NURSING MANAGEMENT

1. DISASTER
MANAGEMENT
Presented by,
Hitha Udayabhanu
2nd year MSc Nursing

2. INTRODUCTION
According to WHO (2005), an emergency is a
situation where a sudden incident or event has
occurred and normally used local responses will
suffice to care for this situation without calling in
outside help.

3. DISASTER MANAGEMENT
Disaster is a natural damage occuring to the people in the
community and environment, causing complications and
altering their normal life.
The disaster occuring in the community cannot be
handled alone, therefore it requires combined team force.

4. DEFINITION
Hazard
Hazard is an unusual drastic event that can be natural
or can be caused by humans and affects the survival of
human life.

5. Disaster
Disaster is the destructive event that causes loss of
human life, affecting the health of the humans and
causing financial loss.

6. The United Nations Office for Disaster Risk Reduction
(UNISDR,2009) defines disaster as:
“A serious disruption of the functioning of a
community or a society involving widespread human,
material, economic or environmental losses and impacts
which exceed the ability of the affected community or
society to cope using its own resources.”

7. TYPES OF DISASTERS
 Unexpected onset of hazards or geological and
climatic hazards
 Manmade environmental hazards
 Industrial and Technological hazards
 Wars and civil strives
 Epidemic hazards
 Natural disasters
 Man-made disasters

8. ORGANISATIONAL RESPONSE TO
DISASTERS
During a disaster, healthcare organisations must ensure
the safety of staff members, volunteers and patients, state
and federal accreditation standards. These standards ensure
that health care organisations have disaster management
plans including plans for assessment and mitigation and
potential hazards planning and evaluation.

9. DISASTER PLAN
Every hospital should create a disaster plan to manage
disaster conditions including enhancement and
coordination of medical performance and additional
important skills.

10. PRINCIPLES
1. Mobilization of manpower within short notice.
2. Predefined and prepared site with required
infrastructure.
3. Delegation of competencies.
4. Ensuring smooth run of the routine hospital work.
5. Availability of resources on the existing base.

11. JOINT COMMISSION STANDARDS FOR
HEALTH CARE ORGANIZATION
DISASTER PLANNING
The standards cover 5 areas defined as critical to disaster
operation plans. It includes:
 Communication
 Resources and assets
 Safety and security
 Staff responsibilities
 Utilities management
 Patient clinical and support activities

12. COMMUNICATION
 Communication includes the surveillance, identification and
communication of emergencies to appropriate authorities.
 Organisations has to plan methods of communication within
the organisation and within the community emergency
response infrastructure.
 Loss of phone lines, fax and computer access can seriously
disrupt the communication.

13. RESOURCES AND ASSETS
 Management of resources and assets is critical to
provide care and services.
 It requires the organization to identify the culture of
the organization and its role within the community.
 The disaster response plans should have open access
for food and shelter to the community.

14.  Disaster management plans should include the necessary
pharmaceutical supplies, non-medical supplies like food,
water and linens.
 Budgeting and planning should be made to upgrade the
infrastructure, PPE, disaster surveillance monitoring
resources and decontamination of equipment during
nuclear, biological or chemical exposure.

15. SAFETY AND SECURITY
 In establishing the plans, the safety and security of staff,
patients and volunteers and the management of resources
and supplies must be considered.
 Security measures may be the responsibility of the
organization to involve in the local, state or federal
agencies at various intervals.
 Provisions for management, isolation and
decontamination of potential hazardous radioactive,
biological and chemical products need to be defined in
the emergency plans.

16. STAFF RESPONSIBILITIES
 During the disaster, the staff roles and expectations
are determined by the emergency needs, report
routes etc
 Prior to an actual disaster, staff are expected to take
disaster training and disaster practice scenarios to
provide effective care during the disaster.

17. UTILITIES MANAGEMENT
 The disaster management plan needs to include how
healthcare organisations will continue to provide
essential utilities to support care.
 Supplies of water, fuel, electricity, waste disposal,
medical gases, ventilation and vacuum systems must be
identified.
 Include an estimate of how long care can be provided
with the current resources and what may be needed
depending on the type of disaster.
 Alternative vendor sources, resource sharing and
resource management need to be addressed in the plan.

