Journal of Nursing Education

Research Briefs 

Development of a Disaster Nursing Competencies Assessment Instrument for Baccalaureate Nursing Education

Mark Siemon, PhD, RN, PHNA-BC, CPH; Jennifer Hackwith, DNP, APRN, FNP-BC; Kim Monson, MSHEP, RN, CHES

Abstract

Background:

Nursing education must prepare graduates for disasters. The purpose of this study was to develop a list of critical disaster nursing competencies to be assessed as part of baccalaureate nursing education.

Method:

The International Council of Nurses (ICN) and World Health Organization (WHO) Framework of Disaster Nursing Competencies was used to develop an online survey. RNs with experience in disaster nursing and disaster education were asked to divide the disaster competencies into two categories—baccalaureate/entry-level or master's/doctorate-advanced practice level. The results were analyzed using one-sample binomial test.

Results:

Sixty-five RNs completed the online survey. Fifteen (12%) of the ICN and WHO disaster competencies were categorized as more appropriate for master's/doctorate nursing education.

Conclusion:

This project has developed a list of disaster nursing competencies for use by baccalaureate nursing programs, as well as a list of competencies specific for community and public health nurse educators. [J Nurs Educ. 2019;58(4):229–233.]

Abstract

Background:

Nursing education must prepare graduates for disasters. The purpose of this study was to develop a list of critical disaster nursing competencies to be assessed as part of baccalaureate nursing education.

Method:

The International Council of Nurses (ICN) and World Health Organization (WHO) Framework of Disaster Nursing Competencies was used to develop an online survey. RNs with experience in disaster nursing and disaster education were asked to divide the disaster competencies into two categories—baccalaureate/entry-level or master's/doctorate-advanced practice level. The results were analyzed using one-sample binomial test.

Results:

Sixty-five RNs completed the online survey. Fifteen (12%) of the ICN and WHO disaster competencies were categorized as more appropriate for master's/doctorate nursing education.

Conclusion:

This project has developed a list of disaster nursing competencies for use by baccalaureate nursing programs, as well as a list of competencies specific for community and public health nurse educators. [J Nurs Educ. 2019;58(4):229–233.]

Graduates of baccalaureate nursing programs are expected to have attained competence in a wide variety of nursing skills, including disaster preparedness. The American Association of Colleges of Nursing (2008), the Association of Community Health Nursing Educators (2008), and others have highlighted the need for RNs to be trained in all aspects of the disaster cycle (Farra, Smith, & Bashaw, 2016; Gebbie, Hutton, & Plummer, 2012; Halstead, 2013; International Council of Nurses [ICN] & World Health Organization [WHO], 2009; Petrini, 2014; Smith & Farra, 2016; Veneema, Losinski, Newton, & Seal, 2017). Smith and Farra (2016) wrote:

Disasters are complex events with inherent risks of mortality and morbidity and thus demand specific knowledge and skills. These events require highly trained personnel.

In addition to disaster competencies developed for all health professionals in disaster medicine and public health (Walsh et al., 2012), competencies related to nursing have been developed for specific disaster events, such as mass casualty events (Gebbie et al., 2012), for emergency nurses (Schultz, Koenig, White-side, Murray, & National Standardized All-Hazard Disaster Core Competencies Task Force, 2012), and for generalist nurses by the ICN and WHO (2009).

The number of competencies developed by these different groups leave baccalaureate nursing educators with a dilemma in regards to which competencies are best suited for evaluating nursing students' abilities in all aspects of the disaster cycle (Langan, Lavin, Wolgast, & Veenema, 2017). Jose and Dufrene (2014) found “no uniformity and wide variation in educational competencies” (p. 544) in their review of articles published on undergraduate disaster nursing competencies. The ICN and WHO (2009) developed the Framework of Disaster Nursing Competencies, which lists 130 disaster nursing competencies divided into 10 domains, for generalist nurses. The ICN and WHO recommended that disaster nursing education be included as part of all nursing education programs. They also recommended that disaster nursing competencies should be evaluated to ensure that generalist nurses have the knowledge and skills needed to be members of interdisciplinary disaster teams and programs (ICN & WHO, 2009).

