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2009-1

NPs' Perceptions of Disaster Preparedness Education: NPs' Perceptions of Disaster Preparedness Education:

Quantitative Survey Research Quantitative Survey Research

Milada Tichy

A. Elaine Bond University of Jordan

Renea L. Beckstrand Brigham Young University - Provo, renea@byu.edu

Barbara Heise Brigham Young University - Provo

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BYU ScholarsArchive Citation BYU ScholarsArchive Citation Tichy, Milada; Bond, A. Elaine; Beckstrand, Renea L.; and Heise, Barbara, "NPs' Perceptions of Disaster Preparedness Education: Quantitative Survey Research" (2009). Faculty Publications. 5306. https://scholarsarchive.byu.edu/facpub/5306

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NP PRACTICE

NPs' Perceptions of DisasterPreparedness Education:Quantitative Survey Research

Milada Tichy, MS, FNP; A. Elaine Bond, DNSc, APRN, CCRN;Renea L. Beckstrand, PhD, RN, CCRN; and Barbara Heise, PhD, APRN-BC

Nurse practitioners need to be effective in responding to

large-scale natural and man-made disasters. However,

disaster core competencies for NPs are largely nonexis-

tent. Tlie purpose of this study was to iissess NPs' level of

disaster preparedness and detertnine how NPs acquired

knowledge about disaster preparation. Findings suggest

ihat a consistent national NP curriculum for disaster

nreparedness, including communication with other disas-

ter agencies, is needed. With proper education, NPs can

play a major role in disaster management.

About 75,000 persons aroundthe world die every year

I because of unanticipateddisasters, with an additional 210million persons directly affeaed insome way by such events.' Recentdisasters such as HurricanesKatrina and Rita in 2005; theIndian Ocean tsunami in 2004;severe earthquake activity inTurkey, Iran, and Pakistan; and ter-rorist activities in numerous coun-tries have exacted a terrible toll.These events not only led to loss oflife and devastation of publicinfrastruaures, but they also over-whelmed hospitals and clinicswith the vast number of peopleneeding urgent care for injuries

and illnesses. These disastersproved difficult to manage initiallyand difficult to analyze properly.

As a consequence, NPs andother dinicicins must take effectiveaction in emergency situations anddisasters. Even in a small-scaleevent such as a local release of bio-logical agents, victims would likelyoverwhelm emergency depart-ments, clinics, and practitioners'offices.* Healthcare systems andfrontline clinicians, induding NPs,must be prepared to address avariety of disaster-related contin-gencies. However, adequately edu-cating practitioners for disasters,which are largely unforeseen andmay never happen in a particular

region, is a challenge. The purposeof this study was to assess NPs' per-ception of their disaster prepared-ness and to find out how NPsacquired knowledge about disasterpreparation.

LiferQture ReyfewA disaster is much larger in magni-tude than an emergency, signifyingevents that are unforeseen, serious,and of immediate threat to thepublic (Table 1).̂ A newer defini-tion of disaster is a calamitousevent resulting in major destruc-tion of property, infrastructure;, andhuman life. The event, caused bynatural or man-made forces, restilts

10 • THE AMERICAN JOURNAL FOR NURSE PRACTmOrOERS JANUARY 2009 VOl. 13 NO. 1

in major disruptíon to the healthand safety of the community ornation, and it exceeds the day-to-day operational capability of localresponders.'"*^ The term mass casu-alty incident was adopted from themilitary to describe the situation.'

Experts suggest that disastereducation, or disaster prepared-ness, must include comprehensiveknowledge and skills to respond toor prepare for natural disasters;chemical, biological, radiological,nuclear, or explosion-type inci-dents; and other large-scale calami-ties.' Although differences existamong the operational definitionsand between natural disasters andman-made disasters, similar strate-gies can serve as the basis for health-care responders' preparation—regardless of the type of disaster.

Some disaster competencieshave been established for registerednurses (RNs). These competenciesinclude describing an agency's rolein responding to an emergency,describing the chain of command,locating an emergency plan, describ-ing one's role within this plan,knowing how to use relevant equip-ment, describing communicationroles, identifying one's knowledgedeficits, recognizing emergency situ-ations and taking appropriateactions, and participating in contin-uing education (CE).'"

