Accepted Manuscript

Research progress in disaster nursing competency framework of nurses in China

Si-Mu Li, Xiao-Rong Li, Dan Yang, Nai-Wei Xu
PII: S2095-7718(16)30091-3
DOI: 10.1016/j.cnre.2016.11.003
Reference: CNR 69
To appear in: Chinese Nursing Research
Received Date: 18 June 2016
Revised Date: 25 July 2016
Accepted Date: 25 August 2016
Please cite this article as: Li SM, Li XR, Yang D, Xu NW, Research progress in
disaster nursing competency framework of nurses in China, Chinese Nursing
Research (2016), doi: 10.1016/ j.cnre.2016.11.003.
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*Corresponding author. E-mail address: 15244618292@163.com (N. -W. Xu). Peer review under the
responsibility of Shanxi Medical Periodical Press.
DOI: © 2016 Shanxi Medical Periodical an open access article under
(http://creativecommons.org/licenses/by-nc-nd/4.0/). Cited information: Li SM, nursing
competency framework Review article Research progress in disaster Si-Mu Li a, Xiao-Rong Li
b, a Osteoarticular Department, China b Operating room, Yinchuan China c Neurosurgery
Department, China d Nursing Department, Tianjin 30052, China Press. Publishing the CC
BY-NC-ND Li XR, Yang D, of nurses in nursing competency Dan Yang c, Nai-Wei Ningxia
People’s Second People’s Ningxia People’s Medical University A R T I C L E I N F O Article
history: Received 18 June 2016
D Xu China. Hospital, M Hospital, Hospital, NW. license Xu A General Chin d,* Research
services framework N Yinchuan, Yinchuan, Yinchuan, Nurs U Hospital, by Res. progress S
Elsevier Ningxia of Ningxia C 2016; Ningxia nurses Tianjing, R in 4: 750021, B.V. disaster
750021, I
750021, in xx-xx. P
Hebei China This T is
Received Accepted Published Keywords Nurses Disaster Competency Overview
ABSTRACT
Nursing in 25 20 A revised August December C C form 2016
2016 E 25 P
July T
2016 E
All types of frequent natural disasters, which seriously threaten the safety of human life and
property, have become a great challenge all over the world. The dangerous and changeable
environment in emergency rescue demands higher requirements for competency of the nurses
who respond to a disaster. Disaster nursing combines medical science, sociology, psychology,
and other disciplines; thus, it has become a comprehensive interdisciplinary branch of nursing.
Disaster nursing has just recently been introduced to our country and is still in the stage of
exploration. Nurses
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comprise the largest rescue force on disaster relief teams; therefore, disaster nursing competency
is influential on the disaster response and recovery of victims after a disaster. Thus, this paper
defines the concepts and elements of disaster nursing, including disaster nursing skill
requirements and architectural framework. It will provide an important contribution to improving
the overall level and comprehensive quality of disaster nursing competency of nurses in China. ©
2016 Shanxi Medical Periodical Press. Publishing services by Elsevier B.V. This is an open
access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
In recent years, due to the interaction of related factors, the occurrence of natural disasters,
accidents, public health events and man-made disasters causes more and more threats to human
life.

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world’s health care teams, nurses’ disaster 1
These mass casualties create a huge S
challenge for the
response and recovery training has not yet knowledge and skills research to improve literature
support.
system. been the of of nursing clinical disaster universal victims 2
As competencies DNC the nursing.
after in largest our a disaster. 5 country. Thus, rescue (DNC) this 3, Clinical force A 4 However,
have article N
of a nurses the U
great examines this first-tier influence lack education disaster the disaster awareness,
on and
nursing disaster relief
2. Definition of related concepts of 2.1. Disasters
in disaster D our country M
nursing
and provide reference and
At present, the definition of disaster has not yet reached a consensus. to of services required.
to preparedness 2.2. association, the reduce facilities, Disaster The World when Japan Because
mortality, defined economic Health nursing and its Society C size response of which
Organization C disaster the exceeds damage, of E
unpredictability Disaster has capabilities.
P nursing the a casualties, T definition, E
7 disasters could lead and the deterioration of 6
According to the deterioration health and health resources available, and special assistance is
of disasters, extensive efforts are necessary direct relationship with the rescue team’s
8

