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Nursing and Health Sciences (2014), 16, 1–2
Editorial
Mitigation, resilience, and nursing “Resilience is accepting your new reality, even if it’s less good than the one you had before. You can fight it, you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something that’s good.” Elizabeth Edwards (2009) Immunity from disasters does not exist. What is the role of nurses in facilitating disaster resilience? What relationship exists between mitigation and resilience? Why do some people, communities, countries bounce back and move forward after a disaster, and others continue to deteriorate to their ultimate demise? What makes the difference? How can individuals and societies increase their resilience, and not only progress but be enhanced because of their misfortune? According to Hengboonyapan et al. (2012), who detail the empowering effects of transforming disaster victims into assistants in relief operations, lessons learned are powerful contributions in preparing others for similar events to minimize the impact on individuals and communities. Disaster mitigation provides for alleviation of the natural and environmental hazards that can produce harm during disasters, and it can promote more timely recovery (Schwab, 2010). In many countries prone to vector-borne disasters or rapidly spread contagious diseases, primary health nurses work within the community to eliminate breeding places, distribute mosquito nets, teach oral rehydration techniques, and implement preventive measures to avoid disease outbreaks such as cholera. Nurses educate the community through direct contact, posters, media, and by teaching school children songs or verses about measures that can be done inexpensively to make a difference. Animated short films such as “The Story of Cholera”, “Malaria Prevention”, and “Oral Rehydration” are available on the Internet site You Tube, and they disseminate the message clearly and in a medium appealing to people of all ages. The same principles apply to other vector-borne diseases. Disaster management is a team effort: in 2005, the United States’ Federal Emergency Management Agency (FEMA) refined the Incident Command System (ICS) utilizing experts from multiple disciplines. The result was an international standard of core competences for responding to disasters and improving on-site relief operations (FEMA, 2014). Reviews of lessons learned have shown that the system improved the outcome of many disasters where there was a lack of central communication, and maximized the usage of limited material resources and personnel. is the system has been used internationally, with many countries recognizing after catastrophic disasters that faulty management was the greatest hindrance to improved outcomes. Nurses are part of the medical response, but in the Haiti earthquake a major © 2014 Wiley Publishing Asia Pty Ltd.
problem was that international aid agencies sent plenty of doctors to care for victims, but there were insufficient nurses to look after them (Desjaradins & Dellorto, 2010). One of the projects presented in September 2013 at a meeting of nurses from 35 countries convened by two World Health Organization Regions, will never make headline news because the scale of the disaster paled in comparison with larger catastrophes, but it nevertheless threatened to overcome the resources available. In the summer of 2013, Kiribati a tiny island in the South Pacific experienced a disaster that did not make international news because it is such a small country with a small population. There was an outbreak of vomiting and diarrhea that was documented as rotovirus with 20 patients on the first day and over 900 within eight days, mostly children under five years; however there were victims of all ages (Cati & Robate, 2013). Strategies employed to minimize the spread included: effective outreach by mobile teams to vulnerable areas; the assessment and treatment of children with symptoms; the promotion of good general hygiene (proper hand washing, clean surroundings, boiling of drinking water and simmering for 10–20 min after boiling); eating only cooked food; the use of media, such as radio spots (about the outbreak and prevention and early reporting to clinic); environmental health (sampling drinking water and determining from the results the cause of diarrhea and vomiting). Public health clinics remained open 24 h (with personnel working in shifts), undertaking triage and rapid assessment of cases, and deployment of staff working after hours where necessary. The lessons learned and plans for improvement began to be implemented just a month after the disaster. Presentations at the 2013 meeting included other examples of nursing interventions in disasters and measures that minimized damage and maximized resilience and recovery. Nurses are critical to the outcome of disasters because in some countries they are the main healthcare providers: Larui and Pego (2013) reported that in the Solomon Islands a tsunami and dengue fever outbreak posed major dilemmas for nurses. The natural disaster was familiar, but the dengue fever was new because only malaria had previously occurred in the islands. Knowledge about recognition of the disease and its treatment was needed quickly. Lessons learned were that nurses responded swiftly and effectively because of the generalist preparation, and the country’s national disaster plan involving nurses, which is aimed towards risk reduction. It has a two-pronged approach: one prong focuses on predisaster actions (understanding the hazards, establishing the institutional arrangement, and taking action on risk reduction), while the other focuses on when disaster strikes (management of response and relief to address the impacts and recovery, fix the damage, rehabilitate livelihoods, and reduce future risk). doi: 10.1111/nhs.12132
2
Editorial
Involvement of victims in evacuation center operations minimizes the trauma of the disaster and facilitates healing (Chulalongkorn, 2013). Thailand’s disaster management is the model from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), which focuses on before (preparedness and prevention mitigation), during (disaster impact, response, and relief or emergency management), and after (rehabilitation and reconstruction) the event. Fighting. Local Heroes (Hengboonyapan et al., 2012) is a booklet containing stories of volunteers and their experiences of providing aid during disasters, and it includes experiential wisdom from survivors which are inspirational examples of resilience. Nurses may want to lead disaster relief, but often they serve as team members. Well educated and prepared nurses, and those who are “adaptable, creative, innovative critical thinkers, able to be collaborative, with knowledge of public health and infection control, are needed to intervene effectively in the face of unexpected situations with extremely limited resources” (Bonito & Fritsch, 2013). The challenge for nurses is to become involved in disaster mitigation, serve on local, regional, and national disaster planning organizations, promote education and organize regular drills for readiness, and consider the value in working with victims to resolve shortages at the scene. Resilience increases with new knowledge and experience. Involvement in mitigation, disaster preparedness, community collaboration in nursing education along with focus on critical thinking, simulations of disasters, creativity, and decision making will enhance nurses’ readiness to respond effectively to all types of disasters confronting the world today. Nurses have a major role in mitigating disasters and to increase individual and community resilience. Marcia A. Petrini, PhD, FAAN Wuhan University, 115 Donghu Lu, Wuhan, China
© 2014 Wiley Publishing Asia Pty Ltd.