Additional competencies havebeen identified for all clinicians(physicians, RNs, advanced prac-tice nurses [APNs], physician assis-tants, clinical psychologists, andsocial workers) in the areas ofassessment and initial decisionmaking.*' These competenciesinclude understanding one's rolein emergencies, knowing the chainof command, knowing emergencyresponse plans and ha\'ing effectivemeans of communication, under-standing the limits of one's knowl-

TABLE 1 DISASTER DEFINITIONS^

DISASTER: Unexpected, man-mode, or notural stressful event(s) tliat couse healtfi-reloted injuries or illnesses tliat exceed local capabilifies ard/or resources

EMERGENCY: Unexpected man-mode or natural stressful evenf{s) ttiat cause healtfi-related injuries or illnesses tfiot can be managed using local capabilities and/orresources

DISASTER AND EMERGENCY: Terms often used interchangeably, but Û\ey representdifferent levels af intensity (also used: mass casualty incident)

u Prevention, planning, preparedness: Information, skills, communications,equipment, and education implemented to respond to an emergency or a disaster

• Response, mitigation: Activities during or immediately after a disaster thatprovide immediate care and relief to prevent injuries from extending

• Recovery: Potential need for long-tenm follaw-up for physical/psychologicaltrauma experienced during a disaster

• Evaluation: Ongoing process after an emergency or disaster, used for ossessinghow effective the disaster plan was, what needs to be added to the plan, andwfrat should be removed from the plan

•Table 1 wos prepared by /kiurad A. A. Al KhatoiWi, RN, PhD(c), vMo ¡s about lo graduate fromthe Universily of Jordan.

edge and authority, being aware ofresources, recognizing unusualevents, and applying critical think-ing skills to the situation. Thesecompetencies are to be carried outduring the four phases of disastercare: preparedness and planning,response and mitigation, recovery,and evaluation (Table I).'

Disaster preparedness corecompetencies developed by thevarious groups are not fully consis-tent in content, have no overridingsupervision, and are difficult toenforce.' A survey of 300 nursingschools nationwide showed that amajor problem with disaster pre-paredness education was the lackof qualified faculty to teach disas-ter preparation.™ TTiis lack maystem from a dearth of faculty disas-ter experience or involvement incommunity disaster plan creation.Also, a survey of 7 baccalaureatenursing schools in one stateshowed that 4 of the schools didnot offer any disaster preparednesscontent as part of the curriculum.'

Because the role of NPs differsfrom that of RNs, disaster corecompetencies for NPs must bedeveloped.' Some experts thinkthat NPs should have a role intriage, diagnosis, and treatment ina disaster,- whereas others areunsure of the NP role, stating thatNPs should simply funaion in therole of an RN in a disaster becauseno core competencies have beendefined for NPs." These views are*disconcerting at a time of increaiseddisaster needs.

Concerns Surrounding theNP Role in DisastersSome N'Ps are limited in their sco|>eof practice in disaster situationsbecause of licensure restrictions."Many NPs need to practice undersupervision or in collaborationwith a physician; certain liabilityissues are raised if they purport toaa on their own. Although RNshave defined core competencies forhandling disasters, NPs lack

VOL 13 NO Î Tt« AMEBCANJOURNAl FOR NURSE PRACTmONEKS • I I

NP PRACTICE

NPs need disaster-specific core competencies.

nationally defined technical skillsstandards in terms of being pre-pared for handling disasters.'

The Essentials of Master'sEducation for Advanced NursingPractice states that one of the corecompetencies required in graduatenursing programs is the ability torecognize emergency situationsand respond effectively." Part ofthe standard nursing school cur-riculum likely includes materialrelated to disaster managementand preparedness. However, educa-tors must evaluate which contentneeds to be added, reframed, andenhanced, and whicb resourcesneed to be augmented to ensurethat appropriate graduate nursingoutcomes are met.' In response,some universities offer disastermanagement courses at the gradu-ate level, and others offer certificatecourses. Some universities offer amaster-of-science degree in emer-gency management." Also, well-known nursing organizations, suchas Sigma Theta Tau, are workingwith the American Red Cross toprepare nurses for disasters byoffering online case study cours-es." However, these courses are notspecific for NPs.

NPs need disaster-specific corecompetendfô. Also, little is knowTiabout NPs' current disaster pre-paredness or about how NPsacquired the disaster preparation

' knowledge that they do possess.This information will aid nursingeducators and disaster responseorganizations in recognizing thelack of formalized disaster pre-paredness education for NPs andmay serve as a catalyst to improveefforts in this area.

The StudyPurpose—This study was con-

duaed to assess NPs' perceptionsabout their preparation for disasters,as well as how NPs acquired knowl-edge about disaster preparation.

