Essay SamplesNo Comments

default thumbnail

Int. J. Environ. Res. Public Health 2014, 11, 3289-3303; doi:10.3390/ijerph110303289
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
Nurses’ Competencies in Disaster Nursing: Implications for
Curriculum Development and Public Health
Alice Yuen Loke
* and Olivia Wai Man Fung
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories,
Hong Kong; E-Mail: [email protected]
* Author to whom correspondence should be addressed; E-Mail: [email protected];
Tel.: +852-2766-6386; Fax: +852-2364-9663.
Received: 12 February 2014; in revised form: 13 March 2014 / Accepted: 14 March 2014 /
Published: 20 March 2014
Abstract: The purpose of this study was to explore Hong Kong nurses‟ perceptions of
competencies required for disaster nursing. Focus group interviews and written inquiry
were adopted to solicit nurses‟ perceived required competencies for disaster care. A total of
15 nurses were interviewed and 30 nurses completed the written inquiry on their perceived
competencies related to disaster nursing. The International Council for Nurses‟ (ICN)
framework of disaster nursing competencies, consisting of four themes and ten domains,
was used to tabulate the perceived competencies for disaster nursing reported by nurses.
The most mentioned required competencies were related to disaster response; with the
ethical and legal competencies for disaster nursing were mostly neglected by nurses in
Hong Kong. With the complexity nature of disasters, special competencies are required if
nurses are to deal with adverse happenings in their serving community. Nurses‟ perceived
disaster nursing competencies reported by nurses were grossly inadequate, demonstrating
the needs to develop a comprehensive curriculum for public health. The establishment of a
set of tailor-made disaster nursing core competencies for the community they served is the
first step in preparing nurses to deal with disastrous situations for the health of the public.
Keywords: competencies; disaster nursing; disaster nursing curriculum
Int. J. Environ. Res. Public Health 2014, 11 3290
1. Introduction
With disasters occurring more frequently threatening people around the world, the need to prepare
nurses for disaster has never been greater [1]. Nurses should be equipped with the necessary
knowledge and abilities to work in a disaster and to meet the needs of the respective serving
community. However, more than 80% of nurses who volunteered to serve for a disaster event had no
previous experience in disaster response [2]. It was recommended by the World Health Organization
(WHO) that all nations, no matter how frequent (or infrequent) the happenings, should prepare
healthcare workers for a disaster. Nevertheless, most nurses were inadequately prepared for
disaster [3]. It is only through education and training can nurses can be equipped with the
competencies required during disasters.
As the largest manpower group in the healthcare team, nurses play an important role in disaster care.
Nurses‟ roles are not only in the emergency phase of a disaster, to rescue life and safeguard the health of
the disaster sufferers, but in fact, nurses have special roles in disaster preparedness and aftermath long-
term recovery [4]. By providing leadership and guidance in different phases of a disaster, nurses can
safeguard the health of the general public and reduce death tolls [5].
Nurses need to be competent in order to deal with disastrous situations. Competency refers to the
actual performance of a person in a specific role, in a given situation [6]. It is defined as a combination
of the knowledge, skills, abilities and behavior needed to carry out a job or special task [7]. Although
there are many sets of competencies being developed to prepare healthcare workers to respond to
disaster, they have been found inconsistent and imprecise. Disaster nursing core competencies specific
to general nurses were limited or not verified. Further effort has to be made and directed toward the
development of an accepted and adapted framework of competency for universal disaster nursing
education [4].
The awareness of disaster preparedness and competencies among Hong Kong nurses is generally
weak [8,9]. With limited research, training and education in the field of disaster nursing in Hong Kong,
it is important to understand nurses‟ perceived competencies in disaster care prior to curriculum
development. A better understanding of nurses‟ perceived competencies and their learning needs for
disaster nursing is the first and essential step if nurse educators and health care administrators are to
launch a disaster nursing course/continuing education program that meet the needs of nurses. This
study adopted the framework of disaster nursing and key competencies delineated by International
Council for Nurses and World Health Organization [10] as the standards to scrutiny Hong Kong
nurses‟ level of competencies for disaster nursing.
The ICN Framework of Disaster Nursing Competencies
With an urge to develop a set of core competencies for disaster nursing education, the ICN launched
a framework of disaster nursing competencies in 2009 for general nurses. It aims to work as a common
set of competencies in disaster nursing for the global nursing workforce and to provide clarification of
nurses‟ role in disasters [10]. The framework of nursing competencies should be applicable globally
