Disaster Nurses Save Lives

Disaster Nurses Save Lives
Lessons learned from a Tabletop Exercise of a Capstone Project

by: Xinyi Xu, BSN, RN & Li-Chen Lin, PhD, RN

Disaster preparedness and management involve important professional nursing skills, and all nurses worldwide need to be prepared for disasters. Facing disasters can be stressful, however, especially during a pandemic. Given the increasing frequency of disasters globally, disaster preparedness and management need to be reinforced. Nurses play an essential role in all phases of disaster response. They serve as frontline responders to treat injured individuals, facilitate the process of disaster management, and coordinate with other disaster responders to mitigate disasters’ negative consequences. Therefore, nurses must be adequately trained in disaster preparedness to ensure that they have the skills and knowledge to protect themselves while helping others during a disaster and in the recovery phase that follows. With proper training, nurses can improve a community’s overall health and well-being from initial disaster preparedness through disasters themselves to recovery.

Identifying Gaps and Conceptualizing Essential Training

Despite a growing call to prepare nurses for disasters, literature reviews show that nurses are underprepared for disaster responses (Labrague et al., 2018; Loke et al., 2021), and there is a lack of disaster training education in nursing curricula (Achora & Kamanyire, 2016). Reasons for this lack of training include (1) a lack of professional disaster training educations in schools, at work, or through professional organizations; (2) a lack of willingness among nurses to attend disaster educational sessions; and (3) insufficient evidence to identify the most effective methods for achieving disaster preparedness (Gowing et al., 2017). Nurses who are inadequately prepared or have insufficient knowledge to respond to disasters may find it difficult to perform familiar nursing tasks during disasters, simply because of high levels of stress.

Initially, the plan for this capstone project was to develop a comprehensive disaster preparedness plan. For a novice nurse lacking real-life experience in disaster management, however, the development of such a plan was not feasible. Various physical and psychological factors must be considered in developing a disaster management protocol, and organizations such as the American Red Cross, the Federal Emergency Management Agency (FEMA), and Ready.gov (2021) provide disaster protocols, even though many nurses may not be aware of them. Gowing et al. (2017) has suggested that when a disaster occurs, every emergency responder should follow consistent standards to communicate and provide care accordingly. Therefore, after careful research into the process of disaster preparedness, a tabletop exercise was found to be a more suitable choice for the capstone project. Tabletop exercises consist of “discussion-based sessions where team members meet in an informal setting to discuss their roles and their responses during an emergency” (Ready.gov, 2021). To teach our target population, it was more practical to design a tabletop exercise using available well-established disaster protocols.

Planning a Meaningful Tabletop Exercise

The aim of the tabletop exercise was to improve participants’ perceived level of confidence and knowledge for disaster preparedness and management. Many tasks were required before implementing the tabletop exercise, including regular meetings to discuss and plan the project. After thoroughly evaluating all relevant factors, a tabletop exercise scenario for mass sheltering during COVID-19 was selected, planned, and implemented. We selected teaching materials, created an agenda and syllabus, invited participants, and assigned roles and responsibilities. Participants were educated on the available resources and tools for disaster management, such as the Federal Emergency Management Institute’s (2018)  Introduction to the Incident Command System (ICS) and the Centers for Disease Control and Prevention’s Guide for the Environmental Health Assessment for Disaster Shelter During COVID-19 (CDC, 2020) . After participants were assigned different roles based on the ICS, they developed an incident action plan and applied their knowledge by communicating and working with each other. They portrayed their assigned roles and followed the ICS communication protocols in responding to the scenario.

Effectiveness of the Exercise

All participants completed baseline and post-exercise surveys, as well as an after-activity evaluation of the tabletop exercise’s outcome and effectiveness. Twelve participants who are key leaders from the University of Texas at Austin Medical Reserve Corps (MRC) attended the tabletop exercise on October 23, 2021. The MRC is a national network of volunteers that aims to improve the health and safety of communities (Public Health Emergency, 2021). All responses were used to compare the results on the level of disaster preparedness and confidence before and after the activity. Participants rated their confidence levels for the ICS, disaster shelter management, and incident action plan process before and after the activity. At the end of the tabletop exercise, all participants were invited to complete an evaluation of the activity.

Twelve participants completed the baseline and post-exercise surveys; 11 participants responded on the after-activity evaluation. Participants reported little to some confidence regarding disaster preparedness and management at baseline, and on the post-exercise survey, participants reported moderate to complete confidence in disaster management. Participants’ confidence for disaster management improved significantly after the activity. The after-activity evaluation showed that all participants rated 5 on a scale of 1 to 5 (1 = poor/not helpful; 5 = well-done/very helpful), indicating that the tabletop exercise was helpful in building their confidence for disaster preparedness/management.

