Disaster Nursing

• Disaster nursing response plans must clearly delineate the roles and responsibilities of all nursing personnel in disaster situations.
• Domains and areas of disaster nursing competencies include mitigation/prevention, preparedness, response, recovery/rehabilitation, and law and ethics.
• Three levels of nursing expertise are recognized: Level I, a nurse who completed a program of basic, generalized nursing education; Level II, a nurse who has achieved the Level I competencies and is/aspires to be a designated disaster responder within an institution, organization or system; and Level III, a nurse who has achieved Level I and II competencies and is prepared to respond to a wide range of disasters and emergencies and to serve on a deployable team.
• Provision of understanding, compassion, and emotional support to all victims and their families is a major role of nursing in disasters.
• Major roles of nurses in disasters include determining the magnitude of the event, defining health needs of the affected groups, establishing priorities and objectives, identifying actual and potential public health problems, determining resources needed to respond to the needs identified, and collaborating with other professional disciplines, governmental and non-governmental agencies.
• Trait Theory, based primarily on the “great man” theory, but it differed by taking the position that leadership qualities can be identified and taught.
• Disaster preparedness, including risk assessment and multi-disciplinary management strategies at all system levels, is critical to the delivery of effective responses to the short, medium, and long-term health needs of a disaster-stricken population.
• Nursing leadership in disaster preparedness and response can be exemplified by the Great Man Theory, which argues that a few people are born with the necessary characteristics to be great, and they can be effective leaders in any situation.
• Situational or Contingency Theory rose to prominence during the 1950s, expanding on “trait theory”; leader traits vary and are determined by the particular situation.
• Democratic leadership (Participative) involves sharing leadership, often a less efficient way to run things but more flexible and usually increases motivation and creativity.
• Transformational Theory asserts that the true nature of leadership is not the ability to motivate people to work hard for their pay but the ability to transform followers to become more self-directed in all they do.
• Leaders need to be aware of their own behavior and influence on others, they need to recognize the individual differences of their followers (characteristics and motivations), they need to understand the structures available to perform specific tasks, and they need to analyze the situational variables that impact the ability of followers to complete tasks, including environmental factors.
• Integrative Leadership Theory concludes that the leader, the follower, and the situation all influence leadership effectiveness.
• Crisis Leadership is the capacity of an individual to recognize uncertain situations that possess latent risks and opportunities to ensure systematic preparedness, to discern necessary direction, to make critical decisions, to influence followers and to successfully eliminate or reduce the negative impact while taking full advantage of positive aspects within a given timeframe.
• Situational theory involves assessing the nature of the task and the follower’s motivation or readiness to learn and using that to determine the particular style the leader should use.
• Nursing Leadership at Multiple Levels involves preparing for and managing crises in homes, caring for disaster victims, at regional, national, and international levels.
• Crisis Management focuses on planning; controlling; leading; organizing; and motivating prior to, during, or after a crisis.
• Autocratic leadership (Directive, Controlling, or Authoritarian) involves the leader giving orders and making decisions for the group, usually dampening creativity and may inhibiting motivation.
• Laissez-faire leadership (Permissive or Non-directive) involves the leader doing very little planning or decision making and failing to encourage others to do so, often a lack of leadership.
• Articulating principles to balance expertise, analysis and intuition is a key aspect of leadership in crisis situations.
• Effective leaders in crisis situations facilitate shared goals and define outcomes across diverse stakeholders.
• Building resilience to cope with prolonged high-stress situations involves embracing the challenge through focus on values and community support, acknowledging the extent of the crisis and focusing on the next best decision, building relationships and relying upon peers to share the burden together.
• Effective leaders in crisis situations leverage diverse experiences, including outside traditional leadership roles.
• Possessing a bias for action is a characteristic of effective leaders in crisis situations.
• Building adaptive strategies that evolve with the crisis is a crucial aspect of leadership in crisis situations.
• Competencies for public health nursing leaders have been defined.
• Public responsibility is a key aspect of leadership in crisis situations.
• Effective leaders in crisis situations balance expertise and intuition to act decisively under uncertainty, acknowledging imperfect information and creating frameworks that result in action.
• Effective leaders in crisis situations adapt their style to engage effectively with spontaneous networks or actors.
• Effective leaders in crisis situations assume and demonstrate responsibility, influencing and motivating others to navigate complex, interrelated systems.
• Disasters may cause premature deaths, illnesses, and injuries in the affected community, generally exceeding the capacity of the local health care system.
• Disasters may affect the psychological, emotional, and social well-being of the population in the affected community.
• Communicable diseases outbreak during disasters may be due to changes affecting vector populations, flooded sewer systems, the destruction of the health care infrastructure, and the interruption of normal health services geared towards communicable diseases.
• Disasters may cause large population movements (refugees) creating a burden on other health care systems and communities.
• Psychological responses to disasters may include fear, anxiety, depression, widespread panic and terror.
• Displaced populations and their host communities are at increased risk for communicable diseases and the health consequences of crowded living conditions.
• Disaster nursing involves preventing further injury or illness.
• Disasters may create environmental imbalances, increasing the risk of communicable diseases and environmental hazards.
• Disasters may cause shortages of food and cause severe nutritional deficiencies.
• Disaster nursing involves leadership, which involves teaching, supervising, and utilizing auxiliary medical personnel and volunteers.