has taken a different approach, identifying key emergency preparedness content that can be incorporated into existing courses and providing resources to assist faculty in delivering the content. The white paper should be published soon and will be widely available. Because disasters are intrinsically unpredictable, complete preparedness for disasters, particularly in the case of a bioterrorism event, is likely not fully attainable [32]. Consequently, the dynamic nature of preparedness makes precise identification of basic educational priorities specific for nurses difficult at best.

Nevertheless, since , progress has been made. Existing literature reflects five general elements important for nurses, and several authors suggest that these should be incorporated into curricula [8] , [33] , [34].

These educational priorities include: detection and reporting of unusual outbreaks, treatment of ill and injured, control measure implementation, resources and preparedness planning, and management of the public. Interestingly, a landmark study of Wisconsin nurses identified at least eight similar educational priorities for nurses dealing with disasters and other large health care emergencies [1].

Unsurprisingly, the top three priorities dealt with nurses' knowledge of: 1 triage and first aid, 2 detection of symptoms associated with biological agent-caused diseases, and 3 accessing critical resources such as the strategic national stockpile.

To date, three models for disaster nursing have been described. The Jennings-Saunders disaster management model highlights four phases that nurses in the community may use to plan disaster nursing care [35].

Each phase focuses on different aspects of disaster planning and response. While the phase 1 predisaster targets planning for disaster and resource allocation, phase 2 disaster addresses nurses' role in the midst of a disaster. Phases 3 and 4 of the model deal with health need evaluation and effects of the disaster on patient or population health, respectively [35]. In Veenema's early ground-breaking text, the author uses the typical disaster model phases of preimpact, impact, and postimpact to describe model nursing roles specific for each phase of the disaster [36].

Most recently, Wynd proposed a model for disaster military nursing [37] , incorporating elements of both the Jennings and the Veenema models [35] , [36]. These examples illustrate the progress thus far that nurses and nurse educators have made in the identification of components of core knowledge and practice models necessary for optimal function in the event of large-scale health emergencies.

The next steps will be to design a suggested curriculum for university and continuing education that is widely available and endorsed by all the major nursing accreditation bodies as requisite knowledge for nurses responding to emergencies caused by natural disasters, infectious illness, or terrorism. Effective response to disasters and other large-scale health emergency requires strong leadership, strategic planning, and interprofessional collaboration.

Several schools of nursing recognize the need for graduate education and to that end have created masters degree programs and post-masters certificates in emergency planning and disaster response [39].

The University of Rochester New York was the first school of nursing to create a masters program to educate nurses as leaders in disaster response and emergency preparedness [39]. The program focuses on the development of skills leaders need to design, implement, and evaluate programs dealing with emergency response and disaster management. Another trendsetter was the Johns Hopkins School of Nursing JHUSON, Baltimore , which in fall inaugurated what is believed to be the first nursing graduate program geared toward the preparation of nurse leaders in emergency response and disaster management in health care facilities.

The masters track was established on the belief that nurses always have held key positions in health care facilities, that they possess valuable insider knowledge of how health care facilities function during disasters, and that they hold pivotal roles in the formulation of institutional disaster management plans.

A 12 credit post-masters certificate is also available. Concurrent to the initiation of the JHUSON masters program, the University of Tennessee at Knoxville also launched a nursing masters degree and post-masters certificate option in homeland security nursing. The post-masters option requires completion of 24 credits. Other university schools of nursing offer masters track subspecialty options or post-masters certificates, including Columbia University and University of Pittsburg Table 1.

As more university schools of nursing expand their masters options to include specialty tracks in emergency response and disaster preparedness, it is likely that graduates will assume groundbreaking new roles as health care leaders, emergency planners, biopreparedness coordinators, and educators.

Educating nurses to meet the challenge of dealing with patients from large-scale health emergencies such as natural disasters, infectious disease outbreaks, and chemical, biological, and radiological terrorism always will be difficult based on the unpredictable nature of such events.

Directions for Disaster Nursing Education in the United States

Preparedness : For Chemical , Biological , and. Radiological Terrorism and Other Hazards ,. Terrorism and Other Hazards , Third Edition. Community-Public Health categoryWhat a wonderful resource! When a disaster strikes a community? I encourage all nurses to develop the knowledge and.

Disaster and Emergency Preparedness by Tener Goodwin Veenema (2018, Hardcover)

Featuring the most current, valid, and reliable evidence-based content available, this three-time AJN winner once again presents an unparalleled resource for disaster and emergency preparedness. Disasters lay heavy burdens upon healthcare systems that stretch all levels of society. While natural and man-made disasters are not new, the global nature, rate, type, and totality of their impact has only increased. The fourth edition of this foundational text uniquely addresses the rapid changes in these crises and analyzes the latest attempts to provide timely, multidisciplinary healthcare.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Because of their diverse education, experience, and practice settings, nurses are uniquely qualified to be first receivers, care givers, and leaders in any large-scale public health emergency.

Methods: A literature review of emergency and disaster preparedness publications was analyzed and synthesized from eight major electronic databases. The universally recognized domains of emergency preparedness described by the revised Emergency Preparedness Information Questionnaire EPIQ served as the conceptual framework for the classification of these findings. Results: Nurses do not possess the necessary knowledge and skills to respond to disaster situations.

Directions for disaster nursing education in the United States.

Bartlett, S. After the tsunami in Cooks Nagar: The challenges of participatory rebuilding. Children, Youth and Environments, 18 1 , Beck, J. Evaluation Review, 22 1 , Bernardo, L. Pediatric emergency preparedness for mass gatherings and special events.

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Tener Goodwin Veenema, PhD, MPH, MS, CPNP, is an Associate Professor of Clinical Nursing, Assistant. Professor of Emergency Medicine, and Program.


Educational demand

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Because of their diverse education, experience, and practice settings, nurses are uniquely qualified to be first receivers, care givers, and leaders in any large-scale public health emergency. Many nurses, however, continue to feel inadequately prepared to function effectively in these types of situations. Great strides have been made since , but much work remains to be accomplished. This article focuses on newer approaches used to teach nurses the principles of disaster preparedness. It also addresses the need to incorporate mass casualty care and disaster management skills into undergraduate curricula, continuing nurse education, and advanced degree programs for nurses in the United States. The potential for a high-impact incident resulting in mass casualties remains a specter plaguing the health care system.

Curriculum for Disaster Nursing and Emergency. Disaster Response and Emergency Preparedness. Disaster nursing and emergency preparedness for chemical, biological, and radiological. Disaster nursing. Emergency nursing. Veenema, Tener Goodwin. Disaster s.

References

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