The Role of the Community Health Nurse in Disaster Preparedness
The past two decades have shown a dramatic increase in the frequency and intensity of infectious diseases and disasters that are weather‐related, caused by technological or human factors. The United States has approximately three million registered nurses making the profession the largest in America’s healthcare workforce. Aknowledging the ability of the healthcare system to respond sufficiently to cases of disaster or any public health emergency depends mostly on the capacity of its nursing workforce. Nurses are trained and prepared to handle extreme and demanding cases in the event of a disastrous public health emergency. The services of nurses are vital since they work under diverse setting and with a broad range of healthcare professionals on a daily basis. Community nurses are well placed to collaborate with families, individuals, and health system leaders such that they can improve health outcomes of the population and develop society’s ability to recover quickly from disasters nationwide. Public trust in the nursing profession for health information giving nurses far‐reaching influence.
Despite the American government dedicating millions of dollars to train and mobilize its nursing labor force to prepare for hospital emergencies and public health disasters like the September 11, attacks, such efforts have at most been done in phases and challenging to sustain. Studies have assessed the professional preparedness of nurses in case of a national emergency indicate in its current state; the nursing workforce is ill-prepared to handle the complexities that come with disastrous events. Furthermore, although various disaster readiness programs have been advanced by different professional institutions, schools, and government agencies, implementation is lacking since there are no formal systems in place to ensure that nurses get pre‐ and post-licensure training in disaster preparedness and emergency response. Community nurses are vital players in disaster preparedness, response, and recovery. The community health nurse is the linchpin in grassroots education and preparedness, and by enhancing awareness of community nurses regarding their roles in disaster management, the nation’s ability to handle disasters will become more challenging.
Aim
The focus of this paper is to identify the knowledge gap in disaster preparedness and management to formulate a strategy to create public awareness as well as inform community health nurse and other health care professionals on emergency and disaster readiness. Studies already show that a knowledge deficit exists in the United States, and available trained nurses lack confidence in roles and responsibilities. Therefore, the paper intends to raise public health nurses’ awareness regarding perceived actual and potential roles in disaster preparation and response, given their unique skills and central position in the public health setting. Although various organizations have response teams from global, National, and Local, there is a disconnect with individual roles within these frameworks.
Method
To achieve the objective the paper, a literature search was undertaken within the databases of Google Scholar, PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Factiva, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Informit. Keywords used to inform the research aims during the study include terms like a disaster, public emergency, community health nurse, Emergency Support Functions (ESFs), public health awareness, and disaster planning, Date limits were set to include articles written within the last ten years showing relevant researches relating to disasters within that period. Also, during literature search, articles that spontaneously popped up in the search engines database and had content relevant to the research aims were also examined. Inclusion criteria included peer-reviewed electronic journals, primary research, article reviews, and professional organizational papers published in national and international journals. Exclusion criteria included opinion articles, unpublished texts, and conference abstracts.
Results
A disaster is an unexpected human-made or natural occurrence that has catastrophic consequences such as property damage and loss of lives. In nursing, disaster is defined “as a situation whereby the need exceeds resources.” (Leblanc, Kosmos, Avchen, 2017. p 13). In other words, a situation where the need for response exceeds the available resources to meet that need. There are two types of disasters, natural and human-made. Natural refers phenomena of world little can be done to prevent occurances. Human-made disasters are caused by human errors. Nevertheless, both events have catastrophic results, made worse by a slow response to events. Geographical features, size and diversity of the United States expose the country to a variety of disastrous natural and manmade events that occur frequently.
Natural disasters in America
The difference between a natural disaster and other extreme natural occurrences is that natural disasters are characterized by a great deal of loss of life and property damage. The most traumatic disaster in American history occurred August 29, 2005. Hurricane Katrina shocked the United States and the entire world. Not only was the damage extensive but response was slowed due to regulations.
Damage of properties and materials can cripple cities completely both in material and loss of life. Although deaths from natural disasters are often mundane, they are equally lethal. Cold fronts or heat waves can exacerbate illness in vulnerable populations. Prolonged exposure causes deadly effects, especially for people from lower socio-economic backgrounds since most of them, cannot afford climate conditioning.
Figure 1: The ten natural disasters that caused the most damage in the United States’ economic from 1900 to 2016 (in billion U.S. dollars)
Other disasters are categorized due to the number of people they’ve affected, although, less deadly. Events such as Midwest Flooding in June 2008, affected over eleven million people. The number is the highest ever-recorded casualty rate from a natural disaster in the United States. While the scenes of death and injury attract extensive media attention, cases considered less lethal also require prompt intervention and government support.