Methodology—Design. A descriptive survey

was used to determine NPs' level ofpreparedness for disasters. The sur-vey was based on suggested com-petencies identified for disasterpreparedness education for NPs inthe literature. Descriptive ques-tions were written to determinewhere NPs received their disasterpreparation. To increase reliabilityand validity, 2 panels of expertNPs reviewed the survey anddescriptive questions and provid-ed feedback for content anddesign. Panel 1 included 6 NP fac-ulty members at Brigham YoungUniversity in Provo, Utah, andPanel 2 included 6 local NPs. Bothpanels evaluated the effectivenessand accuracy of the survey ques-tions and terminology. Based onpanel members' recommenda-tions and comments, questionswere refined and clarified.

Sample, setting, data collec-tion. Inclusion criteria were thatparticipants work as APNs andunderstand/speak English. Afterinstitutional review board approvalwas obtained, 300 NPs nationwidewere randomly selected ftom theAmerican Academy of NursePractitioners (AANP) database TheAANP provided the NP sample atnominal cost. The stirvey, accompa-nied by a letter of explanation, wassent to prospective partidpants.The letter included a statementindicating that when partidpants

forwarded the completed survey,they were granting their consentto participate. A stamped, self-addressed envelope accompaniedthe survey, along with $ 1 as com-pensation for completing the sur-vey. Raw data relating participants'names and demographic informa-tion were secured in a locked officeto maintain confidentiality. A sec-ond (final) mailing with a reminderletter was sent to participants whodid not respond in a timely manner.

Data analysis. Raw data wereentered into SPSS 13.0 (1999).Frequencies and measures of cen-tral tendency and dispersion werecalculated. Items were rankedfrom highest to lowest on the basisof mean scores to determinewhich were the most frequentlyoccurring. Cronbach a scores werecalculated to determine internalconsistency estimates of reliability.

Results—After two mailings,191 surveys were returned. Of the191 surveys, 25 were eliminatedfrom further analysis because theNPs reported that they were ineli-gible or did not wish to participate.Table 2 presents demographicdata for 166 participants (60.4%response rate). Data were analyzedto assess how NPs perceived theirlevel of disaster preparedness andhow they acquired knowledgeabout disaster preparation.

Level of preparedness. Twenty-five items assessed preparedness.TTie scale of answers ranged ftom 1to 6 {strongly disagree to stronglyagree). Cronbach a for prepared-ness section items was 0.93. Itemswere grouped into three categories:knowledge, disaster skills, and per-sonal preparedness (Table 3).

12 • THE AAAERICANIOURNAI FOR NURSE PRACTITIONERS JANUARY 2009 VOL. 13 NO. 1

Level of preparedness forresponse (mitigation, allevia-tion, relief). Sixteen items evaluat-ed response. The scale of answersranged from 1 to 6 {strongly dis-agree to strongly agree], with aCronbach a of 0.934. Items weregrouped into two categories:knowledge and patient manage-ment (Table 4).

Level of preparedness for dis-aster recovery. Six items on thesurvey related to recovery. Thescale of items ranged from 1 to 6[strongly disagree to strongly agree),with a Cronbach a of 0.91. Itemswere grouped into two categories:knowledge and management(Table 5).

How NPs acquired disastereducation. Twenty-three NPs(14%) reported that they receiveddisaster education in their under-graduate program, 101 NPs (61%)received education in facility drillswhile they were RNs, 59 NPs(36%) took relevant CE classes, 29NPs (17%) received disaster edu-cation in their graduate nursingprogram, and 46 NPs (28%)received specific disaster trainingafter they were NPs. Forty-two NPs(25%) participated in real disas-ters. Even with this level of disastereducation, only 25 NPs (15%)stated that they felt well preparedto function in a disaster.

Among the sample, 126 NPs(76%) stated that they neededmore information about biologi-cal agents, as well as ways to iden-tify signs and symptoms (S/S) ofexposure to these agents; 122 NPs(73%) wanted further clarificationof the NP role in a disaster; and102 NPs (61%) wanted moreinformation about how torespond and how to ensure healthpromotion, protection, and dis-ease prevention in community set-tings in case of a disaster. One

TABLE 2 DEMOGRAPHICS OF SURVEY RESPONDENTSCharacteristic

GenderMaleFemaleDid not report

Highest degreeBachelor'sMaster'sDoctorate

Facility typePrivate practiceOther facility (eg, clinic)Community nonprofit hospitolFederal/militory hospitolCommunity for-profit hospitalUniversity medicol centerState hospital

Age (y)

Time as RN (y)

Time as NP (y)

Hours worked/week as NP

KID ^..m^ .1 l'.tïn.imt DM 1 11 ii'i ! • ! «il n.«^K< Cr\ vbi

Mem47.5

18.7

8.03

34.7

Number (%)

12(7.2)150(90.4)

4 (2.4)

4(2.4)156(93.9)

6(3.7)

60 (36.0)41 (24.8)27(16.1)19(11.1)10(6.2)8 (5.0)1 (0.6)

SD9.5

10.7

6.6

13

Range

27-67

1-43

0-30

0-80

hundred two NPs (61%) wantedto know additional methods ofidentifying resources in the com-munity, induding agencies forreferral, health departments, emer-gency contacts, chain of com-mand, and community shelters.