Nursing, which is Japan’s disaster nursing

as follows: It involves a series of activities that are
performed to mitigate the hazards posed by disasters on human life and health that apply unique
knowledge and skills systematically and flexibly and allow for cooperation with other
professional fields. There are two types of views related to the definition of the disaster nursing
structure.
9
 One approach is divided into disaster preparedness,
disaster emergency response and long-term recovery involving reconstruction. Another approach
is divided into four categories as follows: disaster reduction and prevention, disaster
preparedness, response, recovery and reconstruction.
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2.3. Disaster nursing ability
Disaster nursing ability is also called disaster nursing competency, and it is applied to
emergency preparedness capability. According to the concept of emergency preparedness
readiness capability through literature reviews, Slepski
11

states that disaster nurses need comprehensive knowledge, skills and behaviors to prepare and
respond to threatening events that are suspiciously chemical, biological, and radiological. that
other nursing, competency standard 3. in to 3.1. focus efficient performance 3.2. be conditions
3.3. and difficult rescue however, 3.4. this take normally The need cause Temporary Difficult
Acute Mental Significant Due The When relevant on new time, corresponding characteristics
than and rescue definition the frontline to to nuclear work for century. a 12 be the operated. is
rescue it Additionally, of disaster Working general 90% events. the is a treated, organization
team the sudden changes relatively content just disaster damage, disaster for of rescue efforts We
C when a nursing occurs, This measures the Resource Conditions this therefore part occurrence
only E of have wounded nurses. work disaster new of site concept concept disaster the
bombings, of P mechanism have a the work. disaster taken is large disaster concept so in
shortages T making parties often to a nurses that and only is in Additionally, E nursing place
number short grasp lacking. the man-made nursing severely occurs. the limitations in D involves
and disaster 12 disaster should period can the in the impact the of the M world. create nature
competency. Additionally, people damaged, organization characteristics nursing have of the
according accidents are of of A time. difficulty disasters first However, of disaster alive the N
may its more two ability and U change within and be Disaster to the of prediction, aspects can
public the in in complex S currently, of natural a focus to critical the temporary data disaster the
be and C respond nursing
working facilities minimized. first of is regarding characteristics disasters R and on disaster
condition we a accidents 3 unified the I to more
hours; usually and P
cannot events or T
Disasters related to A
within the workload overall can C
6 hours, lead effects to the the of survival destruction the disaster rate of decreases on families
individuals to and 50%.
economic and families; losses, e.g., which the
are
occurrence of post-traumatic stress disorder in victims, etc. Being on the frontline of the disaster,
nurses may have personal experiences of the disaster situation that can cause their own
psychological stress and other issues. Meanwhile, there is a huge challenge to their own
psychological health. 3.5. Change of nursing center of gravity
Early in the disaster, the work of nurses mainly focuses on a variety of specific nursing
operations that are aimed at saving lives and treating bodily conditions. Later in the disaster, the
main responsibility of the nurses is to prevent and stop the spread
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of the epidemic and to provide psychological intervention and human care for the masses.
13

