NCM 120 - ICN Framework of Disaster develop educational curriculum that integrates

Nursing Competencies the disaster management continuum with the

competencies.
The ICN Disaster Nursing Competencies were
developed after an analysis of existing The competencies were organized under
competency frameworks in the area of public four areas:
health, mental, health, health care workers, 1. Mitigation/prevention competencies;
emergency managers, nursing and disaster 2. Preparedness competencies
nursing. Training materials and curricula were 3. Response competencies; and
examined to understand the intended outcomes 4. Recovery/rehabilitation competencies.
of the programmes. Important to the
development of the Within the four areas, 10 domains were
competencies were two disaster nursing identified:
competency documents: 1. Risk reduction, disease prevention and health
(1)Educational Competencies for Registered promotion;
Nurses Responding to Mass Casualty Incidents 2. Policy development and planning;
(Stanley, 2003), and (2) Core Competencies 3. Ethical practice, legal practice and
required for Disaster Nursing accountability;
(Yamamoto, 2004). All efforts were made to 4. Communication and information sharing;
incorporate the concepts from these two 5. Education preparedness;
documents into competencies. 6. Care of the community;
7. Care of individuals and families;
The focus of the ICN Disaster Nursing 8. Psychological care;
Competencies is the generalist nurse. 9. Care of vulnerable populations;and
 All nurses are expected to be able to 10.Long-term recovery of individuals, families
demonstrate these competencies. and communities
 Competencies related to specialty nursing
such as emergency nursing, paediatric
nursing and public health nursing were
not specifically incorporated into the
document.
 It is anticipated that competencies of
specialty nurses would be integrated with
core competencies of the ICN Framework
of Competencies for the Generalist Nurse.
 It should not be forgotten that the ICN
generalist nurse competencies serve as the
foundation of the ICN Disaster Nursing
Competencies A. Mitigation/Prevention
Competencies;
Disaster nursing involves systematic application 1. Risk Reduction, Disease Prevention and
of basic nursing competencies and disaster Health Promotion
nursing competencies to the disaster situation. 1.1 Risk Reduction and Disease Prevention
In developing the competencies, an organizing (1) Using epidemiological data evaluates the risks
structure was and effects
identified to ensure that all aspects of disaster of specific disasters on the community and the
nursing were population
included in the competencies. The “disaster and determines the implications for nursing.
management (2) Collaborates with other health care
continuum” was selected as the organization professionals,
structure for several reasons: community organizations, government and
• It is a process recognized throughout the world; community
nursing roles are integrated through it; leaders to develop risk reduction measures to
• It provides a consistent way to organize the reduce the
competencies; and it enhances the ability to vulnerability of the populations.
(3) participates in planning to meet health care
needs in a
disaster. (5) recognizes the disaster plan in the workplace
(4) Identifies challenges to the health care system at the time of a disaster.
and works (6) Participates in disaster planning and policy
with the multidisciplinary team to mitigate the development.
challenges. (7) Contributes to the development, evaluation
(5) Identifies vulnerable populations and and modification of community disaster plan.
coordinates (8) Ensures thar the needs of vulnerable
activities to reduce risk. populations are included in the community
(6) Understands the principles and process of disaster plan (including children, women,
isolation, pregnant women, individuals with mental or
quarantine, containment and decontamination physical disabilities, older people and other
and assists vulnerable person/households).
in developing a plan for implementation in the (9) Interprets role(s) of nurses in relation to other
community. members of the team.
(7) Collaborates with organizations and (10) Participates politically and legislatively in the
governments to build development of policies related to disaster
the capacity of the community to prepare for and preparedness and response.
respond (11) Describes the role of public health disaster
to a disaster. and how it relates to the nurse’s role.