Eighty-five NPs (51%) expressedconcerns about potential v'ulnera-bilities in their community during adisaster [eg, tomado, flood, hurri-cane). Eighty-three NPs (50%) wereconcerned about patients' needsduring the recovery stage (eg, thosewith acute stress disorder, post-trau-matic suess disorder [PTSD]) andcrisis interventions (focused assess-ment; debriefing strategies; andbehavioral, cognitive, or medicationtherapy).

Discussion—Although mostNP respondents reported that theyreceived a limited disaster educa-tion from various settings, a Iarge^proportion indicated that theyneeded additional disaster educa-tion so that they could better servetheir community. Only a few îsîPsthought that they would be consid-ered leadership figures in theircommunity during a disaster situa-tion. But N"Ps. along with otherpractitioners, would be needed toserve on the front lines, in dinicsor offices or even at the scene ofdisaster itself, where their leader-ship would surely be tested.- NTsmust be prepared to handle triage.diagnosis, and treatment of injuredpatients. Not all NPs will be first

Vd- 13 NO.» JAr4UARr2009 TfiE PRACTITIONESS • 15

NP PRACTICE

TABLE 3 NURSE PRACTITIONERS' DISASTER PREPAREDNESS

Scale of 1 -6, strongly disagree to strongly agree.

Disaster Knowledge

1.1 would be interested in educotional classes on disoster preparedness that relate specifically to my community situation.

2.1 know the limits of my knowledge, skills, and authority os an NP to act in disaster situations.

3.1 am oware of potential vulnerabilities in my community (eg, eortfiquoke, floods, terror).

4.1 find that the reseorch literature on disoster preporedness is understondable.

5.1 hove a list of contacts in the medical or health community in wfiich I practice. I know referrol contocts in case of a

disoster situation (eg, heolth deportment).

4.1 neod ¡oumol articles related to disaster preporedness.

7.1 know where to find relevant research or informotion reloted to disoster preparedness and management to fill in

gaps in my knowledge.

8.1 find thot the research literature on disoster preparedness and management is easily accessible.

9. In case of a disaster situotion, I think there is sufficient support from local officiols on the county or state level.

10.1 am familiar witfi the local emergency response system for disosters.

11. Finding relevont informotion about disoster preparedness rekjted to my community needs is on obstocle to my

level of preparedness.

12.1 know whom to contact (chain of command) in disaster situations in my community.

13.1 am aware of classes about disoster preparedness and monogement that are offered in my workplace, university,

or community.

14.1 participóte in one of the following educational odivities on a regular basis; continuing educotion classes, seminars,

or conferences deoling with disaster preparedness.

15.1 have porticipoted in emergency planning for disoster situations in my community.

16.1 poriicipcrte/hove porticipoted in creating new guidelines or emergency plans or in ksbbying for improvements on

tfie kxral or nationol level.

Disaster Skills

1. In case of a bioterrorismAiiologicol attack, I krxjw how to use personal protective equipment.

2.1 am familiar with accepted triage principles used in disaster situations.

3. In a cose of bioterrorism/biokjgical aliack, i know how to perform isolation procedures so ifxjt I minimize risb for

community exposure.

4.1 participóte in disaster drills or exerases at my wwitplace (eg, dinic, hospital) on o regular bosis.

5. In case of o biotenxHism/biological atkxi, I know haw to execute decontominoHon procedures.

6.1 consider myself prepared for the management of disasters.

7.1 would be considered a leadership figure in my community in a disader situation.

Family Preparedness for a Disaster

1.1 have pervxwl/fainiiy emwgency pksis in place for disaster situations.

2.1 have on agreement virithkived ones O K I family members on how io execute ow penoncj/foniily emergency plans.