Although nurse educators have worked to improve disaster competence and skill of prelicensure baccalaureate nursing students, gaps likely remain in new graduate nurses' ability to actively participate in all phases of the disaster cycle (Labrague et al., 2018). Prior research has found evidence of a practice gap in clinical settings (Berkow, Virkstis, Stewart, & Conway, 2009) and a lack of disaster preparedness content in undergraduate nursing curricula (Chilton & Alfred, 2017; Jose & Dufrene, 2014). The failure to implement evidence-based disaster nursing curricula in baccalaureate nursing programs can have a direct impact on the ability of nurses to participate in all phases of the disaster cycle—mitigation, planning, response, and recovery (Labrague et al., 2018; Langan et al., 2017). Nurse educators play a critical role in ensuring that the graduates are ready to assume their professional roles in the disaster cycle (Gebbie et al., 2012) and in helping the nation meet the ongoing need for trained personnel to assist with public health emergencies (Labrague et al., 2018; Langan et al., 2017; Murthy, Molinari, LeBlanc, Vagi, & Avchen, 2017).

A review of the ICN and WHO (2009) framework by members of ICN and the World Association for Disaster and Emergency Medicine (Hutton, Veenema, & Gebbie, 2016) found additional research was needed into how the ICN and WHO competencies can be used to ensure quality and improve care by nurses during disasters. Their survey results also indicated the need to clarify the level of nursing education and experience that is required to meet each of the ICN and WHO disaster nursing competencies. According to the ICN and WHO (2009), “All nurses are expected to be able to demonstrate these competencies” (p. 48). However, a survey of members of ICN and the World Association for Disaster and Emergency Medicine by Hutton et al. (2016) found that 30% of the respondents believed the ICN and WHO competencies were for nurses with advanced degrees or experience. The purpose of this study was to develop a more specific list of disaster nursing competencies that are appropriate for baccalaureate nursing education based on the ICN and WHO (2009) framework.

Method

An online survey based on the ICN and WHO (2009) framework was developed to help determine which competencies were appropriate for nurses with different levels of education or experience. Survey participants were asked to place each of the ICN and WHO disaster competencies into one of three tiers based on education or work experience: Tier 1—New graduate baccalaureate nurses or entry-level RNs, Tier 2—Master's-prepared nurses or supervisory/management level, or Tier 3—Doctorate in nursing or executive/senior management level. Survey participants were advised that students or RNs should be “knowledgeable” (i.e., comfortable with my knowledge or ability to apply the skill) or “proficient” (i.e., very comfortable, an expert, or could teach this skill to others) with the competency at the completion of their degree or based on work experience.

The survey was approved by the university institutional review board, and permission to use the ICN and WHO (2009) Framework of Disaster Nursing Competencies in the study was provided to the authors by the ICN (V. Bobot, personal communication, August 27, 2017). Requests to participate in the study were posted to online discussion boards, and a convenience sample of nurses with experience in disaster health or disaster nursing education was solicited from nursing organizations in the United States, including the American Public Health Association Public Health Nursing Section, the American Red Cross Disaster Health Services nurses, the Association of Community Health Nurse Educators, the Association of Public Health Nurses, and the Society for the Advancement of Disaster Nursing.

Data from the online survey were downloaded to a secure computer and initially reviewed and formatted using Microsoft Excel®. Survey responses that were incomplete (i.e., no survey questions answered) or from participants whose self-reported knowledge and experience of disaster nursing competencies were at “far below average” were excluded from the final analysis. The data were then dichotomized into Tier 1 baccalaureate or Tier 2/3 Master's/Doctorate-level competencies, and analyzed using nonparametric one-sample binomial proportion test with STATA® 12.1 statistical software to determine whether the proportion of survey responses for each competency was significantly less than the hypothesized percentage of 50% (Pett, 2016; University of California Los Angeles Institute for Digital Research and Education, 2017).

Results

Seventy individuals logged onto the survey site between January 9 and February 19, 2018. The authors deleted five of the survey responses during the initial review due to incomplete surveys (n = 4) or having “far below average” self-reported knowledge or experience in disaster health nursing (n = 1). For the remaining 65 survey responses, there were two or fewer missing values for each question, and missing values were excluded in the statistical analysis.