1.2 Health Promotion

(1)Participates in community education activities A. Mitigation/Prevention
related to disaster preparedness. Competencies;
(2)Assesses the community to determine pre- Prevention/mitigation is the process designed to
existing health issues, prevalence of disease, prevent or
chronic illness and disability and the health care minimize the risks related to disaster.
resources in the com munity. Identifying risk and taking appropriate action
(3)Partners with others to implement measures may prevent a
that will reduce risks related to person-person disaster altogether or reduce the effects of the
transmission of disease, sanitation and foodborne disaster.
illness. Lessons learnt from actual incidents, training and
(4)Participates in planning to meet the health exercises
care needs of the contribute to the development of action plans that
community such as, mass immunization and describe what actions should be taken to reduce
medication administration programmes. or
(5)Works with the community to strengthen the eliminate long-term risks to human life and
health care system’s ability to respond the health safeguard the
care system’s ability to respond to recover from a community or reduce the potential effects of a
disaster. disaster.

2. Policy Development and Planning Competencies;

(1) Demonstrates an understanding of relevant Prevention/mitigation can incorporate
disaster In Bangladesh, early warning systems that direct
terminology. residents to
(2) Describes the phases of disaster management evacuate to shelters have been improved. The
continuum: approach
prevention/mitigation, preparedness, response can involve policy development or legislative
and activities.
recovery/rehabilitation. Examples include legislation that prohibits
(3) Describes the role of government and building in floodprone areas, requirements for
organizations in immunizations, safety codes, building codes to
disaster planning and response. make buildings safer and public
(4) Understands the community disaster plan and education. Role for the general public in reducing
how it risks to self and property by taking measures that
relates to national and international response prevent or mitigate the
plans. impact of disaster.
A. Mitigation/Prevention
Competencies; risk are all part of nursing’s role. Ongoing
Nurse’s Role: community
>identifying risks both at the community and education related to identification and
individual level. elimination of health
> works with other health professionals to and safety risks in the home or community is
determine major another area
disease risks, collaborates on developing plans to where nurses bring expertise.
reduce
identified risk, and assists in the development of B. Preparedness Competencies
surveillance 3. Ethical Practice, Legal Practice and
systems related to disease outbreaks. Accountability
>Nurses perform community needs assessments 3.1 Ethical Practice
to determine (1) Collaborates with others to identify and
the pre-existing prevalence of disease, the address ethical challenges.
susceptibility of (2) Applies the national approved ethical
health facilities and identification of vulnerable framework to support decision-making
populations, and prioritizing.
such as those with chronic disease, mental health (3) Protects the rights, values and dignity of
problems, or individuals and communities.
disability. (4) Practises in accordance with the cultural,
social and spiritual beliefs of
Nurse’s Role: individuals and communities.
This information provides valuable data for the (5) Maintains confidentiality in communication
disaster plan. and documentation.
The nurse collaborates in developing plans for (6) Understand one’s own personal beliefs and
alternative how those beliefs impact on
housing and other interventions designed to disaster response.
reduce the (7) Describes how security issues and ethics may
vulnerability of these populations. conflict.
Participation in risk reduction activities in health
care facilities to create safe and sustainable 3.2 Legal Practice
environments for care or (1) Practices in accordance with local, state,
identifying alternative sites for care following a national and
disaster is international applicable laws.
another activity that requires the expertise of the (2) Understands how laws and regulations
nurse. specific to disaster impact
Working in partnership with other health care on nursing practices and disa
providers and (3) Recognizes the legal role of public health to
community leaders, the nurse helps to plan for protect the
the evacuation community in a disaster.
of health facilities and relocation of patients as (4) Understands the legal implications of
required. disasters and emergency
events (e.g. security, maintaining evidence,
Nurse’s Role: confidentiality).
Helping to shape public policy that will decrease
the 5) Describes the legal and regulatory issues
consequences or potential effects of a disaster is related to issues such as:
an important by working as a volunteer;
role because of the nurse’s knowledge of the By roles and responsibilities of volunteers;
community and By abandonement of patients;
the areas of vulnerability. Working with policy- By adaptation of standards of care;
makers to By role and responsibility to an employer; and
identify hazards, the risk such hazards pose to the By delegation
population,
and health infrastructure to develop solutions 3.3 Accountability
that reduce the (1) Accepts accountability and responsibility for
one’s own actions.
