Accepted Manuscript

Discussion on the Training of Disaster-related Nursing Competencies of Emergency

Nurses

Xu Yehua, Zeng Xia

PII: S2352-0132(15)30051-X
DOI: 10.1016/j.ijnss.2016.04.009
Reference: IJNSS 184

To appear in: International Journal of Nursing Sciences

Received Date: 1 November 2015

Revised Date: 9 December 2015
Accepted Date: 27 April 2016

Please cite this article as: X. Yehua, Z. Xia, Discussion on the Training of Disaster-related Nursing
Competencies of Emergency Nurses, International Journal of Nursing Sciences (2016), doi: 10.1016/
j.ijnss.2016.04.009.

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[Title Page]

Discussion on the Training of Disaster-related Nursing Competencies of

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Emergency Nurses

Xu Yehua, Zeng Xia

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Sichuan Provincial People’s Hospital

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Correspondence information: Xu Yehua, Sichuan Provincial People’s Hospital,

No. 32, Section 2, 1st Ring Road (West), Chengdu City, Sichuan,

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155122743@qq.com, 13541337196
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Necessity for Disaster-Related Nursing Competency Training of Emergency Nurses in
China

Abstract: Emergency nurses play an important role in disaster site rescue, classifying
the injured, transportation, safety nursing, psychological nursing, health education,
health quarantine, and other aspects of disaster relief. Factors underlying the
medium–low disaster response ability of emergency nurses in China were analyzed.
This study presents several recommendations on training of emergency nurses on

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disaster-related nursing competencies.
Key words: emergency nurses; disaster-related nursing competencies; disaster relief

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Disaster refers to any events that can cause facility damage, serious economic
losses, casualties, human health hazard, and deterioration of community health service

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conditions. Disaster occurs when the destructive power exceeds the compensating
capacity of the affected region and inhabitants need to seek external assistance[1]. In
recent years, world disasters have occurred frequently and gradually shown
large-scale, long-term, and intensive trends. Mass casualties and damage derived from

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disasters threaten the health care system and test the competencies of doctors and
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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
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preparedness of emergency nurses directly determines the success of disaster-related

nursing, which considerably affects disaster responses and recovery of the injured
person after the calamity[2,3]. However, surveys[4–7] show that most nurses are
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incompetent in disaster-related nursing.

Disaster-related nursing education and training are vital for disaster prevention
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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
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knowledge and skills[8,9]. In the 512 Wenchuan, 414 Yushu, 420 Lushan, and 425
Niboer earthquakes, emergency nurses in our hospital successfully completed rescue
missions and accumulated substantial practical experience in rescue. However,
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response to these disasters revealed the lack of disaster-related professional

knowledge and rescue skills in some nurses. Therefore, disaster emergency nurses
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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
gradually established a set of integrated management systems for pre-hospital,
in-hospital, and critical care emergency treatments as well as set up a full range of
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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 natural 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

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department nurses; the results indicated (1) low participation of disaster rescue
nursing personnel; (2) insufficient training of nurses in the emergency department
triage; (3) lack of knowledge on disaster nursing; (4) lack of comprehensive,

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standardized, and systematic disaster nursing education; (5) insufficient disaster
nursing continuing education and training efforts; and (6) research lag on disaster
nursing in China.

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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. According to domestic and foreign surveys, the disaster preparedness of

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emergency nurses in China is at medium level[12–14] and must be improved.
Li Yule[9] and other domestic scholars investigated the disaster nursing capacity
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in China; these scholars concluded that the overall level of disaster nursing ability is
low, resulting in weak disaster responses and highlighting the shortage of competent
nurses for responding to disasters. Li Zhen[12]and other researchers reported that most
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emergency nurses know the importance of disaster nursing but lack relevant
knowledge and training. Moreover, the level of participation of these nurses is low.
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3 Analysis of factors influencing the disaster nursing ability of emergency department

nurses
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3.1 Educational degree

Effective disaster responsiveness is influenced by high education degree, long
educational duration, great content, and abundant disaster knowledge and skills of
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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
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Chinese nurses with college degrees or higher was 56% in 2012, and those with
undergraduate and higher education was only 10.6%.
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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
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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

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Training course, content arrangement, method, and training cycle affect the
ability of emergency nurses to respond to disasters. Li fan[16] compared
disaster-related nursing education and training locally and abroad in terms of contents

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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

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simple training formats. This study highlights the need and urgency of developing
disaster-related nursing education and training.
3.5 Others

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Disaster nursing science started late in China and is currently in the exploration
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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
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prevention, mitigation, preparedness, and relief as well as in post-disaster

reconstruction work. A disaster nursing professional training system must be
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developed rapidly to overcome the insufficient disaster-related nursing competencies

of emergency nurses[17].
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4 Recommendations on improving the disaster nursing ability of emergency

department nurses
4.1 Strengthening the systematic disaster nursing continuing education and training
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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].
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4.1.1 Disaster nursing theory training

This type of training should tackle the following: (1) general knowledge of
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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 environment, 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
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syndrome; and (6) CBRN training.
4.1.2 Disaster nursing skills training
This type of training should include the following: (1) professional 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.

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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.

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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

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sufficient supply of emergency material reserves, including life and medical supplies,
must also be maintained.
4.2 Variety of training methods

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Instead of simple model of traditional classroom teaching, various methods, such
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as theory teaching, simulation exercises, role play, practice skills, movie watching,
and case discussions 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
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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
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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,
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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
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give advices using actual rescue scene pictures, audio, video, cases, and their own
rescue experience[19].
4.3 Strengthen scientific research of disaster nursing
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Nurses should be encouraged to actively carry out disaster nursing research,

summarize, promote relevant experience in disaster nursing, and expand the field of
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disaster research[20].
4.4 Take advantage of male nurses
In disaster relief cases, male nurses possess unique advantages over female
nurses in both physiological and psychological 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
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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.
5 Conclusion
China commonly encounters natural and man-made disasters. 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 preparedness
of emergency nurses for disaster relief, systematic disaster nursing education and

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training must be strengthened. 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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