The majority of survey participants, 88%, were female with 10 or more years of nursing experience. Eighty-five percent of the survey participants reported having an advanced degree, and 68% reported working in an academic setting. Eighty percent or more of survey respondents reported above average “Knowledge of disaster nursing competencies,” “Experience with disaster nursing competencies,” “Knowledge of disaster nursing education,” and “Experience with disaster nursing education.”

One sample binomial tests of significance of the survey results found 15 disaster competencies that were rated as more appropriate for master's-and doctorate-level nurses and students (Table 1). The majority of these disaster nursing competencies involved evaluation, data analysis, or collaboration with other organizations and communities.

International Council of Nurses and World Health Organization (2009) Disaster Nursing Competencies—Master's/Doctorate-Level Competencies—Not Appropriate for Baccalaureate Nursing Students or New Graduates

Table 1:

International Council of Nurses and World Health Organization (2009) Disaster Nursing Competencies—Master's/Doctorate-Level Competencies—Not Appropriate for Baccalaureate Nursing Students or New Graduates

After reviewing the remaining 115 Tier 1 baccalaureate disaster nursing competencies, the authors worked to develop a list of disaster competencies they felt should be part of baccalaureate community or public health nursing (C/PHN) student assessments. The selection of the disaster nursing competencies for C/PHN courses was based on the need to have a more specific list of competencies that could be assessed as part of C/PHN courses. The authors categorized each of the 115 Tier 1 baccalaureate-level competencies as “critical” or “optional,” with the recognition that some of the disaster competencies would be assessed in other nursing courses. Only those disaster competencies that achieved >75% agreement by the authors and a consultant, Cathy Deckys, MSN, RN, COHN-S, NHDP-BC, were included in the final list of 65 disaster competencies for use in baccalaureate C/PHN undergraduate nursing courses.

Discussion

The list of baccalaureate disaster nursing competencies, based on the survey of nurses with experience disaster nursing or disaster nursing education, included 115 (88%) of the original disaster nursing competencies from the ICN and WHO (2009) Framework. These baccalaureate level disaster competencies can be used in a formative assessment of the knowledge and skills of nursing students during their nursing education and as a summative assessment of the effectiveness of disaster nursing education before graduation (Carnegie Mellon University, 2016; Langan et al., 2017). For example, a formative assessment of nursing students' knowledge of baccalaureate disaster nursing competencies (e.g., very knowledgeable, some knowledge, no knowledge) could be administered when students begin their baccalaureate nursing program and a summative assessment could be administered when students complete the program.

The authors worked to develop a shortened list of disaster nursing competencies for use specifically in C/PHN courses (Table A; available in the online version of this article). This list of 65 “critical” baccalaureate disaster nursing competencies was developed to ensure that competencies specific to C/PHN were assessed and to help nurse educators address gaps in students' knowledge and skills related to disaster health nursing. Baccalaureate nursing programs are designed to provide students with the education necessary to practice in a variety of different areas of nursing, but it is difficult for baccalaureate nursing programs to provide adequate time for all content. The authors thought that some of the ICN and WHO (2009) disaster nursing competencies identified as appropriate for baccalaureate nursing students were related to content that is taught in other undergraduate nursing courses. For example, the ICN and WHO competency “Utilizes a variety of communication tools to reduce language barriers” (p. 54) is likely to be taught in other nursing courses. In contrast, the ICN and WHO competency “Understands how laws and regulations specific to disaster impact on nursing practices and disaster survivors” (p. 52) is not likely to be covered in most undergraduate nursing courses and should be included in C/PHN course content.

Baccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) CoursesBaccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) CoursesBaccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) CoursesBaccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) CoursesBaccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) CoursesBaccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) Courses

Table A:

Baccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) Courses

Future research, including an assessment of the reliability and validity of the survey, needs to be completed. The authors will provide the list of baccalaureate disaster nursing competencies and the shortened list of baccalaureate disaster nursing competencies to nurse researchers and educators who are interested in a further assessment of the survey instrument. The Baccalaureate Disaster Nursing Competencies Assessment Instrument for C/PHN courses based on this research is available by request to pophealthid@gmail.com.