(2) Delegates to others in accordance with (7) Provides up-to-date information to the
professional practice, disaster response team regarding the health care
applicable laws and regulations and the disaster issues and resource needs.
situation. (8) Works with the disaster response team to
(3) Identifies the limits of one’s own knowledge, determine the nurse’s role in working with the
skills and abilities in media and others interested in the disaster.
disaster and practices in accordance with them. (9) Understands the process of health information
(4) Practices in accordance with the laws and management in a disaster.
regulations governing (10) Demonstrates an ability to use specialized
nurses and nursing practice. communication
(5) Advocates for the provision of safe and equipment.
appropriate care. (11) Maintains records and documentation and
5) Describes the legal and regulatory issues provides reports as required.
related to issues such as: (12) Communicates identified or suspected health
by working as a volunteer; and/or
By roles and responsibilities of volunteers; environment risks to appropriate authorities (i.e
By abandonement of patients; Public Health).
By adaptation of standards of care;
By role and responsibility to an employer; and 5. Education and Preparedness
By delegation (1) Maintains knowledge in areas relevant to
disaster and disaster nursing.
(2) Participates in drills in the workplace and
3.3 Accountability community.
(1) Accepts accountability and responsibility for (3) Seeks to acquire new knowledge and maintain
one’s own actions. expertise in
(2) Delegates to others in accordance with disaster nursing.
professional practice, (4) Facilitates research in disaster.
applicable laws and regulations and the disaster (5) Evaluates the need for additional training and
situation. obtains required training.
(3) Identifies the limits of one’s own knowledge, (6) Develops and maintains a personal and family
skills and abilities in preparedness plan.
disaster and practices in accordance with them.
(4) Practices in accordance with the laws and B. Preparedness Competencies
regulations governing Preparedness is perhaps the most critical phase in
nurses and nursing practice. the disaster
(5) Advocates for the provision of safe and management continuum.
appropriate care Current events have demonstrated that the focus
on preparedness has been inadequate.
4. Communication and Information Recent disasters further underscore the need for
Sharing preparedness
(1) Describes the chain of command and the planning. The inadequacy of preparedness
nurse’s role within the system. planning in these disasters created chaotic
(2) Communicates in a manner that reflects situations, increasing the suffering of survivors
sensitivity to the and loss of life.
diversity of the population.
(3) Describes the principles of crisis Preparedness is the phase of disaster
communication in crisis management where planning and
intervention and risk management. readiness are a priority.
(4) Identifies and communicates important >The goal is to achieve a satisfactory level of
information immediately to appropriate readiness to respond to
authorities. any emergency situation (Warfield, 2007).
(5) Utilizes a variety of communication tools to >The ISDR defines preparedness as “activities
reduce language barriers. and measures taken in advance to ensure effective
response to the impact of hazards, including the
6) Coordinates information with other members issuance of timely and effective early warnings
of the disaster and the temporary evacuation of people and
response team.
property from threatened locations” (ISDR, 2004, 6) Participates in preventive strategies such as
p. 30). mass immunization activities.
(7) Collaborates with relief organizations to
B. Preparedness Competencies address basis needs of the community (e.g.
>is a continuous process that requires periodic shelter, food, water, health care).
review and revision based on changes in the (8) Provides community-based education
environment, staff changes, new information and regarding health
technology. implications of the disaster.
>Building activities that sustain and improve the (9) Evaluates the impact of nursing on different
capacity to respond is the essential element of populations and cultures and uses evaluation
preparedness. results to make evidence-based decisions.
(10) Effectively participates as part of a
Nurse’s Role multidisciplinary team.