and the content can be modified to be culturally specific for different regions and places. It is also
Int. J. Environ. Res. Public Health 2014, 11 3291
emphasized that in-country interpretation of the framework and regular review of the competencies is
important to ensure relevancy to the community served.
The „„ICN framework of disaster nursing competencies‟ was built on the „„ICN framework of
competencies for general nurse‟, which has been widely used as a guideline of nurses‟ competencies at
an international level. The ICN disaster nursing competencies framework was developed according to
the competencies in the areas of public health, mental health, healthcare workers, emergency
managers, nursing and disaster nursing. The framework also based on the two sets of widely-used
disaster competencies for general nurses, the Nursing Emergency Preparedness Education
Coalition [11] for mass casualty incidents and the Centre of Excellence, University of Hyogo (Kobe,
Japan) [12] Disaster Competencies [10].
The ICN framework of disaster nursing competencies consists of four areas in the continuum of
disaster management that corresponds to the four stages of disaster: the prevention, preparedness,
response, and recovery stages. The four areas include ten domains, consists of a total of 130 items, in
which nurses play numerous and multiple vital roles in disaster care and management [10].
2. Study Methods
The aim of this study was to identify nurses‟ perceived competencies for disaster. The study was
divided into two parts: focus group interviews and a written inquiry. The focus group interviews were
to explore the competencies and knowledge of disaster nursing readily reported by the nurses with
minimal guided questions or information. They were, given an explanation of what entails
a disaster at the beginning of the interview sessions. The written inquiry was then followed, which
consisted of a table specifying the four stages of disaster according to the ICN disaster framework as
prompt, and nurses were asked to write down what they considered were the nursing competencies
required for each of the four stages of disaster.
2.1. Participants/Sample Selection
The study focuses on nurses working in the medical/surgical, critical care and community health
settings. These three groups of nurses were selected for their representativeness of the major nursing
workforce during disaster. Medical and surgical nurses constitute the largest group in the nursing
workforce; their competencies represent the competencies of general nursing for disaster care.
The critical care nurses work in high-dependency units including the intensive care unit and the
emergency department; they are the first to response and help victims in disasters. The community
health nurses work closely with the general public, and are most likely to understand the needs of the
community they served. The perceived disaster nursing competencies of these three groups of nurses
could provide a better understanding of the overall competencies level of Hong Kong nurses.
Nurse leaders from specialty associations, with extensive experience in their respective clinical
specialty, were recruited for group interviews. There were four to six nurse leaders from the three
specialties in each of the interview groups. Convenience sampling was used for the written inquiry.
The participants were referred by senior nursing staff in hospitals or clinical settings. A total of thirty
participants, ten from each specialty, were invited to complete the written open-ended inquiry.
Int. J. Environ. Res. Public Health 2014, 11 3292
2.2. Group Interviews
Group interviews were conducted separately among nurses in the three specialities. They were
asked to state the competencies they considered to be necessary to handle disasters in their specialty
area. Simple explanation on the definition of disaster was given. The interviews were tape-recorded
and transcribed within one week after the interview. The interviewer repeated and summarized
the participants‟ stated competencies to get an immediate indication of their agreement that the
summary was a true and comprehensive list of their responses [13]. To ensure accuracy, these initial
sets of compiled competencies were checked by two nurses, who verified the tabulated competencies
separately to ensure exactness [14]. A table is used to summarize the nurses‟ perceived disaster
competencies, which were tabulated according to the specialty areas and according to the domains of
the ICN framework of disaster nursing competencies.
2.3. Written Inquiry
Written inquiry was conducted to further substantiate the findings of the group interviews. Written
forms of data collection have the advantage of putting the participants under less pressure and giving
them time to ponder upon what are being asked. A table listing the four main disaster stages and ten
domains of disaster nursing competencies according to the ICN disaster nursing competencies
framework [10] was given to the nurses in the three specialty groups (general medical/surgical, critical
care and community health) to further substantiate information collected from the group interviews.
The questionnaire was distributed and collected by the researchers in person.
2.4. Data Analysis and Establishing Trustworthiness
Tabulation of the group interview responses was done in a systematic, sequential, verifiable way
separately by the two researchers for the confirmability of the data. The interviews were audio-recorded
