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Discussion

Necessity for disaster-related nursing competency

training of emergency nurses in China

Yehua Xu*, Xia Zeng

Sichuan Provincial People's Hospital, Chengdu City, Sichuan, China

article info abstract

Article history: Purpose: : Discuss on the disaster-related nursing competency training of Chinese emergency
Received 1 November 2015 nurses.
Received in revised form Methods: : By retrieving concerned literatures, summarize the current situation of disaster
9 December 2015 responses of Chinese emergency nurses and the impact factors of disaster-related nursing
Accepted 27 April 2016 competencies.
Available online 25 May 2016 Results: : The disaster preparedness of emergency nurses in China is at a medium level and
must be improved. The impact factors include the educational degree, gender, disaster
Keywords: relief experience, training, and mechanisms for domestic disaster relief.
Emergency nurses Conclusion: : As a direct response to disaster, emergency nurses should improve the
Disaster-related nursing comprehensive ability of disaster nursing by systematic disaster nursing education and
competencies professional training
Disaster relief Copyright © 2016, Chinese Nursing Association. Production and hosting by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/).

Disaster refers to any events that can cause facility damage,
serious economic losses, casualties, human health hazard,
and deterioration of community health service conditions.
Disaster occurs when the destructive power exceeds the
compensating capacity of the affected region and in-
habitants need to seek external assistance [1]. In recent
years, world disasters have occurred frequently and gradu-
ally shown large-scale, long-term, and intensive trends.
Mass casualties and damage derived from disasters threaten
the health care system and test the competencies of doctors
and nurses. Emergency nurses, which are an important part
of the disaster rescue team, constantly fight in the front line
of the operation. An appropriate disaster preparation plan is
a key to effectively and timely address disasters. The degree
of disaster preparedness of emergency nurses directly de-
termines the success of disaster-related nursing, which
considerably affects disaster responses and recovery of the
injured person after the calamity [2,3]. However, surveys
[4e7] show that most nurses are incompetent in disaster-
related nursing.
Disaster-related nursing education and training are vital
for disaster prevention and mitigation. However, disaster-
related nursing education began late in China, and clinical
nurses in China have not received systematic disaster-related
nursing training or higher education; hence, these nurses lack
the required disaster-related nursing knowledge and skills

