PRACTICE IMPROVEMENT

READINESS: HOW PREPARED ARE YOU? Authors: Cathleen A. Evans, MSN, RN, CEN, CNE, and Mary Baumberger-Henry, PhD, RN, Chester, PA

Disaster education is important for everyone and especially nurses. Being informed, making individual and family communication plans, and creating the needed supplies to shelter in place or evacuate for one’s self and family are required core readiness

behaviors. Nurses also need to understand their role within the employer’s emergency plans and incident command structure. All of these behaviors help the nurse to be ready and available to care for patients during disaster and emergency incidents.

embers of the nursing profession engage with patients during experiences of health and illness in many different care environments, and when a disaster occurs, that environment changes. This article offers evidence from the literature that supports the need for emergency readiness. The Ready Campaign, which was launched in 2003 by the Federal Emergency Management Agency (FEMA), is a call for the nation to be ready. To be ready includes being informed about what to do before, during, and after a disaster; making a plan for communication to prepare for and stay informed during emergencies; and building a kit with essentials including food, water, clothing, and medicine. 1 If nurses do not have basic core readiness, for themselves and for their families, they face the quandary of whether to report for or stay at work to care for others. There is a difference between willingness to report and stay and having the readiness to report and stay. The latest 2013–2014 National Snapshot Report of Public Health Preparedness 2 by the Centers for Disease Control and Prevention (CDC) continues the call for nurses and health care providers to be on task for emergency readiness. Readiness is the “knowledge, skills and attitudes that transition abilities to change outcomes” (C. A. Evans, MSN, RN, CEN, CNE, unpublished manuscript, 2012). Prepared nurses send a clear message regarding the profession’s commitment to the public that nurses will be available and ready to care for patients during a disaster or

emergency incident. However, if a disaster occurs and nurses do not have basic core readiness for themselves and their families, the likelihood of their availability to care for patients becomes an unknown. A look at the United States level of disaster readiness was examined in a 2009 Citizen Corps National Survey (N = 4461). Data indicated that just half of the respondents had gathered emergency supplies. 3 Interestingly, this study took place during the 2009 H1N1 virus outbreak, demonstrating the value of measuring actual versus perceived preparedness. In 2011, a federal survey measured preparedness with a citizen sample (N = 3211) from 8 central states. Findings indicated that two thirds of the participants were aware of basic emergency preparedness 4; however, no measurable gains in the actual behaviors of being informed, making a plan for communication, and building a kit were found since the 2009 Citizen Corps National Survey was conducted. 5 These surveys indicate that the level of awareness is important and growing but that a gap in actualized behaviors translates to a lack of readiness on the part of individual citizens. Registered nurses likely have disaster readiness awareness but often lack efficacious disaster readiness behaviors. During hurricanes Katrina and Rita, a survey conducted of health care professionals (N = 725), which included registered nurses (n = 214), identified gaps related to surveillance information, work environment, and other disaster and emergency preparedness and training. 6 Nurses’ perceptions of emergency preparedness knowledge were again measured in 2 separate state studies in Wisconsin and South Carolina. Each study rated overall familiarity with emergency preparedness at a mean of 2.29 using a 1 to 5 Likert scale, with 1 being not familiar and 5 being familiar. 7,8 Mass casualty events, incidents that have an impact on a large area and last longer than an hour, and disasters, regardless of the type, have patterns. If these risk patterns are recognized, preincident plans can be made to meet basic human needs. 9 Emergencies, in contrast to disasters, are unforeseen circumstances that require immediate action 10 and can potentially occur during a disaster. Nurses, as the

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Cathleen A. Evans, Member, BuxMont Chapter, is Visiting Instructor, School of Nursing, Widener University, Chester, PA. Mary Baumberger-Henry, Member, New Jersey Chapter, is Associate Professor, Widener University, Chester, PA. For correspondence, write: Cathleen A. Evans, MSN, RN, CEN, CNE, School of Nursing, Widener University, One University Place, Chester, PA 19013; E-mail: [email protected]. J Emerg Nurs ■. http://dx.doi.org/10.1016/j.jen.2014.03.006 0099-1767/$36.00 Copyright © 2014 Published by Elsevier Inc. on behalf of Emergency Nurses Association.