Because of the various types of disasters that may be associated with high incidence, uncertainty,
and unpredictability, a large number of casualties and huge economic losses are typical
outcomes. Researchers more and more deeply realize the role of the nurse as an important part of
the emergency medical rescue team, whose capacity field. qualified with is to suggest
competency. overall need 4. disciplines emphasizes individual reconstruction follows: proper of
disorders; preparedness competency framework, mainly International practice, categories,
proposed emergency limited. the health; The Disaster adequate for 14 actual disaster planning
includes that It content improved to of care personnel five to is to 15 and and rescue and
preparedness responding A the which the important provide is characteristics Thus, support They
Nurses for nursing and aspects preparation and involves still rescue focuses nursing C nurses 2
two and of disaster management victims, promote is disaster the other new. the for the C
Association” contributions: life clarification recovery closely combines of environment;
challenge to should to disaster on “WHO framework of disaster A E competence: aspects support
planning, conduct prevention, disasters and physiological, the related which response of disaster
P related disaster have holistic and disaster disaster abilities relief. medical prevention, T of is for
can of disaster study 20 reconstruction should unified to intervention. 19 higher nursing E of to
to includes the the competency. etc. construct promote 1 public One and nursing guide the
disaster relief nursing and D disaster victims; noted science, psychological 18 “The nursing not
cultivation continuous demands study emergency The education disaster professional and safety
affected planned M be that the and competency a competency nursing concept nursing The to
indicated rescue ignored sociology, disaster activities; 16, education healing guidance A specific
alleviate and for 17 countermeasures, mission individuals of professional, adjustment command
and N crisis their and capabilities ability disaster of development in nursing of that training U
disaster situations, framework psychology social to the for framework” the to own disease; of
management, provide the bring S framework emergency the pain disaster nursing system,
towards echelon. of disaster functions number to ethical C nursing capability and nursing forth
caused to carry researchers disaster in support of R and provide experiences nursing abilities,
21, emergency three a nursing
the According highly and of to rescue out 22 restoration I
other of by care. nurses P
meet legal for the the
health for is T It
the as the
a
plan procedure, and the role of international organizations in emergency management. China’s
disaster care system has just recently been introduced and is still in the exploratory stage.
Currently accepted theoretical support is lacking related to the requirements for disaster
competency of nurses in our country. On the basis of the actual situations faced by nurses in our
country and the specific tasks associated with disaster nursing and the relevant research on this
topic, exploring the framework for disaster nursing competency in China is of utmost
importance.
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5. The framework of nursing competency in China
The nurse is the most important part of a disaster relief team whose main goal is to help
individuals and the affected communities achieve the best level of health.
23

Lack of adequate competency to respond to disasters will result in chaos and disorganization
experienced country, concepts the specific the construction China’s with the relevant as follows:
5.1. The When save more disaster demography rescue literature the disaster core and lives. a
content research a disaster elements knowledge tortuous and and of According situation on the
training related increase in and the occurs disaster of journey this framework of sociology.
disaster and to to strategies disaster area suddenly, the disaster the participate nursing and
casualties started nursing investigation initially nursing
It for of nursing is having system late disaster nurses particularly in competency. and formed the
and solid competency. is property and in disaster nursing lacked according Deng disaster
analysis a important certain N There an rescue. et losses. competency, al., accurate U to 9
nursing of system. Therefore, is the the to S Disaster On no train characteristics knowledge
unified the C definition knowledge However, our nurses basis R nursing in summary theory our I
of P of
to of country,
the in will has
cope of T on our
is
cardiopulmonary immobilization airway, treatment sites, classification evacuation of disaster
rescue knowledge of hospital emergency fire nursing skills and resuscitation measures and of
care, splinting and trauma personnel earthquake strategies. and for of sanitation triage, (CPR),
unexplained fractures, should sites, According E the wound and include and D use methods other
syncope, epidemic of M hemostasis an to 4 A A for removing techniques, 24
nurses a foreign site
should body know
in the evaluation methods of trauma automatic external defibrillator,
skills, for a total of 15 types of Li et al.,
25

disaster rescue dimensions: first aid, transport,

prevention. These dimensions are
subdivided into site evaluation, field rescue techniques, transit and monitoring, common
emergency and critical care, cardiopulmonary resuscitation, emergency response measures,
psychological counseling, disinfection and isolation technology, epidemic prevention of
infectious diseases and 20 other relevant disaster rescue knowledge topics. 5.2. Disaster nursing
core competency 5.2.1. Competency in preparedness for the prevention of disasters
The important role of nurses in disaster nursing extends beyond the disaster itself and the
post-disaster period to include pre-disaster prevention and preparation measures.