* Corresponding author.
E-mail address: 155122743@qq.com (Y. Xu).
Peer review under responsibility of Chinese Nursing Association.
http://dx.doi.org/10.1016/j.ijnss.2016.04.009
2352-0132/Copyright © 2016, Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 3 ( 2 0 1 6 ) 1 9 8 e2 0 1
[8,9]. In the 512 Wenchuan, 414 Yushu, 420 Lushan, and 425
Niboer earthquakes, emergency nurses in our hospital suc-
cessfully completed rescue missions and accumulated sub-
stantial practical experience in rescue. However, response to
these disasters revealed the lack of disaster-related profes-
sional knowledge and rescue skills in some nurses. Therefore,
disaster emergency nurses from different levels and positions
must be trained through different forms of education and a
scientific, professional, standardized disaster relief nursing
team must be established.
1. Status and role of emergency nurses in
disasters
Since its establishment in 2008, the emergency center in our
hospital has constantly improved the infrastructures, acquired
advanced technology and equipment, and optimized the layout
of various professional disciplines; the center has also gradu-
ally established a set of integrated management systems for
pre-hospital, in-hospital, and critical care emergency treat-
ments as well as set up a full range of equipment, young staff,
and high-level emergency medical personnel. Emergency
nurses serve as vanguard of disaster rescue and are involved in
disaster site rescue, classification of the injured, transportation,
safety nursing, psychological nursing, and health education;
these nurses also participate in health and quarantine in nat-
ural and man-made disasters and public health emergency
rescues both locally and abroad [5,10]. Emergency nurses are an
integral component of disaster relief operations [11].
2. Current situation of disaster responses of
emergency department nurses
Wang [2] studied the current situation of disaster responses of
emergency department nurses; the results indicated (1) low
participation of disaster rescue nursing personnel; (2) insuffi-
cient training of nurses in the emergency department triage; (3)
lack of knowledge on disaster nursing; (4) lack of comprehen-
sive, standardized, and systematic disaster nursing education;
(5) insufficient disaster nursing continuing education and
training efforts; and (6) research lag on disaster nursing in China.
The level of disaster preparedness of nurses indicates their
ability to respond to disasters. This factor also determines the
speed and efficiency of the entire disaster relief team. Ac-
cording to domestic and foreign surveys, the disaster pre-
paredness of emergency nurses in China is at medium level
[12e14] and must be improved.
Li Yule [9] and other domestic scholars investigated the
disaster nursing capacity in China; these scholars concluded
that the overall level of disaster nursing ability is low, result-
ing in weak disaster responses and highlighting the shortage
of competent nurses for responding to disasters. Li Zhen [12]
and other researchers reported that most emergency nurses
know the importance of disaster nursing but lack relevant
knowledge and training. Moreover, the level of participation of
these nurses is low.
199
3. Analysis of factors influencing the
disaster nursing ability of emergency
department nurses
3.1. Educational degree
Effective disaster responsiveness is influenced by high edu-
cation degree, long educational duration, great content of
learning, and abundant disaster knowledge and skills of
emergency nurses [5,12]. In China, the educational degree of
nursing staff is relatively low. The “Chinese health statistics
yearbook data in 2013” released by the Chinese National
Health and Family Planning Commission reported that the
percentage of Chinese nurses with college degrees or higher
was 56% in 2012, and those with undergraduate and higher
education was only 10.6%.
3.2. Gender
In the study of Li Zhen [12], the knowledge reserve of male
nurses was higher than that of the female nurses. Disaster
relief is usually faced with harsh field conditions, heavy load,
and intensive and long-term work. Male nurses exhibit
improved physical fitness, endurance, and other physiological
advantages, especially in moving, lifting, transporting, and
other physical work. When faced with emergency incidents,
male nurses are highly resilient against pressure and are
willing to accept challenges and difficult work to confront
negative events in the disaster site. These advantages could
explain the higher interest of male nurses on knowledge in
disaster nursing [15].
3.3. Disaster relief experience
Nurses who participated in disaster field rescue have gained
adequate practical experience and psychological endurance.
These nurses understand the characteristics of rescue work
and can view the shortage of disaster-trained nurses from
multiple angles. Nurses are targeted to strengthen relevant
knowledge and skills to improve the disaster nursing capacity
of the country. Li [6] stated that disaster field rescue enables
nursing staff to realize the importance of improving disaster
rescue ability to enhance their awareness and motivation to
learn.
3.4. Training
Training course, content arrangement, method, and training
cycle affect the ability of emergency nurses to respond to di-
sasters. Li fan [16] compared disaster-related nursing educa-
tion and training locally and abroad in terms of contents and
forms of education and training practice. The results indicated
shortage in disaster-related nursing education and training
resources in China, particularly few disaster-related nursing
courses in colleges, incomprehensive training contents, and
simple training formats. This study highlights the need and
200 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 3 ( 2 0 1 6 ) 1 9 8 e2 0 1
urgency of developing disaster-related nursing education and
training.
3.5. Others