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TABLE 1

National documents associating emergency and disaster readiness and health care Document

Web site

Health Care at the Crossroads: Strategies for Creating and Sustaining Community Wide Emergency Preparedness Systems 2003 Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 9 (2009) American Nurses Association Professional Definition (2010) and Code of Ethics (2001) Healthy People 2020 (2013) The National Preparedness Goal (2013) 2013-2014 National Snapshot of Public Health Preparedness (2013)

http://www.jointcommission.org/assets/1/18/ emergency_preparedness.pdf

largest and one of the most trusted sectors of health care personnel, 11 have the power to make a positive impact on community resiliency after a disaster or emergency. Nurses may be involved within the community response either as a first responder, providing care and expertise upon arrival at the incident scene, or as a first receiver, administering care for patients at a receiving health care organization. Disaster or emergency incidents, no matter how large, become local phenomena, and without health care providers positioned in treatment/consultation areas and without supplies with which to provide care, the impact of longterm outcomes, particularly with affected vulnerable populations, cannot be predicted with any reasonable confidence. This situation may translate to low-staff/highpatient ratios, regardless of whether the nurse is in the role of a first responder or a first receiver. Consistent empirical evidence from 2 research studies have indicated that health care workers (N = 6248) 12 and nurses (N = 1339) 13 are often able to respond, but the commonly identified barriers of child, elder, family, and pet care and transportation are barriers to being available to provide patient care. Moreover, fear, concerns for family and self, and health issues, either as a result of personal history or the incident itself, influence and obstruct the willingness to report to work. 12,13 Education supports readiness

Nursing education on disaster topics is critical to knowledge, skills, attitudes, abilities, and the creation of a workforce necessary for the management of human needs during emergencies. 14,15 Nurses need disaster education to implement assessment skills for promoting health and

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http://www.ahrq.gov/professionals/clinicians-providers/ resources/nursing/resources/nurseshdbk/nurseshdbk.pdf http://www.nursingworld.org/ http://www.healthypeople.gov/2020 http://www.fema.gov/national-preparedness-goal http://www.cdc.gov/phpr/pubs-links/2013/documents/ 2013_Preparedness_Report.pdf

preventing harm during the course of a disaster, from preplanning to recovery. It is important to note that no mass causality or largescale incident is an event managed alone by health care professionals. Fire, police, EMS, governmental, private sector, and faith-based organizations are all involved in a large-scale event. Through disaster education the nurse develops a working knowledge of the roles and functions of the incident command structure, which is designed to promote communication, organization, and resource management. 16 In addition, it is important that nurses have an understanding of their purpose, function, and role within their employer’s emergency preparedness plan whether they are working or off work. Emergency events may be internal or external to health care organizations, requiring a nurse to be available and capable of providing best patient care while managing an incoming patient surge and determining alternative sites for care or reverse triage of current patient populations. Such decisions require focused thinking and again support the concept that if nurses have a plan for themselves and their families, then the nurses will be available and willing to engage in nursing’s professional priority, patient care. Six national documents support the need for nurses to be educated in disaster and emergency preparedness (Table 1). The Joint Commission, 17 the major health care accrediting organization in the US, has established standard measures for organization preparedness, including staff employment roles, responsibilities, and methods to provide patient care to vulnerable populations affected by a disaster/emergency incident. Next is the Agency for Healthcare Quality and Safety publication Patient Safety

