Disaster nursing: are we prepared?

In the last decade, over 2.6 billion people worldwide have been affected by natural phenomena, from the 2013 Ebola virus outbreak in West Africa, to the 2017 mudslides in Sierra Leone, to the 2009 Black Saturday bush fires in Victoria. Scientists predict that global warming will exacerbate the frequency and intensity of many such events, making vulnerable an even greater number of people. 

How prepared is our international nursing workforce to meet this challenge?

This was the question addressed by Flinders University professor Kristine Gebbie, appearing at a talk at the International Council of Nurses (ICN) 2019 Congress. Held this year over five days in Singapore, the event attracted over 500 delegates.

The professor, who is also associate director at the Torrens Resilience Institute in Adelaide, has spent the last few decades thinking about the competencies of individuals and professionals when confronted with extraordinary, large-scale peril. She co-authored a paper for the Australian Institute for Disaster Resilience on building a household resilience toolkit, and another on assessing community disaster resilience.

Her ICN talk brought focus to the pivotal role of nurses in disasters and emergencies. Nurses are often present at multiple points in the disaster timeline, whether it’s as “the first person to notice a sick family member, or the first person on the scene of a house that collapsed”, she said.

To bolster the nursing workforce’s capacity and capability in these high stakes conditions, said Gebbie, it is critical to establish and apply a set of common competencies. These are not only common across organisations, but across the profession as it exists worldwide, and encompass such domains as preparation and planning, safety and security, law, communication and recovery. 

Produced in collaboration with a steering committee and major nursing organisations, Gebbie introduced ICN’s Building Core Competencies in Disaster Nursing, Version 2.0, a unifying framework intended to establish this set of competencies globally. Designed to be consistent with national laws and policies, as well as local nursing practice, it creates sets of competencies for three different ‘levels’ of nurse – from the freshest nursing school graduate, to a cross-discipline professional, who is prepared to leave their home institution and even country to respond to disaster.

The essential feature of competencies, Gebbie emphasised, is that they are visible. They're “something we can see a nurse do, and can measure against a standard”. They also require clearly defined knowledge, skills and attitudes. In the case of an Ebola outbreak, for instance, this could be encompass knowledge of a germ theory, training in proper use of gloves and masks, instilling behaviours which limit the spread of disease, and an understanding of the cultural sensitives that may come to bear in infection control. 

Another common competency put forward by Gebbie is fluency in disaster terminology. If attained, when crisis strikes, a nurse has the ability to effectively communicate to all responders, improving the flow and accuracy of information. She is aware, for instance, that she mustn’t request the assistance of her supervisor by her first name (“Get me Juanita!”) but by her position title (“Get me the Logistics Supervisor!”). 

Discipline under pressure, in other words, is a must.

Common competencies benefit systems, professions and individuals, Gebbie said. On a systems level, action is better coordinated between people, reducing obstacles and promoting efficiency. Within a profession, these competencies create a standard against which performance can be measured. They also help nurses to individually self-assess and work against a defined framework to advance and develop. 

At the most fundamental individual level, of course, they can also save lives.

ICN is urging for the framework to be adopted by all nursing organisations and education programs nationally, as well as all institutions that employ nurses, and all organisations who participate in emergency/disaster responses. Ideally, the framework would be able to be updated in the same many as a mobile app would be, so that new versions could be rolled out immediately and simultaneously.

ICN’s Building Core Competencies in Disaster Nursing, Version 2.0 will be made available on the ICN website soon. Professor Kristine Gebbie’s talk can be streamed in full here.

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