Disaster nursing science started late in China and is currently
in the exploration stage. The present related system and
mechanism of disaster prevention, disaster reduction, and
disaster relief are unsound. Disaster relief work places a high
demand on emergency nurses. Except for participating in
disaster emergency rescue, nurses should possess certain
disaster management abilities, particularly in disaster pre-
vention, mitigation, preparedness, and relief as well as in
post-disaster reconstruction work. A disaster nursing profes-
sional training system must be developed rapidly to overcome
the insufficient disaster-related nursing competencies of
emergency nurses [17].
4. Recommendations on improving the
disaster nursing ability of emergency
department nurses
4.1. Strengthening the systematic disaster nursing
continuing education and training
Different training plans must be developed in accordance with
different levels of disaster nursing knowledge. Local and
foreign studies in recent years suggested that disaster nursing
training content include the following aspects [16,18].
4.1.1. Disaster nursing theory training
This type of training should tackle the following: (1) general
knowledge of disaster includes disaster-related concepts,
such as treatment techniques for common disaster diseases,
disaster epidemiology, and disaster emergency preparedness
of nurses; (2) disaster psychological intervention, such as
psychological counseling for disaster victims and rescue
workers, management of posttraumatic stress disorder, and
communication skills; (3) protection of disaster rescue
worker's occupation, including knowledge about the envi-
ronment, epidemics, safety, and survival; (4) disaster nursing
management, which covers hospital infection control and
ambulance management, nursing information management,
and disaster relief coordination; (5) common emergency
nursing knowledge, such as emergency nursing principles
of thoracoabdominal injury, craniocerebral injury, burn,
extrusion, fracture, and shock syndrome; and (6) chemical,
biological and nuclear knowledge training.
4.1.2. Disaster nursing skills training
This type of training should include the following: (1) profes-
sional skills training, including triage, judgment of injury
severity, wounded transport, nursing records, medical staff
occupational protection, and accident treatment skills; and (2)
first-aid skills training, which covers basic first-aid skills, such
as cardiopulmonary resuscitation, bleeding bandage, fracture
fixation, artificial airway establishment, emergency use of
drugs and equipment, use of rescue equipment, and survival
skills.
4.1.3. Disaster rescue plan and rehearsal
The disaster rescue plan includes a disaster warning system,
an emergency plan, and a rescue plan for groups of patients.
4.1.4. Preparation of manpower and material resources
A healthy body is a basis for rescue work. Emergency nurses
should exercise, enhance their own physical fitness, and be
prepared for rescue at any time. A sufficient supply of emer-
gency material reserves, including life and medical supplies,
must also be maintained.
4.2. Variety of training methods
Instead of simple model of traditional classroom teaching,
various methods, such as theory teaching, simulation exer-
cises, role play, practice skills, movie watching, and case dis-
cussions can be combined. Experts can be invited to provide
comments and recommendations. Enthusiasm should be
instilled in nurses. Moreover, nurses should be trained to
analyze problems from different points of view and master
learned knowledge for practice and improve practical rescue
skills. In recent years, an increasing number of experts have
promoted the use of simulation scene, in which psychological,
technological, and first-aid training are integrated. This
approach would not only exercise the ability of nurses to
respond to the scene, judgment agility, and infield disposal
ability but also exercise team collaboration, communication,
and other skills. In this training process, each nurse can
determine one's own weakness in a specific training. The
teachers with abundant rescue experience can be invited to
give advices using actual rescue scene pictures, audio, video,
cases, and their own rescue experience [19].
4.3. Strengthen scientific research of disaster nursing
Nurses should be encouraged to actively carry out disaster
nursing research, summarize, promote relevant experience in
disaster nursing, and expand the field of disaster research [20].
4.4. Take advantage of male nurses
In disaster relief cases, male nurses possess unique advan-
tages over female nurses in both physiological and psycho-
logical aspects, rendering the former more suitable for
disaster relief work. Therefore, male nurses must focus on
their daily work, such as mental health, work performance,
learning and communication platform, favorable growth
environment, and confidence and pride in nursing work.
4.5. Others
With increasing need for international disaster relief, basic
English language training should be included in the routine
training plan. Domestic and international communication
and cooperation must also be improved. Nurses should learn
from domestic and international research and experience on
disaster nursing to improve disaster nursing ability.
 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 3 ( 2 0 1 6 ) 1 9 8 e2 0 1
5. Conclusion
China commonly encounters natural and man-made di-
sasters. As a direct response to disaster, the disaster nursing
ability of emergency department nurses directly affects the
result of disaster rescue. To address the low level of pre-
paredness of emergency nurses for disaster relief, systematic
disaster nursing education and training must be strength-
ened. The ability of emergency nurses for disaster nursing
must also be improved to reduce community loss and health
hazards caused by disasters.
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