Comptencies, Scope of Practice in Disasters Essay Example

emphasizes the role of nurses in developing programs for disaster preparedness and responding to actual disasters.

Birnbaum (2002) states that previously, there were no established core competencies for nurses in disaster zones. However, as the number of disasters increase, it is expected that the situation will worsen in the future. Therefore, it is now more important than ever to develop and implement competencies that nurses must follow in such situations.

There are various factors contributing to the rise in disasters including climate change, construction in disaster-prone areas, unplanned urban growth, loss of natural barriers, lack of warning systems, and inadequate systems for relocating populations to safety.

In 2005, the Hyogo Framework for Action was adopted by 168 countries with the goal of reducing disasters over a decade. This framework aims not only to save lives but also minimize economic, social, and environmental losses experienced by communities.

The World Health Organization (WHO) recognizes nurses and midwives as essential responders during disasters but acknowledges a significant flaw in global disaster and emergency response due to insufficient training provided for handling such situations.

It is crucial that all nurses and midwives receive training in disaster nursing and acquire the necessary competencies. This training is equally important because it enables them to effectively respond during a disaster. According to Geebie and Qureshi (2002), disaster nursing requires utilizing nursing knowledge and skills in challenging circumstances with limited resources and constantly changing conditions. Nurses must be able to adapt their practice to address the specific requirements of a disaster, thus minimizing life-threatening damage and health risks resulting from such an event.

Jennings-Sanders, Frisch, & Wing (2005) emphasize the significance of collaboration among nurses, healthcare professionals, emergency services,

non-governmental organizations, and governmental organizations during a disaster. Working together plays a vital role in achieving the best possible outcome in these situations.

In a disaster situation, nurses must have the ability to shift their attention from caring for one patient to caring for multiple patients. This change in focus occurs as the response to the disaster transitions from immediate life-saving measures to addressing public health and preventing further hazards. It is important for nurses to understand that regardless of where the disaster takes place, they must follow relevant laws and regulations. According to Seda (2002), nursing competence is demonstrated by applying knowledge, skills, and judgment at an above-average level. This definition can serve as the basis for both general nursing competencies and competencies specific to disaster nursing established by the ICN.

In his work, Wynd (2006) emphasizes the significance of establishing a standardized set of competencies for nurses to effectively respond to complex disasters worldwide. These competencies are crucial in enabling nurses to collaborate with other healthcare professionals globally. The competencies include ensuring consistent care delivery, instilling confidence in nursing staff, promoting shared goals and objectives, supporting successful collaboration within multidisciplinary teams, aiding navigation of organizational structures, fostering a unified approach, promoting professionalism, facilitating communication, and enabling global deployment of nurses during disasters.

According to Hyrd (1995), competencies play a vital role in supporting learning and assessing nurses. They serve as a guide for curriculum development, ongoing education, training programs, and creating position descriptions in disaster settings. However, their greatest impact lies in empowering individual nurse practitioners to assess their own knowledge, skills, and abilities. These competencies allow individuals to make informed decisions about work assignments and

the need for further education or training.

Expanded Scope of Practice

Nurses have an expanded scope of practice in disaster management, as stated by Davies and Moran (2005). Their roles go beyond saving lives and preserving health during the response phase. They are involved in all stages of the process, from preparedness to long-term recovery. Birnbaum (2002) highlights the crucial role that nurses play in crisis situations and disasters. Throughout history, nurses have consistently been at the forefront, providing their assistance when disasters occur.