and also preserved for repeat auditing. The transcription and tabulation of the data was done within
one week of the interviews. The content (stated competencies) was categorized according to the four
areas and ten domains of the ICN framework of disaster nursing. The tabulation were discussed and
verified by the two researchers for rigor of the study [14].
For the written inquiry, the written responses of the specific competencies were directly categorized
and tabulated under the four stages and 10 domains of the ICN framework of disaster nursing.
The findings of the three interview groups and three written inquiry groups were merged in one table
for ease of comparison.
2.5. Ethical Considerations
Ethical approval was obtained from the institute where the researchers work, and the conduct of
the study was according to the stipulated regulation of the institute. The nurse participants were given
an explanation of the aims of this study, and assured that participation was voluntary. All studies were
completed in anonymity so that their personal identity could not be identified. Participants who willing
to join the group interviews and being recorded, or complete the written inquiry were considered
Int. J. Environ. Res. Public Health 2014, 11 3293
giving an implied consent to the study. The audio-recordings, notes and interview transcripts were
anonymous, and contained only information on the nurses‟ specialties and work experience.
3. Results
3.1. The Participants
A total of 45 nurses participated in the study, the majority of them were female (82%). Group
interviews of 4–6 nurse leaders from the three specialties were conducted separately to explore nurses‟
perceived competencies in disaster management. All were experienced nurses with 3 to 23 years of
experience, averaging of 17.2, 13.8, and 15.3 years of experience in the medical/surgical, critical and
community specialty respectively (Table 1).
A total of 30 participants, 10 from each specialty, were invited in the written inquiry study. They
had 3 to 28 years of working experience in their specialty, with an average of 16.4, 14.7, and
10.7 years of experience in the medical/surgical, critical, and community specialty.
Table 1. Clinical experience of the participants.
Method of Data Collection Medical/Surgical Critical Care Community Unit
Focus groups
No. of participants 6 5 4
Year of Experiences
9–23 years
17.2 years
3–20 years
13.8 years
8–23 years
Open ended inquiry
No. of participants 10 10 10
Year of Experiences
3–24 years
16.4 years
4–28 years
14.7 years
3–15 years
10.7 years
Hong Kong Nurses‟ Perceived Competencies for Disaster
Hong Kong nurses‟ perceived disaster competencies solicited from group interviews and written
inquiry were tabulated under the four main areas (stages of disaster) of the ICN framework of disaster
nursing competencies. The findings are discussed below according to the four stages of disasters
(Table 2).
3.2. Prevention and Mitigation Competencies
From the group interviews, there was consensus of nurses from all three specialties considered:
„„risk assessment and management”, „„provision of appropriate protective materials”, „„development
and planning of organizational guidelines or protocol for disaster management”, and „„planning for
specific incident management” as required disaster nursing competencies. However, only the critical
care and community health nurses regarded „„adhering to infection control principles” and „„the need
for contingency plans for disasters as important competencies in disaster prevention.
Int. J. Environ. Res. Public Health 2014, 11 3294
Table 2. Hong Kong nurses‟ perceived competencies for disaster care reported in focus group interviews (n = 15) and written inquiry (n = 30).
The 4 areas and 10 domains of the ICN Framework of Disaster Nursing Competencies Focus group interviews Written inquiry
(total = 23)
(n = 6)
(n = 5)
(n = 4)
(n = 10)
(n = 10)
(n = 10)
1.Risk Reduction, Disease
Prevention and Health
Risk Reduction and
Disease Prevention (7)
Health Promotion (5)
-Risk assessment and management √ √ √ √ √ √
-Adhere to infection control principles √ √ √ √ √
-Provide appropriate protective materials √ √ √ √
-Knowledge in disaster/illness and primary health care √ √ √
-Practice personal hygiene √ √
-Preparation of health staff and the public in preventing disaster √
-Provide relevant reference materials √
-Work in a multidisciplinary approach to care √
-Understand public health/epidemiology/vaccination √
-Understand causes/mechanisms/prevention of disaster √
2. Policy Development
and Planning (11)
-Development of organizational and unit guidelines/protocol √ √ √ √ √ √
-Provide contingency planning √ √ √ √ √
-Plan (with protocol) for specific incident management √ √ √
-Infection control policy √ √ √
-Public health policy √ √
-Regular review of protocol √
-Risk management policy √
-Fire safety and evacuation plan √
-Quality and safety guidelines √
-Occupational health and safety √
-Manpower deployment plan √ √
Int. J. Environ. Res. Public Health 2014, 11 3295
Table 2. Cont.
The 4 areas and 10 domains of the ICN Framework of Disaster Nursing Competencies Focus group interviews Written inquiry
(total = 29)
(n = 6)
(n = 5)
(n = 4)
(n = 10)
(n = 10)
(n = 10)
3. Ethical Practice, Legal
Practice and
3.1. Ethical
Practice (7)
3.2. Legal
Practice (5)
3.3. Accountability (5)
-Professional obligation to include disaster prevention, response,
plan and recovery in practice