Nurses play a key role in preparedness activities. 7. Care of Individuals and Families
>Policies related to use of unlicensed personnel 7.1 Assessment
including health care providers from outside the (1) performs a rapid assessment of the disaster
disaster jurisdiction or alteration of standards of situation and nursing care needs.
care cannot be created without full involvement of (2) Conducts health history and age-appropriate
nursing. assessment that includes physical
>Nurses provide assessments of community and psychological responses to the disaster.
needs and resources related to health and medical (3) Recognizes symptoms of communicable
care which contribute to the planning activities. disease and takes measures to reduce
>Nurses develop and provide training to other exposure to survivors.
nurses and health professionals, as well as the (4) Describes the signs and symptoms of exposure
community. to chemical, biological.
>Capacity-building through recruitment and Radiological, nuclear and explosive agents.
maintenance of a ready disaster nursing (5) Identifies unusual patterns or clustering of
workforce illnesses and injuries that may indicate exposure
>In addition, nurses are involved in leadership to biological or other substances related to the
roles, planning, disaster.
participating in, and evaluation of readiness (6) Determines need for decontamination,
exercises to assure isolation or quarantine and takes appropriate
that the community, and the nursing workforce action.
itself, is prepared in the time of an emergency or (7) Recognizes health and mental health needs of
disaster. responders and makes
>Collaboration with planners, organizations 7.2. Implementation
involved in disaster relief, government agencies, (1) Implements appropriate nursing interventions
health care professionals and community groups including
to develop the preparedness plan is vital. emergency and trauma care in accordance with
accepted scientific principles.
C. Response Competencies (2) Applies critical, flexible and creative thinking
6. Care or Communities to create solutions
(1) Describes the phase of community response to on providing nursing care to meet the identified
disaster and the implications for nursing and anticipated
interventions. patient care needs resulting from the disaster.
(2) Collects data regarding injuries and illnesses (3) Applies accepted triage principles when
as required. establishing care based
(3) Evaluates health needs and available on the disaster situation and available resources.
resources in the disaster affected areas to meet (4) Adapts standards of nursing practice, as
basic needs of the population. required, based on
(4) Collaborates with the disaster response team resources available and patient care needs.
to reduce hazards and risks in the disaster- (5) Creates a safe patient care environment.
affected areas. (6) Prepares patients for transport and provides
(5) Understands how to prioritize care and patient safety during transport.
manage multiple (7) Demonstrates safe administration of
situations. medication, vaccines and immunizations.
(8) Implements principles of infection control to responders.
prevent the spread of disease. (9) Identifies survivors and responders requiring
(9) Evaluates outcomes of nursing actions and additional mental
revises care as health nursing support and refers to appropriate
requires. resources.
(10) Provides care in a non-judgmental manner.
(11) Maintains personal safety and the safety of 9. Care of Vulnerable Populations ( Special
others at the scene of a disaster. Needs Populations)
C. Response Competencies (1) Describes vulnerable populations at risk of a
12) Documents care in accordance with disaster disaster (e.g. older persons, pregnant women,
procedures. children, and individuals with a disability or
(13) Provides care in a manner that provides chronic conditions requiring continued care) and
cultural, social, spiritual identifies implications for nursing including:
and diverse background of the individual. (a) physical and psychological response to the
(14) Manages the care of the deceased in a disaster of vulnerable populations; and
manner that respects the (b) unique needs and high risks of vulnerable
cultural, social and spiritual beliefs of the populations associated with the disaster.
population as situation (2) Creates living environments that allow
permits. vulnerable populations to
(15) Manages health care activities provided by function as independently as possible.
others. (3) Advocates for the needs of the vulnerable
(16) Works with appropriate individuals and populations.
agencies to assist (4) Identifies available resources, makes
survivors in reconnecting with family members appropriate referrals and collaborates with
and loved ones. organizations serving vulnerable populations
(17) Advocates for survivors to other groups or impacted by a disaster.
agencies as needed. (6) Consults with members of the health care
(18) Refers survivors to other groups or agencies team to assure
as needed. continued care in meeting special care needs.