Mean

4.66

4.50

4.29

3.96

3.90

3.76

3.75

3.69

3.67

3.66

3.65

3.57

3.48

3.05

2.77

2.17

Mean

4.11

3.99

3.49

3.16

3.13

3.10

2.61

Meon

3.56

3.29

SD1.23

1.30

1.39

1.29

1.56

1.55

1.42

1.41

1.39

1.54

1.49

1.80

1.76

1.76

1.83

1.54

SD1.64

1.53

1.62

1.94

1.6Ó

1.50

1.59

SD1.57

1.71

n164

164

164

156

166

165

166

164

164

164

164

165

166

166

166

164

n164

163

164

166

164

166

164

n164

164

1 6 • THE AAAERICANJOURNAl FOR NURSE PRACimONERS JANUARY 2 0 0 9 VOL 13 N O . Î

responders, but all must know howto identify problems and protectthemselves and others.'

NPs' limited disaster prepared-ness is disconcerting. Variousgroups have tried to develop spe-cific competencies but, because ofa lack of coordinated efforts with

other emergency responders, theseattempts have been less than effec-tive.' NP competencies from theNational Organization of NursePractitioner Faculties" must bebroadened to apply to disasters.These competencies include assess-ment; health promotion/disease

prevention; assessment of healthrelated to community situations;interventions to promote health;comprehensive differential diag-noses with epidemiology andidentification of characteristicsspecific to a particular communityin mind; and development of

TABLE 4 NURSE PRACTITIONERS' RESPONSE ABILITIES (MITIGATION, ALLEVIATION, RELIEF)Scale of 1-Ó, strongly disagree to strongly agree.

Knowledge Specific to Response1.1 am familiar with psychological interventions, behavioral therapy, cognitive strategies, support groups, and

incident debriefing for patients who experience emotional or physical trauma.

2.1 am able to describe my role in the response phase of a disaster in the context of my worltpbce, the general public,

medic, and personal contacts.

3. Some research has shown that NPs feel constrained by medical rrralpracHce concerns or license restrictions in terms

of responding to disasters. This constraint applies to me too.

4.1 am familiar with the organizational logistics and roles among local, state, and federal ogencies in disoster

response situations.

Patient Management During Response

1.1 would feel reasonably confident providing potient education on stress and abnofmal functioning related to

trauma.

2.1 can manage common symptoms and reactions of disaster survivors thot are or on affective, benovioral, cognitive,

or physical nature.

3.1 feel reasonably confident I can treat patiwts indep«idenlly without supwvision of o physkion in a disaster

situation.

4.1 con identify possible indicators of nwss exposure evidenced by a clustering of patients with similar symptoms.

5.1 would fed confident working as a trioge NP and sdting up ten^wray dinks in disaster situations.

6, As an NP, I would fed confident as a mœxjger or o axxdinator of a shelter.

7. As an NP, i would fed confident in my abilitias as a direct cere provider and firsi responder in disaster sHuations.

8.1 would fed reasonably confident implementíng emeigency plans, evocuoiion procedures, and similar fundiore.

9. As an NP, I would fed reasonably confklent in my abilities to be a member af a deœrtonwicticn team.

10.1 fed reasonably confident discerning dévidions in heaMi assessment incfioo&ig potemÄd exposure to biaiogpcai

agents.

U . I am familiar with the main groups (A, 6, q af bkJagkd v«apans (eg, otArax, p l a ^ , b<**sm, sma^xjx), í ie r

s i ^ cná sympkxTa, and dfedive tneahnert.

12. b a bwtemxism/bkJogiaJ («adc, I v w l d laK>v haw to perfcmi a b i ^

to bioagef^ ÍKÉ are used.

Mean3.81

3.58

3.45

2.98

Meon

4.12

3.95

3.86

3.80

3.72

3.66

3.57

3.37

3.35

3.30

3.21

3.20

SD1.36

1.46

1.52

1.48

SD

1.36

1.25

1.38

1.34

1.45

1.49

1.45

1.50

1.51

1.31

1.37

1.49

n164

163

164

163

n

163

164

164

164

164

164

164

163

164

164

164

164

VOL 13 N O . 1 JANUARY 2 0 0 9 THE AMERiCAN JOURNAl FOR NURSE PRACnTKDNHJS • 1 7

NP PRACTICE

TABLE 5 NPs' DISASTER RECOVERY PREPAREDNESSScale of 1 -6, strongly disagree to strongly ogree.

Recovery Knowledge

1.1 am familiar with what the scope of my NP role

would be in a posfdisaster situation.

Recovery Management

1.1 am able to discem signs and symptoms of acute

stress disorder and post-traumatic stress disorder (PTSD).

2.1 am comfortable providing education on coping skills

and training for patients who experience traumatic

situations.

3.1 am comfortable managing (treating, evaluating)

emotional outcomes for acute stress disorder or FTSD.

4.1 am familiar with how to perform focused healthassessment for PTSD.