Key Takeaways

In addition to benefiting the participants, the nurse planner was able to use this activity not only to learn disaster management and preparedness, but also to enhance leadership skills in the process of planning, revising, implementing, and evaluating the activity. The preparatory phase of a project is similar to setting up a SMART goal (a goal that is specific, measurable, achievable, and realistic within a particular time frame). The SMART goal coupled with the preceptor’s guidance were keys to success in this capstone project. 

This capstone project shows that even a novice disaster nurse can succeed in planning and implementing a tabletop exercise on disaster management through active engagement and involvement in all phases of project planning and delivery. The novice nurse can conduct a project by leveraging available tools and resources on disaster planning in order to build and enhance knowledge in disaster nursing, critical thinking skills, level of confidence in general, and leadership ability, incorporating management of group dynamics as well as diversity. More importantly, the positive feedback from the participants was encouraging, in that even implementing such a small project could make a difference. Of course this one-time exercise would not be enough to improve disaster management competency among nurses and community leaders; more activities must be implemented to reach a larger, broader population.

Preparing for the future

Disaster nursing is an indispensable component in educating nursing students and in-service training for nurses across a wide variety of settings (Loke et al., 2021). The level of disaster preparedness among participants in this project was significantly improved after the activity. The tabletop exercise was effective in helping the participants to better utilize well-established disaster guides and understand the concepts of disaster management in the context of a pandemic. Regular tabletop exercises with interprofessional panelists might be beneficial for improving individuals’ readiness for disaster preparedness on a larger scale with higher complexity or with various types of disaster that require different skill sets and types of expertise. Health professionals may feel less prepared for one form of disaster than for another, or less prepared for specific aspects of managing disasters (Gowing et al., 2017). Therefore, rotating scenarios for multi-type disasters should be introduced in future tabletop exercises. Simulation (Geng et al., 2021) and virtual reality (Loke et al., 2021) are recognized as effective ways in disaster nursing education and training. Using multi-delivery methods and blended training methods may increase the effectiveness of training healthcare professionals and support staff in disaster management education, A long-term evaluation should be helpful in testing the benefits and impacts of such activities. Nurses can become involved in disaster management in many ways to save lives.

References

Achora, S., & Kamanyire, J. K. (2016). Disaster preparedness: Need for inclusion in undergraduate nursing education. Sultan Qaboos University Medical Journal, 16(1), e15–e19. https://doi.org/10.18295/squmj.2016.16.01.004

Centers for Disease Control and Prevention. (2020, March 31). Guide for the environmental health assessment for disaster shelter during COVID-19. https://www.emergency.cdc.gov/shelterassessment/pdf/Shelter_Assessment_instructions_COVID508.pdf

Federal Emergency Management Institute. (2018). Introduction to the Incident Command System, ICS 100 [Online course]. https://training.fema.gov/is/courseoverview.aspx?code=is-100.c

Geng, C., Luo, Y., Pei, X., & Chen, X. (2021). Simulation in disaster nursing education: A scoping review. Nurse Education Today, 107, Article 105119. https://doi.org//10.1016/j.nedt.2021.105119

Gowing, J. R., Walker, K. N., Elmer, S. L., & Cummings, E. A. (2017). Disaster preparedness among health professionals and support staff: What is effective? An integrative literature review. Prehospital and Disaster Medicine, 32(3), 321–328. https://doi.org//10.1017/S1049023X1700019X

Labrague, L. J., Hammad, K., Gloe, D. S., McEnroe-Petitte, D. M., Fronda, D. C., Obeidat, A. A., Leocadio, M. C., Cayaban, A. R., & Mirafuentes, E. C. (2018). Disaster preparedness among nurses: A systematic review of the literature. International Nursing Review, 65(1), 41–53. https://doi.org/10.1111/inr.12369

Loke, A. Y., Guo, C., & Molassiotis, A. (2021). Development of disaster nursing education and training programs in the past 20 years (2000–2019): A systematic review. Nurse Education Today, 99, Article 104809. https://doi.org/10.1016/j.nedt.2021.104809

Public Health Emergency. (2021, July 23). The Medical Reserve Corps. U.S. Department of Health and Human Services. https://www.phe.gov/mrc/Pages/default.aspx

Ready.gov. (2021, October 12). Exercises. https://www.ready.gov/exercises