Comptencies, Scope of Practice in Disasters Aust free essay sample

It will give emphasis to four main proficiencies those being nursing competencies, expanded scope of practice, ethical practice and the ability to respond in disasters. The emphasis of this assignment will commence with the issue of nursing competencies within a disaster region and will define what a nursing competency actually is. It will also describe some nursing competencies that have been set in order to ensure that an international nursing workforce is ready, willing and able to respond in the case of a disaster. Following on from the issue of nursing competencies is that of a nurses extended scope of practice when working in a disaster hit local. It illustrates how the nursing role not only develops into a managerial role but also how there is a necessity for further education and training specific to that of disaster management in order to ensure there is a readily available workforce to respond to a disaster situation. The next nursing competency to be brought to the forefront is that of ethical practice which demonstrates how there is a code of practice that nurses follow and outlines that if nurses are having to practice in a disaster region they may be confronted with both challenging and ethical decision that need to be made. It will also establish the numerous elements that a nurse will be face with when choosing to practice ethically in the face of adversity along with the legal and accountability issues that these nurses are to endeavour. The final competency to be brought into focus is that of the ability to respond to a disaster. This sub-topic will concentrate on the disaster management continuum at take a glimpse at prevention, mitigation, preparedness, response and recovery phases of the continuum. Competencies The International Council of Nurses (ICN) (2006) has worked tirelessly for more than 100 years to bring nurses and nursing to the forefront of the healthcare profession worldwide and has ensured that quality nursing care and education has been implemented and maintained on an international level. The ICN also illustrate how the skills that nurses possess can not only assist in developing disaster preparedness programs but also when responding to an actual disaster. Birnbaum (2002) describes that until recent times, core competencies for nurses working in disaster zones were unheard of but with the dramatic increase of disasters occurring, the situation is predicted to continually worsen in the years to follow it is important now more than ever before to formulate and implement competencies which nurses must abide by in disasters. Some factors that are said to contribute to the ver increasing disasters are climate change, increased building in disaster prone areas, unplanned urban growth, natural barrier loss, lack of warning systems and also the lack of system’s ability to move populations from disaster to safe areas. The Hyogo Framework for Action (2005) was adopted by 168 countries in 2005 and is a 10 year blueprint for the reduction of disaster. The goal of this fra mework is not only to reduce the number of lives lost as a result of various disasters but also to reduce the economic, social and environmental losses to communities. Nurses and midwives are viewed by WHO (2007) as being essential in response to a disaster, but also notes that the lack of training provided for dealing with disasters as a major flaw in the disaster and emergency response worldwide. Therefore, it is essential that all nurses and midwives are trained in disaster nursing and meet these competencies just like any other competencies they are required to meet, in order to be effective when disaster strikes. Geebie and Qureshi (2002) explain how they believe that disaster nursing requires individuals to use their nursing knowledge and skills in difficult situations with limited resources and ever changing conditions. During these difficult times it is essential that nurses can adapt their practice to be disaster specific in order to minimise life-threatening damage and health hazards caused by the disaster. Jennings-Sanders, Frisch amp; Wing (2005) demonstrate that nurses, other healthcare professionals, emergency services, and both non-governmental and governmental organizations must work in collaboration during these situations in order for the best outcome to prevail. It is essential in a disaster situation that nurses involved in the care of patients must be able to shift their focus from one patient too many patients, as the operational focus of the disaster changes from that of initially life-saving and emergency response to that of public health and hazard prevention. It is essential for nurses to realise that no matter where the disaster that they are expected to work within the parameters of law for the particular nation, region or state that they are working. Seda (2002) defines nursing competence as the demonstration and applicable application of a nursing knowledge, skills, and judgement at an above average level. This definition of nursing competence can be used to underpin both the generalist nursing competencies and the disaster nursing competencies by the ICN. Due to the varying complexities and array of disasters nurses are often faced with, Wynd (2006) elucidates that there is an essential need for a common set of competencies to be formulated, which will assist nursing staff to work internationally, in a variety of settings with both other nurses and healthcare professionals from all over the world. The competencies listed below will ensure that there is a global nursing workforce ready, willing and most important able to respond in the event of a disaster:- 1. Create more consistency in the care given; 2. Build confidence; 3. Promote shared aims; 4. Assist nurses in their attempts to function as a successful member of the multidisciplinary team; 5. Assist nurses with their attempts to function effectively within the organisational structure; 6. Allow for a more unified approach; 7. Facilitate and more professional approach; 8. Facilitate communication; and 9. Facilitate the global deployment of nurses when disaster strikes. Hyrd (1995) believes that competencies facilitate the support, learning and assessment of nurses and will be able to serve as a guide for the curriculum development and ongoing education and training programmes and the establishment of competencies for nurses in the disaster settings. They are also used when creating position descriptions, but most importantly they allow the individual nurse practitioner to evaluate their own knowledge, skills and ability. It is these competencies that allow each individual to make decisions with regards to the appropriateness of their work assignments and any additional education they will need. Expanded Scope of Practice Davies and Moran (2005) illustrate how nurses fill varying roles throughout the continuum of disaster management although their roles are most often associated with life preservation and health maintenance within the response phase of a disaster. However, they also eluded that the nursing role in a disaster is indispensable and as varied as nurses are not used just in the initial response phase, but are used from preparedness for a disaster right through