The presence of nursing staff is crucial during crisis situations due to their caregiving skills, leadership abilities, adaptability, and other diverse skills that can be utilized in various crises. Davies and Moran (2005) emphasize the importance of including a knowledgeable healthcare workforce in disaster response teams, enabling quick response and the ability to work across all stages of a disaster. Recent incidents have highlighted a lack of understanding in disaster response and management, leading to delays in humanitarian efforts. In Australia, CRANA (2012) explains the scope of practice for nurses in rural/remote or disaster-affected areas as encompassing a wide range of responsibilities, accountabilities, purposes, accomplishments, and decision-making capacity. This scope is based on the knowledge, experience, and authorization held by nurses as professionals. The scope of practice for Australian nurses is regulated and follows professional standards such as competency standards, codes of ethics, conduct, and practice. Multiple factors can influence a nurse's scope of practice, including the practice's context, patients' health requirements, the nurse's level of competence and experience, organizational policies, quality and risk management practices, as well as education and qualifications.

Jennings-Saunders (2004) states that many countries, including Australia, previously had

a lenient approach to educating nurses in disaster nursing. This resulted in undergraduates receiving limited or no education on the subject and postgraduate courses being optional for interested individuals. Interestingly, Weiner, Irwin, Trangenstein & Gordon (2005) demonstrate how the United States once included disaster nursing in its nursing curriculum until the early 1970s. Although it only covered the basics, it was later removed and reintroduced in the late 1990s due to population growth and increasing impact of natural and man-made disasters. Mosca, Sweeney and Brenner (2005), taking a global perspective, describe how education in disaster nursing has followed a similar pattern as that of the United States. The lack of competencies and resources is attributed to growing demands on nurses' curriculum worldwide. Consequently, there is a significant lack of preparedness and minimal or no competency in disaster nursing among nurses globally.

Ethical Practice

In terms of ethical practice, nurses are expected to adhere to a code of ethics that emphasizes the importance of respecting human rights, valuing cultural beliefs and practices, maintaining dignity, ensuring fairness, and promoting justice (Deeny, Davies, Gillespie & Spencer, 2007). When working in disaster situations with limited resources, nurses often face difficult ethical dilemmas. According to Smith (2007), nurses frequently have to make decisions that benefit the overall community rather than individual patients. This can be challenging because nurses are trained to prioritize each patient's best interests instead of solely focusing on providing optimal health services at a broader community level.

According to Chapman and Arbon (2008), nurses who work in international crisis situations must respect the culture and values of the community they are serving. They

need to prioritize showing respect, dignity, and adherence to cultural norms, rather than getting too absorbed in the mechanics of disaster response. Qureshi et. al. have identified various factors that nurses must handle in such situations.

To practice ethically in the face of adversity, nurses in 2005 must work together with others to recognize and tackle ethical challenges. They should also safeguard the rights, values, and dignity of individuals and communities while ensuring that their actions align with cultural, social, and spiritual beliefs. Additionally, maintaining confidentiality in communication and documentation is crucial for nurses during a disaster. Lastly, nurses must be aware of their own personal beliefs and how these can impact their response during a crisis.

The final aspect of ethical practice in disaster nursing involves understanding how security issues and ethics can conflict. Chapman and Arbon (2007) demonstrate that ethical practice in disaster nursing can extend into the legal issues faced by nurses working in disaster zones. It is crucial to ensure that you comply with all applicable laws at the regional, state, national, and international levels. Another legal concern for nurses working in disaster areas is comprehending how laws and regulations specific to disasters can affect nursing practices and the survivors. Smith (2007) highlights that recognizing the legal role of public health in safeguarding the community is another legal challenge for nurses practicing in disaster areas.

It is crucial for nurses to have an understanding of the legal implications related to disasters and emergencies. Additionally, nurses practicing in disaster areas need to be able to explain the legal and regulatory issues they encounter, including working as a volunteer, the responsibilities of volunteers, patient abandonment, adapting

care standards, employer roles and responsibilities, and delegation. Perry (2007) points out that accountability is another important aspect of disaster nursing that differs from ethical concerns. When nursing in disaster areas, it is necessary to accept accountability and responsibility for one's own actions, while also being able to delegate tasks and comply with applicable laws and regulations. It is also important to recognize personal limits in terms of knowledge, skills, and abilities, and ensure that nursing practice aligns with them. Those nursing in disaster areas also have a responsibility to adhere to the laws and regulations governing nursing practice.