5.1 participate in peer evaluation of skills in disaster

preparedness and response.

Mean

3.Ó8

Mean

4.18

SD

1.37

SD

1.23

B

164

n

164

4.00 1.23 164

3.59

3.54

2.29

1.47

1.50

1.38

164

163

164

plans of care to prevent disease andmaintain optimum health. In addi-tion, the Essentials of Master'sEducation for Advanced PracticeNursing'^ includes a requirementthat graduate students be taughthow to recognize emergency situa-tions and respond effectively. Theserequirements have not been fullymet. Graduate curricula must incor-porate such content without delay.

Although many NP respon-dents knew how to use personalprotertive equipment for biologi-cal/bioterrorism attacks and werefamiliar with triage principles,fewer NPs knew how to executedecontamination procedures. Thislack of knowledge is especiallyunsettling in light of participants'lack of knowledge about biologicalweapons. This finding was alsoreported in an earlier study, whichfound that only 23% of RNs andMDs had confidence in their abili-ty to provide health care to disastervictims."" Also of note, few NP

respondents felt reasonably confi-dent in their ability to implementemergency plans, evacuation pro-cedures, or similar functions. Allpraaitioners need to have the skillsto respond to the rapidly changingsituations encountered in disasters.

In disasters, knowledge of re-source availability is necessary tonotify response teams immediately.Many NP respondents reportedthat they had referral contacts intheir community in case of a disas-ter, but few knew whom to contaaor knew the chain of command intheir community. Not all NPs werefamiliar with local response sys-tems. Earlier reports emphasizedthat knowing the chain of com-mand was a critical component ofcompetency for practitioners.^ Allpractitioners should be familiarwith the incident command sys-tem, which is widely used by lawenforcement, firefighters, and themilitary in emergency preparednessand response NPs must be able to

reach appropriate units to commu-nicate quickly and effectively toprevent situations from worseningin mass casualty incidents. Ofconcern, no reports in the litera-ture describe how NPs would com-municate with other practitionersor law enforcement groups duringa disaster.-

Family preparedness plays ahuge role in the ability of NPs to beable to respond to a disaster. Not allrespondents had family emergencyplans in place for disasters or agree-ments on how to execute familyplans. If NPs do not think that theirfamilies are safe or cared for, theirfocus and ability to fully engage indisaster response will be compro-mised. For example, in a recentJapanese study, many nurses did notparticipate in an earthquake disasterbecause they could not providealternative care for their families."

Since the Indian Ocean tsuna-mi slammed coasts in SoutheastAsia in December 2004 andHurricane Katrina struck theUnited States in August 2005, sev-eral authors have called for addi-tional education and preparationfor nurses in general."*^^ Someworldwide facilities have begunnew disaster educational pro-grams.̂ ^̂ ** However, NP prepara-tion remains largely unaddressed.Although respondents in the cur-rent study reported moderate levelsof disaster education, obvious gapsexisted. Because of the high risk forfuture disasters in the UnitedStates, educators must increase dis-aster content in graduate programsto prepare NPs for greater leader-ship in such occurrences.

Possible NP Rdes inDisoster MonogementGiven their advanced educationand skills, NPs can play a more

18 • THE AMERICAN JOURNAL FOR NURSE PRACTITIONERS JANUARY 2009 VOI. 13 NO. 1

sophisticated role in all four phasesof a disaster: preparation, responseand mitigation, recovery, and eval-uation. Potential roles aredescribed.

Preparation—NPs must becompetent in advanced healthassessment to identify abnormalhealth deviations in individuals, aswell as the specific needs of fami-lies within the community.-' Theymust know how to set up and man-age temporary clinics." NPs mustlearn more about epidemiologyand tbe effects of exposure to toxicagents to be ready to intervene."""In cases of bioterrorism or man-made disasters, they must be ableto diagnose and treat patients withexposure to various biochemicaland radiological agents. Knowledgeof community resources and agen-des is essential. NPs must collabo-rate with others to develop andimplement disaster plans. Not onlymust NPs know what their role is indisaster response," but they alsoneed to develop a plan that enablesthem to leave their family for workduring a disaster.

Response (Mitigation, Alle-viation, Relief)—Isolation, decon-tamination, surveillance, and majorleadership during bioterrorismattack are essential skills/rolesfor NPs.""'-^ NPs would assesspatients, make diagnoses, imple-ment care, and identify exposedpersons witb unusual S/S. In par-ticular, NPs would make referralsto community resources, prescribemedications, provide anticipatoryguidance and teaching to patients,assist families or individuals withethical issues, and treat physicaland mental illnesses.'' Emergencyplans, evacuation routes, and relat-ed procedures must be implement-,ed. If they are on the scene, NPsmight get involved in organizingand performing triage care, super-

Given their advanced education and skills,

NPs can play a more sophisticated role in

all four phases of a disaster.

vising care, and collaborating withphysicians or other healthcare per-sonnel.

