Health Emergency and Disaster Nursing Vol. 4(2017) No. 1

Aim: Disasters often result in an unanticipated ‘surge’ of patients to hospitals requiring care. Hospitals are expected and required to have emergency operation management plans to expand surge capabilities to care for incoming disaster victims while continuing to care for current patients. Reverse triage for early discharge or transfer uses assessment of the clinical status of current inpatients and decision-making regarding discharge, transfer, and further definitive care to open hospital resources for a sudden surge of patients. This type of decision-making lies well within the scope of nursing practice; however, many nurses may be unaware of this patient management strategy or their role using it as a strategy to enhance hospital surge capacity.

Methods: A systematic literature review was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Inclusion and exclusion criteria were identified to query three databases (CINAHL, OVID, and PubMed) for literature addressing the role of the nurse in reverse triage of hospitalized inpatients in readiness for a disaster event patient surge.

Results: Twenty-six records were identified for full review. Of the 26 records, seven provided some reference but little information regarding the role of the nurse in reverse triage.

Conclusion: This review provided limited information regarding the role of the nurse in reverse triage. Nurses’ roles will be extended during disaster events that require a hospital to utilize surge capabilities and are integral to the process of operationalizing reverse triage. There is a lack of evidence to aide understanding of the role of the nurse in reverse triage.

Aim: This manuscript explores nurses’ emergency preparedness for disaster response and describes a variety of educational resources to support nurses’ preparedness competencies for disaster situations.

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. As trusted healthcare providers, all nurses are expected to acquire and sustain knowledge and skills that meet society’s contemporary healthcare demands, including the ability to provide care in disaster events. Previous research indicated that a scarcity of emergency preparedness resources has hindered nurses’ efforts to become knowledgeable and informed. Findings demonstrated a collection of peer-reviewed research studies, government websites, hospital training guides, academic training modules, continuing education courses, and professional organization guides focused on emergency preparedness and disaster nursing education.

Conclusions: Research has suggested that many nurses do not feel comfortable responding to disaster situations. A comprehensive narrative guide to US emergency preparedness and disaster nursing continuing education resources was scripted in a simple-to-use table format. This article will acquaint nurses with this guide, which provides a quick and easy means of accessing a multitude of free online continuing education resources to support the demand for nurses’ requisite training and education in emergency preparedness for disaster response, without incurring the burden of cost.

Aim: A systematic literature review was conducted to explore research on the subject of nurse leadership competencies during disasters.

Methods: A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)search and review method was used, with pre-specified inclusion and exclusion criteria, definition of terms, and documentation of selection decisions, to retrieve articles published in the last 5 years that contained some or all of the desired search criteria. Articles were excluded if they were unrelated to leadership during disasters, or had solely an education- or clinical-care focus. Three reviewers performed the screening process.

Results: Interrater reliability (0.81) was confirmed through two rounds of title review and two rounds of abstract review. Twenty-two articles from a total of 207 identified were deemed relevant from a search using PubMed, CINAL, Scopus, Embase and Web of Science.

Conclusion: Results from the literature search were limited, and few articles were directly related to the specific search. Three articles that were reviewed addressed disaster competencies; no articles were found to focus on nursing or nursing leadership disaster competencies. This negative literature search revealed that more rigorous research on nurse leadership needs to be conducted and available, from then which a cohort of standardized competencies can be shaped to address future disaster management.

Throughout history, nurses have volunteered to serve in wars and disasters worldwide. There is a curiosity about why some nurses feel compelled to volunteer to serve in extreme circumstances. Volunteer theory provides a theoretical framework for better understanding this phenomenon, in particular theories from sociology and psychology. Experiences of nurses who volunteered in the immediate aftermath of Hurricane Katrina in the United States are presented using a phenomenological approach to begin to develop a nursing knowledge base about volunteerism and service in nursing. The essence of the Hurricane Katrina volunteer experience is presented and considered in the context of theoretical explanations.