Nurses may consider advocating for safe and appropriate care for patients to be the most important form of accountability.

Ability to Respond

According to WHO (1999), the disaster management continuum is an ongoing process aimed at minimizing harm from disasters and promoting community resilience. The phases of a disaster are not necessarily sequential, but can occur simultaneously, with varying lengths. Cutter, Barnes, Berry, Burton ; Evans (2008) explain that the first phase of the disaster management continuum is prevention/mitigation, which involves identifying and minimizing risks associated with disasters. Taking appropriate action to address these risks will eliminate or reduce the effects of disasters.

Prevention and mitigation encompass a variety of activities that aim to decrease the loss of life and property. These activities also involve developing and implementing action plans based on lessons learned from past disasters and training exercises. Perry (2007) emphasizes the global importance of disaster nursing in terms of preparedness and mitigation efforts, which ultimately save lives by reducing the risk and impact of disasters on populations. Nurses can play a vital role in disaster

planning at different levels, such as regional, state, national, and international. They contribute their knowledge regarding community resources, vulnerable populations, workforce issues, supply needs, as well as nursing roles and practices. According to Warfield (2007), preparedness is crucially important as it is the second phase of the disaster management continuum. However, recent disasters have exposed inadequate preparations which resulted in chaotic situations for responders. This lack of preparation has increased suffering among survivors while causing loss of life and property.

The main objective of this phase is to ensure preparedness for any emergency situation. According to Cutter, Barnes, Berry, Burton ; Evans (2008), the immediate action taken in the face of a disaster is known as the response phase. This involves mobilizing responders to the affected area with the primary goal being to save lives and minimize long-term health impacts caused by the disaster. The duration of this phase varies depending on the magnitude of the disaster, ranging from a few days to several weeks.

Warfield (2007) explains that nurses have a crucial role during disaster response. They provide care in various areas including triage, emergency care, trauma, acute care, infection control, palliative care, and public health. While these areas are usually provided in hospital settings, nurses may be required to care for patients in different settings such as emergency aid stations, shelters, homes, mortuaries, field hospitals and makeshift clinics when a disaster occurs. In addition to providing direct patient care responsibilities include making decisions about delegating patient care to volunteers and other healthcare professionals as well as assuming leadership roles in managing and coordinating healthcare and caregivers.

Perry (2007) states that the final phase of a

disaster is the recovery and rehabilitation phase. This phase begins once the immediate needs of the affected area are met. During this phase, the focus is on assisting the affected community and its population in their recovery from the disaster. The restoration of services and infrastructure, as well as reestablishment of housing, are included in this phase. It is a lengthy process that requires short and long term rehabilitation, reconstruction, and sustainable development goals.

Conclusion

This assignment has highlighted the critical need for core competencies in disaster nursing. It has discussed four key concepts that emphasize this need: competencies, expanded scope of practice, ethical practice, and the ability to respond to a disaster.

Nursing competencies are crucial in general nursing and especially important in the context of disaster nursing. Although there is a lack of global competency standards for disaster nursing, it is still necessary to promote ongoing development and improvement in order to empower individual practitioners to make appropriate nursing practice decisions. When it comes to the expanded scope of practice for nurses in disaster-affected areas, it is important to determine each individual's knowledge, skills, and experience. In Australia, where we are located far away from the rest of the world, continued education in disaster nursing is paramount. It is essential to rely on our well-educated and prepared staff to handle future disasters and emergencies in Australia. The code of ethics followed by nurses worldwide ensures the provision of patients' human rights and respect for different customs, dignity, fairness, and justice. This essay also addresses legal issues and accountability to demonstrate their connection with the ethical challenges faced by nurses working in these

devastated regions.

Finally, the focus is on the ability to respond to a disaster or emergency using the disaster management continuum. This continuum considers the phases of prevention, mitigation, preparedness, response, and recovery, and explores ways to improve each phase on a regional, state-wide, national, and international level.

References

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