18. PATIENT CLINICAL AND SUPPORT ACTIVITIES
 During a disaster, the health care organizations focus is to
provide emergency services to protect life and to prevent
further disability.
 Basic sanitation needs must be addressed.
 Plans must include provision of care for special needs
population, mental health care and mortuary services.

19.  The health care organizations must have plans to
manage patients through all phases of expected
assessment, treatment, admissions, discharge,
transfer or evacuation.

20. ROLE OF LOCAL GOVERNMENT IN
A DISASTER
The local governments has the first hand knowledge
of your communities, social, economic, infrastructure
and environmental needs, helping them to provide
support in a disaster.

21. The role of local government under the Disaster
Management Act 2003 is to:
 Have a disaster response capability.
 Approve a local disaster management plan.
 Ensure local disaster information is promptly given
to the district disaster coordinator.

22. Local Disaster Management Group
Local governments appoint local disaster management
groups. Their role is to:
 Develop review and assess effective disaster
management practices.
 Help local government to prepare a local disaster
management plan.
 Ensure the community knows how to respond in a
disaster.

23.  Identify and coordinate disaster resources.
 Manage local disaster operations.
 Ensure local disaster management and disaster
operations integrate with state disaster management.

24. DISASTER MANGEMENT PLAN

25. PRACTISING AND EVALUATING
DISASTER DRILLS
 Disaster plans provide the framework for disaster
response, without practice and drills.
 Disaster training should be included in all staff
orientation sessions, included in annual competency
updates.
 These should be evaluated for changes and plans
redesigned based on lessons learned during drills to
ensure continuous quality improvement.

26.  Drills are a vital way to test new equipment and to
provide additional training to staff.
 Disaster response drills should occur on weekends,
holidays and non-day light hours.
 Apart from the drill experiences, the evaluators who
are part of health organizations and from outside
observe and record positive and negative
observations.

27.  Being sensitive to feelings of failure, assuring staff
that their honest feedback is vital to eventual safe and
effective care during a disaster drill.
 If changes to the disaster response plan are made, it
should be clearly communicated to the staff.
 Staging a disaster drill may point out potential disaster
plan failures.

28. LEADERSHIP AND MANAGEMENT
IN A DISASTER
Leadership is essential to successful outcomes,
whether in an established organization or during periods
of crisis.
Management is also essential to an organization but
leadership and management skills are not the same set of
competencies.

29. LEADERSHIP SKILLS DURING A
DISASTER
1. Leadership and communication
2. Motivation and trust
3. Flexibility
4. Developing self and others

30. 1) Leadership and Communication
 Leadership may arise from unexpected sources and
clear communication between all levels of authority.
 Communication skills are an integral part of every
leadership competency.
 Strong written verbal communication skills are
integral to importing plans and expected outcomes
throughout the groups.

31. 2) Motivation and Trust
 During initial disaster situation, responders are highly
motivated to succeed.
 Trust and confidence in leadership is essential in
disaster situations.
 Leadership gains trust and confidence from followers
partially by the role assigned and training for the
assigned role.
 Leaders must appear decisive, thoughtful and
confident.

32. 3) Flexibility
 The leader must assess the plan for improving the
opportunity and proceed with updated and new
information.
 Unexpected obstacles and incomplete or inaccurate
information must be reassessed and improvements
are made.
 In disaster situations, thoughtful but rapid response
is needed and creative thinking is essential.

33. 4) Developing self and others
 Development of self and others are skills that are
instituted and fostered by effective leaders.
 The effective leader seeks continuous self-
improvement and must be comfortable with change.
 Although common disaster scenarios can be
anticipated and practiced, the real event rarely
follows the same planning scenerio.

34. LEGALAND ETHICAL
CONSIDERATIONS IN A DISASTER
 Legal issues present an area of concern for all nurses
practising disaster nursing care.
 The legal framework affecting disaster nursing is
complex and constantly evolving.
 Hence it is imperative, that the nurse intending to
practice in a disaster situation should well aware of
the potential legal issues that can affect the practice.
 The nurses must stay up-to-date on changes in the
laws affecting the practice.