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TABLE 2

Recommended emergency supplies a Basic Kit

• 1 gallon of water per person per day for drinking and sanitation • At least a 3-day supply of nonperishable food • National Oceanic and Atmospheric Administration battery-powered weather radio with tone alert • Flashlight and extra batteries • First-aid kit • Whistle to signal for help • Infant formula and diapers • Moist towelettes, garbage bags, and plastic ties for personal sanitation • Dust mask or cotton t-shirt to help filter the air • Plastic sheeting and duct tape to shelter in place • Wrench or pliers to turn off utilities • Nonelectric can opener Clothing and Bedding If you live in a cold weather climate, one complete change of warm clothing and shoes per person, including: • A jacket or coat • Long pants • A long-sleeved shirt • Sturdy shoes • A hat and gloves • A sleeping bag or warm blanket for each person and rain gear Other Essentials • Mess kits, paper cups, plates, and plastic utensils • Cash or traveler’s checks, change • Paper towels • Fire extinguisher • Tent • Compass • Matches in a waterproof container • Signal flare • Paper, pencil • Personal hygiene items, including feminine supplies • Disinfectant • Household chlorine bleach to be used as a disinfectant (diluted 9 parts water to 1 part bleach), or in an emergency, to be used to treat water (16 drops of bleach per gallon of water); do not use scented bleach, color safe bleach, or bleach with added cleaners • Medicine dropper • Important family documents such as copies of insurance policies, identification, and bank account records in a waterproof, portable container Data from, Ready Campaign.1 a Customize each family or individual kit to meet specific needs, such as medications and infant formula.

and Quality: An Evidence-Based Handbook for Nurses. 18 In Chapter 9, Phillips, Hughes, and Savits relate safety, emergency preparedness, and knowledge translation to



health care and nursing’s primary mission, patient care. Third, the American Nurses Association 19 professional definition for nursing and Code of Ethics 20 establish

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constitutive and contextual values of the professional nurse, engaging the obligation for nurses to have disaster readiness. Fourth, the National Preparedness Goal of 2011 requires a ready workforce in support of resilient communities, 21 of which nurses are members, along with being the largest sector of health care providers. 11 The fifth document, Healthy People 2020, 22 established preparedness as a new topic and objective. A constitutive value of the nursing profession is promoting health and preventing harm for patients during life cycle experiences within the environment of care. Lastly, the 2013 CDC National Snapshot of Public Health Preparedness 2 report presents the current state of all-hazard readiness for the US. The report highlights national and state achievements, which are many, but the call for attention is clear for 3 identified critical gaps. These needs include improving health security through monitoring and response for threats, such as infectious disease, weather-related events, or terrorism; protecting people through individual, workforce, and agency infrastructure readiness; and strengthening collaboration by having all health care agencies and providers be ready to manage public health needs during all-hazard events.

How does a nurse prepare for readiness?

The FEMA Ready Campaign and the latest 2013 CDC report continue to promote “resilient individuals and communities,” 2 providing an appropriate opportunity for every nurse to become involved and increase their individual level of preparedness. A nurse can begin the journey to readiness by utilizing the many free resources available at the Web Site, http://www.ready.gov. The Ready Campaign on this site contains multiple resources, such as Be Informed, which directs a focused look at assessing the community for risks and vulnerabilities. A second resource for readiness is Make a Plan for the communication and emergency care for family, children, elders, and pets. This available tool establishes full and pocket-size resources to provide assurance of the safety and whereabouts of everyone. An additional source is Build a Kit. Each individual nurse and family member needs a kit with consumables to meet their basic needs of food, water, medicines, and clothing for 72 hours, and this kit should be ready to go in the event of sheltering in place (at home or work) or evacuation (Table 2). As mentioned earlier, it is important that nurses be aware of incident command structure. 16 If all agencies involved in an emergency use the same language and have the same reporting and role organization, then incident command structure helps to remove confusion during

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multiagency disasters. The Incident Command System (ICS 100) for Healthcare/Hospitals is a 3-hour online Webbased course from FEMA and is an education opportunity appropriate for nurses to help establish an awareness level of the all-hazard, all-agency communication. Only when nurses are prepared can they influence the readiness of the public before a disaster strikes. If a nurse believes that nursing is a practice discipline with a mission to care for patients, then building, incorporating, and sustaining basic nurse readiness also needs to be an active ongoing professional behavior. Actions promote readiness to report and stay, rather than having willingness to report and stay. Individual nurse readiness supports the profession’s role as care providers of patients, families, and communities. Once nursing is ready, the profession can be at the forefront of motivating a nation to be ready, but the process must begin with the individual nurse. Are you ready?