Humanmade disasters in the United States
Mississippi River Bridge
On August 1, 2007, the eight-lane bridge in Mississippi River collapsed. The bridge, on Interstate 35 and the busiest in Mississippi, collapsed during rush-hour traffic. At the time, more than one hundred vehicles were involved, including a bus carrying 64 schoolchildren on a field trip. There were 13 confirmed deaths and 150 casualties. Investigators revealed that the collapse was caused by a flaw in the bridge design, that been operating for four decades. The aftermath led to an increase in policy on road safety to avoid a similar disaster from occuring again.
Texas City Disaster
Another human-made disaster occurred on April 16, 1947, when an SS Grandcamp laden with ammonium nitrate exploded at a marina in Texas City. The severity of the explosion destroyed the fire department, while the fire department was trying to put out a fire in the ship’s cargo. The first explosion killed hundreds of civilians who’d gathered at the dock to watch the event. The fire later spread to a nearby chemical plant, setting a major oil pipeline ablaze. The resulting fire spread quickly throughout the city now rendered defenseless. A second explosion occurred later, decimating the town, leading to more than 500 confirmed deaths. Additionally, thousands of civilians were injured, and hundreds of properties destroyed. The event prompted Congress to take legislative actions that would better prepare the country for such a disaster, leading to enactment of stringent controls regarding hazardous chemical transportation.
Emergency Support Functions (ESFs)
The ESF function is to provide a framework for coordinating the government’s interagency activities whenever there is a disaster. Outlining mechanisms used during grouping of functions most frequently provided during such events. ESFs also provide Federal support between countries for both declared emergencies and disasters. The first ESF is to enable transportation by helping local, nongovernmental organizations, state, voluntary organizations, and private sectors to manage infrastructure and transportation systems in the event of domestic threats to actual incidents (Couig, Martinelli, and Lavin 2005, p. 34)
Another function is to offer support for the restoration of communications infrastructure to enable effective coordination of communications during response efforts. Through the facilitation of communication efforts, ESF disseminates information during decision making, enabling the reestablishment and stabilization of applications and systems during incidents.
The third ESF in a national framework is the coordination and organization of public works and engineering. ESF ensures federal resources are appropriately used to enhance delivery of various core capabilities. Lastly, ESF through firefighting provides support to federal units to enable the detection and suppression of natural or human-made incidences.
Community Nurses and response to Disasters
Community health nurses
Community health nursing can be described as the utilization of practice and knowledge from social, nursing, and public health sciences to advance and protect the population’s health. Advancements in the political and societal landscape in this century has revolutionized disaster management and preparedness through enhanced evolution of threat identification and effective response. Major disastrous threats include environmental hazards, reemergence of communicable disease, civic and physical limitations to healthy living and even contemporary public health epidemics including obesity, influenza, etc. Lastly, there are global and emerging crises that are increasingly exposing populations to numerous health threats.
Community health nurses and management of Disasters
Community health nurses are critical to implementing response plans for disasters. They form the most significant portion of the American public health labor force. Furthermore, community nurses are the most trusted professionals in the United States. Their unique skill set enables them to coordinate response activities. To make the most contribution, nurses must be conversant with every phase of the disaster cycle and integrate well. Also, services offered should conform to the scope of practice (Jakeway, LaRosa, Cary, and Schoenfisch 2008, p. 353). Community health nurses’ clinical awareness of disease pathophysiology and epidemiology together with assessment skills serves as vital elements during the preparation for or response to emergencies.
The American Association of Colleges of Nursing (AACN) requires nurses to have a disaster education, which entails communication of risks, preparedness for an emergency and appropriate response to disasters including self‐protection. However, the available resources and guidance needed for implementation are inadequate. In this case, numerous educational programs that are not empirically based are available (Seyedin, Dolatabadi, and Rajabifard 2015, p. 126). The available training programs are shallowly developed as a reaction to specific disasters such as the use of personal protective equipment by healthcare professionals in the United States during the Ebola disease scare.
Prevention measures
Before considering anything else, policies should be prepared that ensure that disasters are prevented rather than responded to. In this case, a country would be able to minimize vulnerability to the impact of a disaster. Enter, the nurse role. For example, nurses are better placed to assess the awareness of a group of elderly citizens regarding the prevention of heat stroke. Subsequently, the community nurse can take the opportunity to devise a community education plan that would raise awareness regarding the protection from heat stroke. Being the most trusted professionals, community nurses can effectively conduct activities of community education activities to increase awareness about preventing heat stroke (Kapucu 2008, p. 239).