REFERENCES Bonito S, Fritsch K (eds). Nurses and Midwives in Action During Emergencies and Disasters Case Studies from the Western Pacific Region. Geneva: World Health Organization, 2013. Cati I, Robate M. Emergency and Disaster in Kiribati. Bangkok: APEDNN, 2013. Chulalongkorn PMH. Building Community Resilience: Strategies, Facilitating Factors and Lessons Learnt from Thai Communities. Bangkok: APEDNN, 2013. Desjaradins L, Dellorto D. (2010) Haiti awash in doctors; nurses in short supply. CNN. January 25, 2010. http://edition.cnn.com/2010/ WORLD/americas/01/25/haiti.doctors.nurses/. Edwards E. Resilience: Reflections on the Burdens and Gifts of Facing Life’s Adversities. New York: Broadway Books, 2009. Federal Emergency Management Agency. (2014) Incident Command System. U.S. Department of Homeland Security. February 26, 2014. http://www.fema.gov/incident-command-system/. Hengboonyapan D, Nuntaboot K, Tongboonchoa K. Fighting. Local Heroes. Bangkok: Thai Health, 2012. Larui M, Pego C. Integrated Response To Natural Disasters And Emerging Infectious Diseases Solomon Islands. Bangkok: APEDNN, 2013. Schwab JC. Hazard Mitigation: Integrating Best Practices into Planning. Planning Advisory Service Report No. 560. Chicago, IL: American Planning Association, 2010.
Nursing and Health Sciences (2014), 16, 1–2
Editorial
Mitigation, resilience, and nursing “Resilience is accepting your new reality, even if it’s less good than the one you had before. You can fight it, you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something that’s good.” Elizabeth Edwards (2009) Immunity from disasters does not exist. What is the role of nurses in facilitating disaster resilience? What relationship exists between mitigation and resilience? Why do some people, communities, countries bounce back and move forward after a disaster, and others continue to deteriorate to their ultimate demise? What makes the difference? How can individuals and societies increase their resilience, and not only progress but be enhanced because of their misfortune? According to Hengboonyapan et al. (2012), who detail the empowering effects of transforming disaster victims into assistants in relief operations, lessons learned are powerful contributions in preparing others for similar events to minimize the impact on individuals and communities. Disaster mitigation provides for alleviation of the natural and environmental hazards that can produce harm during disasters, and it can promote more timely recovery (Schwab, 2010). In many countries prone to vector-borne disasters or rapidly spread contagious diseases, primary health nurses work within the community to eliminate breeding places, distribute mosquito nets, teach oral rehydration techniques, and implement preventive measures to avoid disease outbreaks such as cholera. Nurses educate the community through direct contact, posters, media, and by teaching school children songs or verses about measures that can be done inexpensively to make a difference. Animated short films such as “The Story of Cholera”, “Malaria Prevention”, and “Oral Rehydration” are available on the Internet site You Tube, and they disseminate the message clearly and in a medium appealing to people of all ages. The same principles apply to other vector-borne diseases. Disaster management is a team effort: in 2005, the United States’ Federal Emergency Management Agency (FEMA) refined the Incident Command System (ICS) utilizing experts from multiple disciplines. The result was an international standard of core competences for responding to disasters and improving on-site relief operations (FEMA, 2014). Reviews of lessons learned have shown that the system improved the outcome of many disasters where there was a lack of central communication, and maximized the usage of limited material resources and personnel. is the system has been used internationally, with many countries recognizing after catastrophic disasters that faulty management was the greatest hindrance to improved outcomes. Nurses are part of the medical response, but in the Haiti earthquake a major © 2014 Wiley Publishing Asia Pty Ltd.