The response phase encompasses the immediate
8. Psychological Care action taken in the
(1) Describes the phase of psychological response face of a disaster.
to disaster and Ø It includes the mobilization of responders to
expected behavioural responses. the disaster area.
(2) Understands the psychological impact of Ø In the response phase, the objective is to save as
disasters on adults, many lives as
children, families, vulnerable populations and possible, provide for meeting the immediate
communities. needs of the
(3) Provides appropriate psychological support survivors and reduce the longer-term health
for survivors and impact of the
responders. disaster.
(4) Uses therapeutic relationships effectively in a Ø This phase may last a few days to several weeks
disaster situation. depending on the
(5) Identifies an individual’s behavioural magnitude of the disaster.
responses to the disaster C. Response Competencies
and provides appropriate interventions as Nurse’s Role:
required (e.g >providing both physical and mental health care.
psychological first aid). >Managing scarce resources, coordinating care,
C. Response Competencies determining if
(6) Differentiates between adaptive responses to standards of care must be altered, making
the disaster and appropriate referrals,
maladaptive responses. triage, assessment, infection control and
(7) Applies appropriate mental health evaluation
interventions and initiates >Identifying individuals with chronic disease or
referrals as required. disability is a critical
(8) Identifies appropriate coping strategies for responsibility
survivors, families, and
Post Traumatic Stress Disorder, collaborates with. Nursing organizations to
depression and anxiety are resolve issues and
frequently seen in the aftermath of a disaster. The improve response.
nurse must (3) Participates in analysis of data focusing on
continually monitor survivors for signs of mental improvement of
health issues, response.
must provide care and must make referrals, as (4) Identifies areas of needed improvement and
necessary. communicates those
Roles include advocacy for patients and survivors, areas to appropriate personnel.
teaching, and (5) Assists the community in transitioning from
leadership and management. the response phase of
Nurses must monitor responders to assure that the disaster/emergency through recovery and
mental health or rehabilitation to
physical care is not needed. normal functions.
Additionally, nurses provide onsite training to (6) Shares information about referral sources and
other nurses and resources used in
health care workers and volunteers. the disaster.
In this phase, nurses often work as part of a (7) Assists in developing recovery strategies that
health care team and improve the quality
collaboratively with other responders to provide of life for the community.
assistance to as (8) Collaborates with appropriate groups and
many survivors as possible. agencies to re-establish
During the response, nurses use their skills in health care services within the community.
epidemiology to Once immediate needs are met, the recovery
identify patterns of illness to detect any threat of phase can begin.
communicable In this phase, work is concentrated on assisting
disease or other health hazards. the community and
They also collect data on injuries and illnesses the affected population recovers from the impact
seen during the of the disaster.
disaster, which are later communicated to >restoring vital services, rebuilding infrastructure
epidemiologists for and housing, and
analysis. meeting the needs of the population while
10.Long-Term Care Needs assisting them to
10.1 Individual and Family Recovery restore their lives.
(1) develops plans to meet short- and long term > is a long-term process
physical and Nurse’s Role:
psychological. Nursing needs of survivors. >providing care and support to those with
(2) Identifies the changing needs of survivors and physical and mental
revises plan of care health needs.
as required. >Those injured or ill or those with chronic
(3) Refers survivors with additional needs to disease, mental health
appropriate illness, or disability must be monitored to reduce
organizations or specialists. the risk of
(4) Teaches survivors strategies for prevention of complications.
disease and injury. >do referrals
(5) Assists local health care facilities in recovery. >evaluates the disaster plan and champions
(6) Collaborates with the existing health care required changes to
community for health improve the management of the disaster and the
maintenance and health care. disaster’s impact
(7) Serves as an advocate for survivors in meeting on the population..
long term needs. >providing documentation and evaluating
D. Recovery/Rehabilitation Competencies
10.2 Community Recovery
(1) Collects data related to the disaster response
for evaluation.
(2) Evaluates nursing response and practices
during the disaster and