This article describes the development of a baccalaureate nursing disaster competency assessment instrument; the instrument has not been tested for reliability or validity at this time. Limitations of this study include an online convenience sample of RNs who self-reported their experience with disaster health or disaster health education. Although 69% of participants in the study sample worked in academic settings, over 50% reported eight or more years of disaster nursing experience. It is unclear whether their disaster nursing experience is directly related to disaster health nursing or disaster nursing education. Thirty-seven percent of respondents reported “Experience with disaster nursing competencies” as “far above average,” which the authors have assumed is direct experience with disaster health. The development of the final list of disaster nursing competencies for baccalaureate C/PHN courses was completed by the authors and a consultant, Cathy Deckys, MSN, RN, COHN-S, NHDP-BC. All of the authors and the consultant work in Idaho universities or public health settings; therefore, the final list of C/PHN disaster nurse competencies may need to be revised based on differences in resources and other factors specific to each state or baccalaureate nursing program.

Conclusion

Nurses are vital to the mitigation, planning, response, and recovery from disasters, and adequate preparation in baccalaureate programs is necessary to give new graduate nurses the ability to meet nursing and intercollaborative response objectives in disasters (Langan et al., 2017). Undergraduate nursing education provides the foundation for RNs to build the knowledge and skills necessary to be active members of interdisciplinary disaster teams. Unfortunately, studies have shown that many nursing students and RNs need additional education and practice to be prepared to respond during disasters (Baack & Alfred, 2013; Labrague et al., 2018; Nilsson et al., 2016; Schmidt et al., 2011). Shannon (2015) described how “a lack of consistency in curricular design, measuring educational outcomes, and disaster education methodology may limit the preparedness level and practice ability of registered nurses (RNs) nationwide” (p. 1). Nursing students who receive disaster education are more likely to be prepared to respond to disasters (Chilton & Alfred, 2017; Farra, Smith, & Bashaw, 2017; Labrague et al., 2018). This project has developed a list of disaster nursing competencies for use by baccalaureate nursing programs, as well as a list of competencies specific for C/PHN educators that can help to assess baccalaureate nursing students' readiness to work as part of interdisciplinary health care teams before, during, and after disasters occur. The authors believe the results of our project provide a more realistic list of 65 disaster nursing competencies, half of the original 130 ICN and WHO (2009) competencies, which could be used by nurse educators teaching C/PHN courses to evaluate students' knowledge and skill in the 10 ICN and WHO disaster health nursing domains. The authors hope that the Baccalaureate Disaster Competency Assessment Instrument will stimulate further investigation into the assessment of disaster nursing competence and the development of innovative disaster nursing education that can be integrated into baccalaureate nursing programs.

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International Council of Nurses and World Health Organization (2009) Disaster Nursing Competencies—Master's/Doctorate-Level Competencies—Not Appropriate for Baccalaureate Nursing Students or New Graduates