the continuum to long-term recovery from a disaster. Birnbaum (2002) depicts that nurses undeniably play a key role in disaster and crisis situations. Nurses have been shown throughout history to be at the forefront of those called upon for help when disaster strikes. Nursing staff are required in these crisis situations due to the skill that they possess such as care giving skills, leadership and adaptability plus a wide range of other skill which can be implemented in a variety of crises. It is shown by Davies and Moran (2005) that it is important that disaster response teams need to include an educated healthcare workforce which are able to respond quickly in times of crisis and be able to work in all areas of the disaster continuum. The scope of practice for nurses in Australia is legislated and has professional standards set as competency standards, codes of ethics, conduct and practice. A nurses scope of practice can be affected by numerous items including the context in which the practice, the health requirements of the patients, the nurses level of competence and experience, the policy, quality and risk management of the organisation plus education and qualifications. Jennings-Saunders (2004) illustrates that up until recently Australia like many other countries have had a laze fair attitude to that of education for disaster nursing. Minimal if any education in disaster nursing is taught at universities for undergraduates, with relatively new post graduate courses offered in disaster nursing which is obviously optional if an individual show a particular interest in this area of study. Amazingly, Weiner, Irwin, Trangenstein amp; Gordon (2005) illustrate how in the United States of America education in disaster nursing had been part of the nursing curriculum until the early 1970’s and although it was very limited it did cover the basics of disasters and the nursing role. It was phased out and not until the late 1990’s that disaster preparedness was also added into the curriculum and as the impact of both natural and man-made disasters has started to affect an increased population the content covered has increased accordingly. Mosca, Sweeney and Brenner (2005) describe how globally, education in disaster nursing has unfortunately been very similar to that of the USA and with the ever increasing curriculum demands for nurses and the under developed competencies in disaster nursing causing education in this field to be sparse at best. As a result of the lack of education and under developed competencies in this area of nursing there is a workforce that is greatly unprepared with minimal or no competency in disaster nursing. Ethical Practice Deeny, Davies, Gillespie and Spencer (2007) illustrate how nurses are expected to practice within a code of ethics which emphasises the respect of human rights and sensitivity to values and customs, dignity, fairness and justice. It is important to remember when nurses are tested with having to practice in a disaster they are confronted with challenging and ethical decisions in the face of limited available resources. Smith (2007) explains how in times of disasters, nurses are often faced with making decisions for the greater good of the community rather than that of individuals. This can often be a difficult process, as nurses are trained to be a patient advocate and strive for the best for each individual patient rather than the provision of optimal health services at a community level. Chapman and Arbon (2008) Nurses, who work internationally at times of crisis, are confronted with the culture and values of the community they are working in and must exhibit the upmost respect within the norms of that culture. It is essential for nurses not be become so involved in the mechanics of the disaster response so that they ignore the respect, dignity and cultural norms of the community affected by disaster. There are numerous elements a nurse must contend with as elucidated by Qureshi et. al. 2005) if they are to practice ethically when faced with adversity, firstly the collaboration with others in order to identify and address ethical challenges they will or are being faced with. Secondly, the protection of the rights, values and dignity of both individuals and communities, followed by the assurance of practicing within the cultural, social and spiritual beliefs of the individuals and communities. Next, maintaining confidentiality in both communication and documentation i s a disaster situation is another essential role in ethical nursing. Another element of practicing ethically is being able to understand ones one personal belief’s and how those beliefs can impact on the disaster response. The final element of ethical practice when nursing in disasters is being able to describe how security issues and ethics may clash. The ethical practice of disaster nursing is shown by Chapman and Arbon (2007) can branch out into the legal issues faced by nurses practicing in disaster zones most importantly is to ensure that you practice in accordance with all applicable laws in the regional, state, nation and of course internationally. Another legal issue faced by nurses practicing in disaster areas is the understanding of how laws and regulations which are actually specific to disasters can impact on nursing practices and disaster survivors. Smith (2007) shows, that the next legal issue facing nurses practicing in disaster areas is the recognition of the legal role of public health in order to protect the community. Also, it is essential for nurses to understand the legal implications of disasters and emergency events. Finally it is essential for nurses practicing in disaster regions to be able o describe the legal and regulatory issues facing them including working as a volunteer, the roles and responsibilities of volunteers, the abandonments of patients, the adaption of standards of care, the role and responsibilities to an employer and delegation. Perry (2007) illustrates another divergence from that of ethical issues facing disaster nursing is that of accountability. It is essential that when nursing in disaster regions you accept accountability and responsibility for you own actions along with the ability to delegate to others in order to follow all applicable laws and regulations in a disaster setting. Also essential in the disaster setting is the ability to identify your own limits in terms of knowledge, skills and abilities and ensure that you practice in accordance with them. Another accountability which faces those nursing in disaster is to ensure that you practice in accordance with the law and regulations governing nurses and their nursing practice. The final accountability is probably seen by nurses as the most important and that is being the advocate for the provision of safe and appropriate care for our patients. Ability to Respond http://www. polity. org. za/polity/govdocs/green_papers/disaster/gpdm2-3. html WHO (1999) describes Figure 1 the disaster management continuum as a continuous process which was calculated in order to lessen harm to populations, infrastructure and development struck by disasters and ensure community resilience is built. The phases of a disaster are not sequential and can overlap and simultaneously occur along with the length of each phase varying.