problem was that international aid agencies sent plenty of doctors to care for victims, but there were insufficient nurses to look after them (Desjaradins & Dellorto, 2010). One of the projects presented in September 2013 at a meeting of nurses from 35 countries convened by two World Health Organization Regions, will never make headline news because the scale of the disaster paled in comparison with larger catastrophes, but it nevertheless threatened to overcome the resources available. In the summer of 2013, Kiribati a tiny island in the South Pacific experienced a disaster that did not make international news because it is such a small country with a small population. There was an outbreak of vomiting and diarrhea that was documented as rotovirus with 20 patients on the first day and over 900 within eight days, mostly children under five years; however there were victims of all ages (Cati & Robate, 2013). Strategies employed to minimize the spread included: effective outreach by mobile teams to vulnerable areas; the assessment and treatment of children with symptoms; the promotion of good general hygiene (proper hand washing, clean surroundings, boiling of drinking water and simmering for 10–20 min after boiling); eating only cooked food; the use of media, such as radio spots (about the outbreak and prevention and early reporting to clinic); environmental health (sampling drinking water and determining from the results the cause of diarrhea and vomiting). Public health clinics remained open 24 h (with personnel working in shifts), undertaking triage and rapid assessment of cases, and deployment of staff working after hours where necessary. The lessons learned and plans for improvement began to be implemented just a month after the disaster. Presentations at the 2013 meeting included other examples of nursing interventions in disasters and measures that minimized damage and maximized resilience and recovery. Nurses are critical to the outcome of disasters because in some countries they are the main healthcare providers: Larui and Pego (2013) reported that in the Solomon Islands a tsunami and dengue fever outbreak posed major dilemmas for nurses. The natural disaster was familiar, but the dengue fever was new because only malaria had previously occurred in the islands. Knowledge about recognition of the disease and its treatment was needed quickly. Lessons learned were that nurses responded swiftly and effectively because of the generalist preparation, and the country’s national disaster plan involving nurses, which is aimed towards risk reduction. It has a two-pronged approach: one prong focuses on predisaster actions (understanding the hazards, establishing the institutional arrangement, and taking action on risk reduction), while the other focuses on when disaster strikes (management of response and relief to address the impacts and recovery, fix the damage, rehabilitate livelihoods, and reduce future risk). doi: 10.1111/nhs.12132
2
Editorial
Involvement of victims in evacuation center operations minimizes the trauma of the disaster and facilitates healing (Chulalongkorn, 2013). Thailand’s disaster management is the model from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), which focuses on before (preparedness and prevention mitigation), during (disaster impact, response, and relief or emergency management), and after (rehabilitation and reconstruction) the event. Fighting. Local Heroes (Hengboonyapan et al., 2012) is a booklet containing stories of volunteers and their experiences of providing aid during disasters, and it includes experiential wisdom from survivors which are inspirational examples of resilience. Nurses may want to lead disaster relief, but often they serve as team members. Well educated and prepared nurses, and those who are “adaptable, creative, innovative critical thinkers, able to be collaborative, with knowledge of public health and infection control, are needed to intervene effectively in the face of unexpected situations with extremely limited resources” (Bonito & Fritsch, 2013). The challenge for nurses is to become involved in disaster mitigation, serve on local, regional, and national disaster planning organizations, promote education and organize regular drills for readiness, and consider the value in working with victims to resolve shortages at the scene. Resilience increases with new knowledge and experience. Involvement in mitigation, disaster preparedness, community collaboration in nursing education along with focus on critical thinking, simulations of disasters, creativity, and decision making will enhance nurses’ readiness to respond effectively to all types of disasters confronting the world today. Nurses have a major role in mitigating disasters and to increase individual and community resilience. Marcia A. Petrini, PhD, FAAN Wuhan University, 115 Donghu Lu, Wuhan, China
© 2014 Wiley Publishing Asia Pty Ltd.
REFERENCES Bonito S, Fritsch K (eds). Nurses and Midwives in Action During Emergencies and Disasters Case Studies from the Western Pacific Region. Geneva: World Health Organization, 2013. Cati I, Robate M. Emergency and Disaster in Kiribati. Bangkok: APEDNN, 2013. Chulalongkorn PMH. Building Community Resilience: Strategies, Facilitating Factors and Lessons Learnt from Thai Communities. Bangkok: APEDNN, 2013. Desjaradins L, Dellorto D. (2010) Haiti awash in doctors; nurses in short supply. CNN. January 25, 2010. http://edition.cnn.com/2010/ WORLD/americas/01/25/haiti.doctors.nurses/. Edwards E. Resilience: Reflections on the Burdens and Gifts of Facing Life’s Adversities. New York: Broadway Books, 2009. Federal Emergency Management Agency. (2014) Incident Command System. U.S. Department of Homeland Security. February 26, 2014. http://www.fema.gov/incident-command-system/. Hengboonyapan D, Nuntaboot K, Tongboonchoa K. Fighting. Local Heroes. Bangkok: Thai Health, 2012. Larui M, Pego C. Integrated Response To Natural Disasters And Emerging Infectious Diseases Solomon Islands. Bangkok: APEDNN, 2013. Schwab JC. Hazard Mitigation: Integrating Best Practices into Planning. Planning Advisory Service Report No. 560. Chicago, IL: American Planning Association, 2010.