CompetencyNObserved (k)Expected (k)Observed ProportionSE95% CIp
Domain 1.1 (1): Using epidemiological data evaluates the risks and effects of specific disasters on the community and the population and determines the implications for nursing.6415320.230.053[0.13, 0.34].00
Domain 1.1 (2): Collaborates with other health care professionals, community organizations, government, and community leaders to develop risk reduction measures to reduce the vulnerability of the populations.6419320.30.057[0.18, 0.41].00
Domain 1.1 (4): Identifies challenges to the health care system and works with the multidisciplinary team to mitigate the challenges.6421320.330.059[0.21, 0.45].00
Domain 1.1 (7): Collaborates with organizations and governments to build the capacity of the community to prepare for and respond to a disaster.631331.50.210.051[0.10, 0.31].00
Domain 1.2 (5): Works with the community to strengthen the health care system's ability to respond to and recover tifrom a disaster.6424320.370.061[0.25, 0.50].03
Domain 2 (7): Contributes to the development, evaluation, and modification of the community disaster plan.6422320.340.60[0.22, 0.46].01
Domain 2 (10): Participates politically and legislatively in the development of policies related to disaster preparedness and response.6415320.230.05[0.13, 0.34].00
Domain 5 (4): Facilitates research in disaster.63731.50.110.04[0.03, 0.19].00
Domain 5 (10): Assists in developing systems to address nursing and health care personnel capacity-building for disaster response.631231.50.190.05[0.09, 0.29].00
Domain 5 (11): Takes on a leadership role in the development and implementation of training programs for nurses and other health care providers.63531.50.080.03[0.01, 0.15].00
Domain 5 (12): Evaluates community readiness and takes actions to increase readiness where needed.632031.50.320.06[0.19, 0.43].00
Domain 6 (9): Evaluates the impact of nursing interventions on different populations and cultures and uses evaluation results to make evidence-based decisions.6422320.340.06[0.22, 0.46].01
Domain 10.2 (2): Evaluates nursing response and practices during the disaster and collaborates with nursing organizations to resolve issues and improve response.631531.50.240.05[0.13, 0.35].00
Domain 10.2 (3): Participates in analysis of data focusing on improvement of response.631231.50.190.05[0.09, 0.29].00
Domain 10.2 (7): Assists in developing recovery strategies that improve the quality of life for the community.631931.50.300.06[0.18, 0.42].00

Baccalaureate Disaster Nursing Competencies which should be assessed as part of Community or Public Health Nursing (C/PHN) Courses

Domain 1- Risk Reduction, Disease Prevention and Health Promotion

Risk Reduction and Disease Prevention (7 original competencies)

Identifies vulnerable populations and coordinates activities to reduce risk.

Understands the principles and process of isolation, quarantine, containment and decontamination and assists in developing a plan for implementation in the community.

Health Promotion (5 original competencies)

Assesses the community to determine pre-existing health issues, prevalence of disease, chronic illness and disability and the health care resources in the community.

Partners with others to implement measures that will reduce risks related to person-to-person transmission of disease, sanitation and foodborne illness.

Domain 2 - Policy Development and Planning (11 original competencies)

Demonstrates an understanding of relevant disaster terminology.

Describes the phases of disaster management continuum: prevention/mitigation, preparedness, response and recovery/rehabilitation.

Describes the role of government and organizations in disaster planning and response.

Understands the community disaster plan and how it relates to the national and international response plans.

Recognizes the disaster plan in the workplace and one's role in the workplace at the time of a disaster.

Interprets role(s) of nurses in relation to other members of the team.

Describes the role of public health in disaster and how it relates to the nurse's role.

Domain 3 - Ethical Practice, Legal Practice and Accountability

Ethical Practice (7 original competencies)

Practices in accordance with the cultural, social and spiritual beliefs of individuals and communities.

Understands one's own personal beliefs and how those beliefs impact on disaster response.

Describes how security issues and ethics may conflict.

Legal Practice (5 original competencies)

Understands how laws and regulations specific to disaster impact on nursing practices and disaster survivors.

Recognizes the legal role of public health to protect the community in a disaster.

Understands the legal implications of disasters and emergency events (e.g. security, maintaining evidence, confidentiality).

Accountability (5 original competencies)

Accepts accountability and responsibility for one's own actions.

Delegates to others in accordance with professional practice, applicable laws and regulations and the disaster situation.

Identifies the limits of one's own knowledge, skills and abilities in disaster and practices in accordance with them.

Practices in accordance with the laws and regulations governing nurses and nursing practice

Advocates for the provision of safe and appropriate care.

Domain 4 - Communication and Information Sharing (12 original competencies)

Describes the chain of command and the nurse's role within the system.

Communicates in a manner that reflects sensitivity to the diversity of the population.

Describes the principles of crisis communication in crisis intervention and risk management.

Identifies and communicates important information immediately to appropriate authorities.

Coordinates information with other members of the disaster response team.

Understands the process of health information management in a disaster.

Communicates identified or suspected health and/or environment risks to appropriate authorities (i.e. Public Health).

Domain 5 - Education and Preparedness (12 original competencies)

Participates in drills in the workplace and community.