REFERENCES 1. Ready campaign. Available at: http://www.ready.gov. Accessed April 1, 2014. 2. Centers for Disease Control and Prevention. 2013–2014 National snapshot of public health preparedness. Office of Public Health Preparedness and Response, Department of Health and Human Services. Available at: http://www.cdc.gov/phpr/pubs-links/2013/ documents/2013_Preparedness_Report.pdf. Accessed April 1, 2014. 3. Federal Emergency Management Agency. Personal Preparedness in America: Findings from the 2009 Citizen Corps National Survey. Government Printing Office, Washington, DC; 2009. 4. Federal Emergency Management Agency. Central States Disaster and Earthquake Preparedness Survey Report. Government Printing Office; 2011. 5. Homeland Security. 2012 National Preparedness Report. Available at: http://www.fema.gov/media-library/assets/documents/26675?id=5914. Accessed April 1, 2014. 6. Rogers B, Lawhorn E. Disaster preparedness: occupational and environmental health professionals’ response to hurricanes Katrina and Rita. AAOHN J. 2012;55:197-207. 7. Wisniewski R, Dennik-Champion G, Peltier J. Emergency preparedness competencies: assessing nurse’s educational needs. J Nurs Adm. 2004;34:475-80. 8. McKibbin A, Sekula K, Colbert A, Peltier J. Assessing the learning needs of South Carolina nurses by exploring their perceived knowledge of emergency preparedness: evaluation of a tool. J Cont Educ Nurs. 2011;42:547-58. 9. Flint M, McPhee K, Comninellis N. INMED disaster medicine management self-paced course. Available at: http://courses.inmed.us/self-paced_courses/ disaster_medicine_management/details.asp. Accessed April 1, 2014. 10. Merriam-Webster. Definition of emergency. Available at: http://www. merriam-webster.com/dictionary/emergency. Accessed April 1, 2014. 11. Chen PW. Nurses’ role in the future of health care. Available at: http:// www.nytimes.com/2010/11/18/health/views/18chen.html?_r=0. Accessed April 1, 2014.

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12. Qureshi K, Gershon R, Sherman M. Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82:378-88. 13. Adams LA, Berry D. Who will show up? Estimating ability and willingness of essential hospital personnel to report to work in response to a disaster Online J Iss Nurs. 2012;17:8. 14. Stanley J. Disaster competency development and integration in nursing education. Nurs Clin North Am. 2005;40:453-67. 15. Littleton-Kearney M, Slepski L. Directions for disaster education in the United States. Crit Care Nurs Clin North Am. 2008;20:103-9.

Available at: http://www.jointcommission.org/assets/1/18/ emergency_preparedness.pdf. Published 2003. Accessed April 1, 2014. 18. Hughes RG, (ed.), Patient safety and quality: an evidence-based handbook for nurses (AHRQ Publication 08–0043) Rockville, MD: Agency for Healthcare Research and Quality; 2008. 19. American Nurses Association. Nursing’s social policy statement. American Nurses Association, Silver Spring, MD; 2010. 20. American Nurses Association. Code of ethics for nurses with interpretive statements. American Nurses Association, Silver Spring, MD; 2001.

16. Gebbie K, Qureshi K. Emergency and disaster preparedness: core competencies for nurses. Am J Nurs. 2002;102:46-51.

21. Federal Emergency Management Agency. National preparedness goal. Available at: http://www.fema.gov/national-preparedness-goal. Accessed April 1, 2014.

17. Joint Commission. Health care at the crossroads: strategies for creating and sustaining community wide emergency preparedness systems 2003.

22. US Department of Health, Services Human. Healthy people 2020. Available at: http://www.healthypeople.gov/2020. Accessed April 1, 2014.



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Readiness: how prepared are you?

Disaster education is important for everyone and especially nurses. Being informed, making individual and family communication plans, and creating the...
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