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Pre-disaster preparedness involves meeting the health needs of the affected

individuals in the early and middle periods, which has a certain effect on the sustainable
development of the economy. Rogers advocated that occupational health nurses and other
professional practitioners need to master knowledge and skills, in addition to understanding
related diseases that can occur at any time of injury. Personnel not only need to be competent in
clinical skills but also should possess skilled application related to supervision, management and
coordination of the
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community, risk handling, risk information transfer, health protection and other fields. 27
Preparedness for the prevention of disasters enables nurses to serve as part of the emergency
disaster relief reserve force, not only in their daily work to meet critical and special patient care
requirements but also at the moment of disaster when their preparedness will serve as an
advantage in the response.
28

5.2.2. Emergency rescue competency the quality Emergency of nursing response care.
competency is one of the important indicators in measuring T

A
29

Competence in handling emergencies is very important for of very it first awareness subtle react
wounded. safety psychological analyzed noted and of emergency and rescue 5.2.3. classification
carry poor storage specification, management disaster effective is the education, improving the
other a 10 The important environment and disposable very that unexpected changes and
situation, The min of nursing nursing. resources the nurse assess competencies, The in all
treatment and high response competence as the current and lack types of and intervention the
nurse platinum alertness in at should C equipment requirement the injuries field and items 34
coordination the conditions. success ensuring nature a and The for of scene, disaster C should
coordination, status awareness. researchers disaster of supplies, lack examine temporary to nurse
of rescue of E and emergency which of reduce rate, promptly the and of is rational of accurate all
focus medical P that coordinate When outdated. scene. should the supplies. overall of types
accuracy, other time. are carefully prioritize Nurses T the need they quality nursing treatment on
attend factors allocation a E rescue, As delivery need take of education be 30 aspects adequate
disaster must to situation Additionally, The The emergencies. medical lack their flexible D
reflect of check and appropriate to and resources for that save emergency there and nurse special
nurses psychological of transport. and cleaning quality manage M occurs and preparation, cannot
background, the and the on application. in admiral the is minimization should management A the
these should material emergency populations, are a observe prime nurses of suddenly, Early
treatment lack be patients and selection N After rescue an emergency injury deficiencies.
maintain ignored of be indispensable disinfection rescue U rescue first on-site do type, the and
first-aid the familiar in according protocol. not will nurses of S measures, of environment aid of
and do disaster, China. in quantity, time, waste. knowledge, resources emergency the have first
treatment C for happen not the offer specialty with need existing because the which have aid, R
 emergency The a 31
part 33 to it high and effective Cui wounded the and The within is to the transit I
study
a of for because P best in quickly treat skills strong use level nurses, et of the al.
the to 1 and the h,
32 is

5.2.4. Psychological support and health education

The destruction of homes and separation of individuals from their relatives and friends
cause individuals to experience a lack of security and belonging and often creates extreme panic
and anxiety. If we do not intervene in time, it will lead to emotional, cognitive, behavioral and
other issues related to the mental health of individuals; ultimately, individuals may experience
post-traumatic stress disorder.
35

The nurse should give psychological counseling and humanitarian care to affected individuals in
a timely manner and encourage them to be positive about overcoming
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the situation and rebuilding their homes. In addition, Fung et al. believe that when disaster
strikes, the needs of the nurses are often greater than other types of health professionals.
36

Excessive pressure and a heavy mental workload can cause psychological

problems for the nurse. Therefore, nurses need to learn to control and adjust their psychological
state. Therefore, psychological stress management is an important resource for professional
nurses in disaster management.
37

5.2.5. Others In disaster skills, and good rescue mission. strengthening exercises, The nurse has a
relief.
38 However, response ability relief, We unique physical should medical role and qualities
also in improve rescue device strengthen successfully medicine these technology, exercise,
aspects complete and interpersonal in plays including daily the an training important key
physical skills, elements and critical role exercise R
education. in in I
the P disaster thinking
and

T
competency has A
there is a need for increased of nurses in the harsh environment aroused extensive concern and
requirements attention of the of ambulance. researchers. for the C
emergency
Disaster nursing
In summary, disaster nursing is a new comprehensive cross-discipline integrating medicine,
sociology, psychology and other disciplines. To improve the ability of disaster nurses, it is
necessary to define the concept and elements of disaster nursing competency and develop a
theoretical framework for disaster nursing education. It is necessary to clarify the demand for
disaster nursing competency and construct the disaster nursing ability standard and evaluation
system suitable for our country. Long-term challenges will help build the framework for disaster
nursing competency to further confirm the abilities of disaster nurses.
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Conflict of interest

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