NPs who are in clinical settingswhen a disaster strikes can expectan arrival of injured and potential-ly exposed patients.' ITiey must beprepared to function in a rationaland systematic manner to reduceexposure wbile treating personswho are injured. NPs must notonly function in the RN role, withits identified competencies, butalso in the advanced practice roleof an NP

Recovery—As the recoveryphase begins, NPs must be vigilantin assessing for acute stress disor-der and, later, PTSD or other psy-chological consequences. NPsmust facilitate continuity of carefor individual patients and familymembers,'' espedally if psycholog-ical uauma is involved. NPs mustassess the impact of illness/injurieson the family as a unit.'' Crisisintervention is essential to a suc-cessful recovery stage. NPs mustaddrfôs each of these concerns withfocused assessment, debriefingstrategies, and behavioral, cogni-tive, and/or medication theraj>y."

Some national disaster curricu-lum development efforts havebeen under way since 2003, initiat-ed by the Department of Home-land Security and sponsored by theHealth Resources and ServicesAdministration and the Agency forHealth Care Research andQuality." However, confusion and

misunderstanding about the prop-er forum for the uaining of health-care professionals in emergencypreparedness skills have impededthe success of these efforts. Also,barriers to implementing educa-tional efforts exist, including defi-ciencies in funding for developinga curriculum about weapons ofmass destruction, lack of a nation-al clearinghouse, and lackof atten-tiveness on the part of nursingleaders that education in this areais a priority.̂

Education about disasters forNPs nationwide has not been a pri-ority. Nursing education has beeninconsistent in terms of disastereducation and training or inimparting this information toschools and workplaces. Limitednational curriculum developmentefforts are under way, but nonational curriculum has beendelineated. Disaster preparationeducation for NPs seems to be lim-ited, inconsistent, and unregulatedftom state to state

Limitation—This report didnot address post-disaster evalua-tion. In general, evaluation stagedata are sparse in the literature.Because disasters are new and notyet vvell understood, furtherresearch in this area is needed,espedally for long-term evaltiationdata.

Implications and Recommen-dations—The literature indicatesthat NPs' disaster preparedness hast\\ro major shortcomings. First,

VOL 13 NO. 1 JANUARY 2009 I K AA(i|BaCAN JOURNAI FOR NIÄSE PRACTTTOslERS • 21

NP PRACTICE

development of a national curricu-lum on disaster preparedness innursing schools is needed. Currenttraining and education vary fromstate to state or are absent, with nostandards defined." NP competen-des-' and the Essentials of Master'sEducation core competencies'-must include disaster educationimmediately. Second, no specificNP competencies for disaster pre-paredness exist. NPs are a majorhealthcare workforce and can pro-vide invaluable leadership in a dis-aster. NPs must assume leadershipin disaster preparedness and workwith local community groups indeveloping disaster plans andcommunication between groupsduring disasters.

Results of this study can helpidentify core competencies and roledevelopments needed for NPs toassist community members duringdisasters. These results can also beused to lobby for improvements infederal and state disaster plans.Many NPs in this study lacked con-fidence in implementing emergen-cy plans, indicating that they areunaware of what these plans entailor they do not know how to exe-cute them because of lack of knowl-edge about chain of command,disaster skills, and similar func-tions. Appropriate education forNPs will increase the number ofqualified healthcare professionalsavailable to respond effectively todisasters, thereby decreasing mor-bidity and mortality for patientsduring tumultuotis times. •

Milada Tichy is a nurse practitioner atthe Sandy Health Care Center's pul-monary clinic in Sandy, Utah. A.Elaine Bond is the director for gradu-ate studies at the Univenity of JordanFaculty of Nursing in Amman,Jordan. Renea L. Beckstrand is a criti-cal care profesor, and Barbara Heise

is an assistant professor, both atBrigham Young University in Provo,Utah. The authors state that they donot have a financial interest in orother relationship with any commer-cial product named in this article.

References1. Deeny P, McFetridge B. The impact of disasteron culture, self, identity: increased awareness byhealth care professionals is needed. Nurs ClinNorth Am. 2005;40;431-440.