Preparedness
During preparation for public health emergencies and disasters, the plan is to ensure that a country is well capacitated to respond effectively in case of disasters or emergencies. The first step is to assess the populations at risk to identify its unique needs in case of a disaster. Then a plan is developed, which is to handle the special needs identified. Lastly, training is conducted to take care of persons with special needs (Seyedin, Dolatabadi, and Rajabifard 2015, p. 124).
Response
During response, support is needed for the communities affected by emergencies and disasters. Nurses can serve at any capacity on a response team to ensure that survivors of public disasters are adequately treated to impact specific health needs of hurricane survivors. In this phase, employees are rotated to prevent burnout and stress among nurses and respondents. Deploy staff to shelters after a hurricane, by local and state emergency response plans. Participate in after action reviews and debriefings to evaluate the quality of health services provided and lessons learned (LeBlanc, Kosmos, and Avchen, 2017, p. 143)
Recovery
Flexibility is required to return to conventional operations. This can be achieved community assessment and psychological support. The community health nurse acts as a society and client advocate during the restoration of the functional level of the systems. Nurses will serve in groups to investigate the assets and community that have the potential of the disaster. Recovery requires the partnership of all stakeholders and community leaders to develop a long-term plan that outlines priorities after a disaster (LeBlanc, Kosmos, and Avchen 2018, p. 134).
Role of the Community Health Nurse
Preparation, response, and recovery from disasters should be prioritized as a public health issue and addressed, mindful of economic as and environment of constraints of the nation. The significance of the role played by nurses was best displayed by Florence Nightingale, who highlighted the importance of nurses during a war-related disaster. In the 21st Century, the roles and capabilities of nurses continue to expand and increase. Community health nurses have the opportunity to significantly enhance their capacity across the cycle of disaster in the society if resources are dedicated appropriately. Since 2000, professional nursing has undergone a series of robust growth concerning the assurance of resilience to the society whether at a local, state, or regional level. Community health nurses are needed to provide expert services and engage various internal and external partners and the communities as well (Murthy, Molinari, LeBlanc, Vagi, and Avchen 2017, p. 180).
No particular agency, discipline, jurisdiction, or organization can confidently claim sole responsibility for all the activities during disaster preparedness and management, as there are complicated aspects associated with the disaster. These challenges could be caused by humans, nature, or combinations of both. Community health nurses have a critical role to play by adhering to the objectives of Emergency Support Functions of the National Response Framework (Couig, Martinelli and Lavin,2005,P 38). This will ensure that a nation is secure and resilient as well as have the capabilities necessary across the society to identify, mitigate, or appropriately respond to and recover from dangerous threats posed by the most significant risk. Community health nursing practice should be constant across the state ESFs planning framework and the cycle of disaster preparedness, response, and recovery. Recognizing the importance of community-nursing population’s skills during times of public emergency and disaster is a crucial part of a nation’s capacity to adequately and timely response (Rokkas, Cornell, and Steenkamp 2014, p. 60).
Community health nurses are not considered as acute care replacements or triage personnel in the event of a disaster where the casualty rate is very high. However, this does not mean that Community nurses cannot perform such functions if well trained. Indeed, in extreme cases, health care professionals are usually called upon to perform various non-routine duties and areas. During the preparation and management of disasters, community nurses are better placed to perform services of their specialty such as performing population-based rapid needs assessments as impacted by the incident (Nash 2015, p. 425).
The knowledge and skills that community nurses possess allow them to develop comprehensive plans and policies on disasters in addition to developing and evaluating response drills, training, exercises, and preparedness. The highest contribution of the community nurses is perhaps through leadership and managerial roles during the response operations and at the command centers whereby they provide core frontline public health services. The community health nurse works across the various health departments, therefore, are well versed with how to collaborate with other specialists including epidemiologists, social workers, biostatisticians, laboratorians, physicians, environmentalists, and even fellow nurses. Despite their unique placement to handle emergencies and disasters, they still require inter-professional practice to enhance their preparedness, response, and recovery. To achieve this, strong models and systems are required that will maximize the collaboration of volunteers, health care professionals, and first responders during an emergency (Jakeway, LaRosa, Cary, and Schoenfisch 2008, p. 353).
Conclusion
Community nurses are vital players in disaster preparedness, response, and recovery. By enhancing the awareness of the community nurses regarding their roles in disaster management, the nation’s ability to handle disasters more conveniently will be enhanced. Although the ESF framework necessitates effective response activities, the larger bulk rests with the community nurse. The main reason why nurses play a determining role in disaster management is the unique roles that enable them to cut across various professional(Marcinkutė,2011,P 70). Therefore, they provide leadership and managerial skills necessary. However, to improve the roles of the community nurse in disaster preparedness, they should be educated about their role in such incidences. Many nurses are not certain of their roles in disaster preparedness hence lack the confidence to execute the responsibilities.