35. Ethical considerations
 Before engaging in the legal and ethical discussions
surrounding disaster nurses, it is important for
volunteer responders to understand the laws and
ethics behind the disaster response.
 Social values, medical practice and the law are not
static creatures.
 In the course of normal medical practice, several
issues arise requiring consultations from lawyers,
risk mangers or ethicists.

36. PSYCHOLOGICAL REACTION TO A
DISASTER
1) Pre-School (1-5years)
 Fearfulness
 Nightmares
 Clinging to parents
2) Early childhood (5-11 years)
 Night terrors, nightmares, fear of dark.
 Aggressive behaviour at home or at school.
 Poor concentration in school.

37. 3) Adolescence (14-18 years)
 Irresponsible
 Poor concentration
 Hypochondria
4) Adulthood
 Distress and depression
 Irritability, blunting of feelings
 Lack of interest
 Insomnia, poor concentration

38. HEALTH SECTOR INVOLVEMENT
IN DISASTER MANAGEMENT
National organization
 It is important responsibility of all the state cabinet
to provide protection from all kinds of disaster.
 There is a team of members such as cabinet
secretary, who have the team contacts.
 The assessments of the disaster and releases the
funds and makes plan to provide relief to the affected
people.

39. State level organization
There is usually the in-charge staff from state cabinet
to provide relief activities for the people affected from
the disaster.
District level organization
A district level coordination and review committee is
constituted, it is headed by the Collector as Chairman
with participation of all other related agencies and
departments.

40. Community level Helper (CLH)
 Any community when faced with a disaster displays a
response to the situation by the local people who
immediately come forward to help. They are called
community level helper.
 They play a vital link between the affected population
and the helping agencies.
 The CLH provides psychological support during their
daily visits like health education, discuss health
problems, motivate individuals, hold group meetings,
organize educational activities etc.

41. NATIONAL
ORGANIZATION
STATE
ORGANIZATION
DISTRICT LEVEL
ORGANIZATION
COMMUNITY LEVEL
HELPERS

42. ROLE OF A NURSE DURING
DISASTERS
Immediate care provider
ICN, INC initiates and motivates the nursing community
to provide care immediately by training disaster team
nurses in every health centre
Government and Voluntary organizations
The concerned state government and the voluntary
organization constitute a core team, which manages the
team of disaster nurses, health team members,
paramedical workers.

43. Human rights
The rights of the affected victims should not be violated at
any time during and after the disaster.
Maintain social justice and equality
All the victims should receive equal core impartially in
terms of social class, caste or race or religion.

44. Accountability
Every member in the health team should be responsible
in the administration of the disaster care and should keep
the case recorded. The members are accountable for the
health of the victims during the disaster.
Relief development and planning
Plan effectively to manage the disaster by receiving the
resources in time for providing relief to the victims who
experienced the disaster.

45. Prevention, mitigation and preparedness activities
It is necessary to:
 Be familiar with methods of raising public awareness.
 Be informed of disease and behaviour patterns
associated with the disaster.
 Be aware of associated physical and mental health and
socio-economic and nursing needs.
 Actively participate in strategic planning and
implementing disaster plans.

46.  Urge the development and implementation of relevant
policies, procedures and legislation.
 Celebrate World Disaster Reduction Day every
October.

47. Relief response
 Assist in efforts to mobilize the necessary resources.
 Work with existing capacities, skills, resources and
organizational structure.
 Assist with resettlement programme, psychosocial,
economic and legal needs.
 Partner with independent, objective media, local and
national branches of government, international agencies and
non-governmental organisation.
 Provide care for those who are providing direct services.

48. HOSPITAL DISASTER MANUAL
I. Introduction
II. Distribution of responsibilities
III. Chronological action plan

49. MANGERIAL ISSUES IN DISASTER
MANAGEMENT
 Clinical issues
 Administrative issues
 Documentation
 Police documentation
 Communication
 Friends and relatives

50.  Involvement of voluntary workers
 Blood donation activity
 Donation of foods, clothes, drugs etc
 Patients property

51.  Press and broadcasting services
 Ambulance services
 Emergency lights
 Disposal of dead
 VIP visits
 Uneccessary crowding