Maintains a personal disaster/emergency kit (e.g. identification card, appropriate clothing, insect repellent, water bottle) in the event of deployment to a disaster.

Implements preparedness activities as part of a multidisciplinary team.

Domain 6 - Care of Communities (11 original competencies)

Describes the phases of community response to disaster and the implications for nursing interventions.

Evaluates health needs and available resources in the disaster affected Domain to meet basic needs of the population.

Understands how to prioritize care and manage multiple situations.

Participates in preventive strategies such as mass immunization activities.

Effectively participates as part of a multidisciplinary team.

Domain 7 - Care of Individuals and Families

Assessment (7 original competencies)

Performs a rapid assessment of the disaster situation and nursing care needs.

Recognizes symptoms of communicable disease and takes measures to reduce exposure to survivors.

Describes the signs and symptoms of exposure to chemical, biological, radiological, nuclear and explosive agents.

Identifies unusual patterns or clustering of illnesses and injuries that may indicate exposure to biological or other substances related to the disaster.

Determines need for decontamination, isolation or quarantine and takes appropriate action.

Recognizes health and mental health needs of responders and makes appropriate referrals.

Implementation (18 original competencies)

Applies accepted triage principles when establishing care based on the disaster situation and available resources.

Adapts standards of nursing practice, as required, based on resources available and patient care needs.

Creates a safe patient care environment.

Demonstrates safe administration of medication, vaccines and immunizations.

Implements principles of infection control to prevent the spread of disease.

Provides care in a non-judgmental manner.

Maintains personal safety and the safety of others at the scene of a disaster

Documents care in accordance with disaster procedures.

Provides care in a manner that reflects cultural, social, spiritual and diverse background of the individual.

Advocates for survivors and responders to assure access to care.

Domain 8 - Psychological Care (9 original competencies)

Describes the phases of psychological response to disaster and expected behavioral responses.

Understands the psychological impact of disasters on adults, children, families, vulnerable populations and communities.

Identifies an individual's behavioral responses to the disaster and provides appropriate interventions as required (e.g. psychological first aid).

Differentiates between adaptive responses to the disaster and maladaptive responses.

Identifies appropriate coping strategies for survivors, families and responders.

Identifies survivors and responders requiring additional mental health nursing support and refers to appropriate resources.

Domain 9 - Care of Vulnerable Populations (6 original competencies)

Describes vulnerable populations at risk as a result of a disaster (e.g. older persons, pregnant women, children, and individuals with a disability or chronic conditions requiring continued care) and identifies implications for nursing...

Advocates for the needs of the vulnerable populations.

Implements nursing care that reflects the needs of vulnerable populations impacted by a by a disaster.

Consults with members of the health care team to assure continued care in meeting special care needs.

Domain 10 - Long-term Care Needs

Individual and Family Recovery (7 original competencies)

Identifies the changing needs of survivors and revises plan of care as required.

Teaches survivors strategies for prevention of disease and injury.

Community Recovery (8 original competencies) none selected for C/PHN course assessment.

Authors

Dr. Siemon is Public Health Nurse Consultant, Population Healthcare Consulting, PLLC, Ketchum; Dr. Hackwith is Accelerated Program Coordinator and Clinical Assistant Professor, Idaho State University School of Nursing, Meridian; and Ms. Monson is North Central Division Nurse Lead, American Red Cross National Nursing Network, Lewiston, Idaho.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank the nurses who participated in the initial survey to develop the list of baccalaureate disaster nursing competencies. They also thank Cathy Deckys, MS, RN, COHN-SNC, NHDP-BC, for her help with developing the list of disaster nursing competencies for community and public health nursing courses and Blake Boursaw, MS, University of New Mexico College of Nursing for his input on the statistical analysis of the survey results.

Address correspondence to Mark Siemon, PhD, RN, PHNA-BC, CPH, Public Health Nurse Consultant, Population Healthcare Consulting, PLLC, P.O. Box 5165, Ketchum, ID 83340; e-mail: pophealthid@gmail.com.

Received: December 18, 2018
Accepted: February 04, 2019

10.3928/01484834-20190321-08

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