Aim: This original oral history research explores the motivation for, and experience of, humanitarian nursing. It demonstrates nursing’s role in relief work, offering a unique record of such remarkable nursing contributions in the late 20th and early 21st century. The formation of modern nursing is often associated with times of conflict, such as the Crimea and other wars, where nurses offered their services. This research adds understanding to the continuing attraction of such work and its place in nursing history and practice.

Methods: Following ethical approval, oral histories were recorded with seven nurses who worked for Médecins Sans Frontières during this period. Analysis used the Listening Guide, a feminist approach employing four related readings of the data.

Results: The histories of these nurses locate their extraordinary experiences within their life and identity as nurses; escapism and moral outrage, combined with a love of travel and thirst for adventure, influenced their decision to undertake humanitarian work. Once on a mission, their narrative captures the contrast between the ordinary and the extraordinary; familiar routine experiences side by side with mortal danger. Returning to normal life required resilience and a reappraisal of their life story in order to locate their experiences, finding meaning and peace in their post-mission world. An overarching theme of ‘dreams’ includes romance, nightmares and impossible dreams.

Conclusion: At a time of debate and challenge regarding the role and identity of nursing within society, this research records and analyses the oral histories of nurses working with Médecins Sans Frontières at this time.

Aim: Little is known about the relationship between age and levels of resilience following a major disaster. The aim of this pilot study was to determine self-rated levels of resilience of young, middle-aged and older adult survivors of the 2011 Joplin tornado 3 years’ post-disaster.

Methods: A mixed-methods design of a 25-item survey and focus groups was used to study three distinct adult age groups (young, 18–39 years; middle-aged, 40–64 years; and older, 65 or more years). A total of 182 individuals completed the survey, and 20 participated in one of three age-specific focus groups.

Results: Overall, 162 of the 182 tornado survivors reported normal-to-high resiliency 3 years after the event. However, 20 of the 182 participants had a total mean score of 62 or below, which is consistent with generalized anxiety and post-traumatic stress disorder. No statistical difference was found in resilience according to the three age groups.

Conclusion: Although the majority of participants reported normal-to-high resiliency, a small but troubling proportion of survivors reported difficulty in adjusting to the effects of the disaster 3 years after the event. Age did not appear to be a significant factor in resiliency of the participants.

Aim: This study aimed to clarify the nature of health support activities carried out for schoolchildren by a Yogo teacher at a school for special needs education who experienced the Great East Japan Earthquake.

Methods: A qualitative case study was carried out in June 2014 and involved a Yogo teacher working at a school for special needs education in Fukushima Prefecture that was damaged by the Great East Japan Earthquake in 2011. The School Principal and Yogo teacher at the institution in question were notified of the nature of the research, and consent to participate was obtained with the return of consent forms. A semi-structured interview was conducted using an interview guide developed by the author. A verbal transcript of the interview was created and qualitatively analyzed using a narrative approach.

Results: The experience of the Yogo teacher was examined in three chronological stages: (a) at the time of the earthquake; (b) during the move to an emergency shelter; and (c) after the school was reopened at a branch location. At the time of the earthquake, despite efforts to avoid inciting panic among schoolchildren, many students experienced considerable anxiety. In their lives at the shelter, it became clear that medical care for children with disabilities was not carried out on a priority basis.

Conclusions: The Yogo teacher was evacuated along with the children and was aware of the particular challenge of empathizing with the children’s feelings of anxiety. The findings suggest the need for long-term health support in relation to mental health care for affected schoolchildren.

This paper addresses and illustrates shortfalls in information sharing and responses for public health issues in shelters and the affected areas after the Kumamoto Earthquake of April 16, 2016. Drawn from situation reports published by the Japanese Cabinet Office and major newspaper companies, analysis of these various reports within 1 month of this natural disaster revealed chaotic situations in evacuation centers. Despite the availability of consultations regarding health problems and living conditions provided by various organizations, health assessment and public health surveillance were slow and unsystematic, especially in their application to vulnerable groups that required population study and high-risk approaches for health. Furthermore, overall health response management tended to overlook the problems that existed outside of shelters. What is needed is more efficient information-sharing methods and a system that enables reasonably rapid responses to health problems and population care during the acute phase and issues requiring long-term care.