2. Weiner E. A national curriculum for nurses inemergency preparedness and response NUTS ClinNmh Am. 2005;40:469-479.

3. Gebbie KM, Quereshi K. Emergency and disas-ter preparedness: core competencies for nurses. Am¡Nuri. 2002;102{I):46-51.

4. Bond EF, Beaton R. Disaster nursing curricu.lum development based on vulnerability assess-ment in the Pacific Nortliwest. Nurs Clin North Am.20O5;40:44I-451.

5. Stanley IM. Disaster competency developmentand integration in nursing education. Nurs ClinNorth Am. 2005;40:4S3-467.

6. Stanley )M. International Nursing Coalitionfor Mass Casualty Education (INCMCE).Educational Competencies for Registered NursesResponding to Mass Casualty Incidents. 2003.Available at: www.mc.vanderbilt.edu/nuising/

7. Slepski LA. Emergency preparedness: conceptdevelopment for nursing practice Nurs Oin NorthAm. 2005:40:419-430.

8. Columbia University School of Nursing,Center for Health Policy, supported by Centers forDisease Control and Prevention and Association ofTeachers of Preventative Medidne. Bioterrorismand Emergency Readiness: Competencies for AllPublic Health Workers. November 2002. Availableat: http://www.cu.mc. columbia.edu/

9. Association of Teachers of Preventive Medidnein Collaboration with Center for Health Policy,Columbia University School of Nursing.Emergency Resfionse Clinidan Competendes inInitial Assessment and Management. 2003.Available at: http://www.cunK:.ooIumbia.edu

10. Weiner E. Emergency preparedness curriculumin nuising schools in the United States. Nms EäucPenpecL 2005;26(6):334 339.

11. Cole FU Ttie role of the nurse practitioner indisaster plannir^ and response Nio3 C3nt NorthAm. 2005,40:511-521.

12. American Assodalion of CoIkgES of Nmâng.The Essentials of .Master's Education for AdvancedNursing Practice 1996. Available at: www.aacn.rKfaeedu/

13. VeenemaTG. Expanding educational opportu-nities in disaster response and emergency pre-paredness for nurses. Nurs Educ Perspect. 2006;27(2):93-99.

14. Willshire L. Disaster Preparedness andResponse for Nurses, by American Red Cross andSigma Theta Tau International. 2003. Available at:www.nuisingknowledgeorg/

15. National Organization of Nurse PraaitionerFaculties. Nurse Practitioner Competencies inSpecialty Areas: Adult, Family, Gerontological,Pédiatrie, and Women's Health. 2002. Available at:www.nonpforg/

16. Rose M, Larrimore K. Knowledge and aware-ness concerning chemical and biological ter-rorisms: continuing education implications. /Oman Educ Nurs. 2002;33(6):253-258.

17. Mitani S, Kuboyama K, Shirakawa T Nursingin sudden-onset disasters: faaors and informationthat affect participation. Prehosp Disaster Med.2003,18(4):359-366.

18. Kane-Unabazo C. Duty in a time of disaster, aconcept analysis. Nurs Forum. 2006:42(2):56-65.

19. Mitciiel MA, Sakraida T, Zaiice KK. Disastercare: psychological considerations. Nurs Oin NorthAm. 2005;40:535-550.

20. NeSmith EG. Defining "disastere" with impli-cations for nursing scholarship and praaice.Disaster Manag Response. 2006;4(2):59-63.

21. Wynd CA. A proposed model for military dis-aster nursing. Online I Issues Nurs. 2006;ll(3).Available at: http://nursingworid.ofg/

22. Douglas V. Developing disaster managementmodules: a collaborative approach. Br J Nurs.2007;16(9):526-529.

23. Steiert MW. President's message Disaster pre-paredness. AORN/. 2OO7,86(2):175-176.

24. Igbobi L. Communiqué released at the end ofa two week certificate course on 'Disaster nursingemeTgency preparedness" origanized by the WestAfrican College of Nuising for senior nurses. WestAfrlNurs. 2OO7;18(l):72-73.

25. Ueda Y. Care provided by home care nursesduring disasters and their awareness of disasterntirsing and issues regardi ng disaster nursing. AsianISms. 2007;10(l):67-68.

26. Kingsley G. ANA takes national steps on disas-ter nursing: NMA conference brings it local. MinnNurs Accent. 2007;79{4):l-3.

27. Veenema TG. Chemical and biological terror-ism preparedness for staff dev-elopment spedalists.INimStaffDev. 2003;19{5):215-222.

28. Steed IC. Howe LA, Pruitt RH, Sherill WW.Integrating bioterrorism education into nursingcurricula. / Nms Educ. 2004;43(3)362-367.

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