-Follow code of conduct √
-Legal liability and government overall disaster planning √
-Establish, understand and reinforce laws on disaster prevention √
-No discrimination based on gender, religion, nationality, social

-Compliance with Privacy Ordinance √
-Human dignity is important √
-Patient charter √
-According to HK Nursing Council code of conduct √
-Provide complaint system √
-Practice according to professional standard √
-Knowledge of legal practice √
and Information Sharing
-Develop communication skills √ √ √ √
-Debriefing/incident reporting and meeting √ √ √ √
-Use of various tools for communication √
-Establish fast and accurate communication of information
system among government and non-government organizations,
the community, hospitals and wards
√ √ √
-Press release of information √ √
-Yearly review, share information with other countries √
-Use various tools for communication √ √ √
-Familiarity with the data disclosure, communication, and
information according to the guidelines

Int. J. Environ. Res. Public Health 2014, 11 3296
Table 2. Cont.
The 4 areas and 10 domains of the ICN Framework of Disaster Nursing Competencies Focus group interviews Written inquiry
(total = 23)
(n = 6)
(n = 5)
(n = 4)
(n = 10)
(n = 10)
y nurses
(n = 10)
5. Education and
Preparedness (12)
-Provide: drill/audit/talk √ √ √ √
-Knowledge and skill in different disaster situations √ √ √
-Leadership skills √ √ √
-Understand role in disaster assignment √ √
-Basic life support, CPR skills √
-Updating information about new diseases √
-Training in IT and communication skills √
-Skills in psychological intervention √
-Understanding of the nature of disasters √
6. Care of the
Community (11)
-Allocation/distribution of? limited resources √ √ √ √ √
-Knowledge of prioritizing care √ √
-Active participation in rescuing activities √
-Collaboration in community resources/voluntary service √
-Reminder cards for management of specific disasters √
-Care for the safety, security, access of food and water, medical
care, temporary shelters, etc.

-Provide talks and a hotline in service area √
-Community services for different groups, e.g., geriatric
assessment service

Int. J. Environ. Res. Public Health 2014, 11 3297
Table 2. Cont.
The 4 areas and 10 domains of the ICN Framework of Disaster Nursing Competencies Focus group interviews Written inquiry
(total = 40)
(n = 6)
Critical care
(n = 5)
(n = 4)
(n = 10)
Critical care
(n = 10)
(n = 10)
7. Care of Individuals
and Families
7.1. Assessment (7)
7.2. Implementation
-Personal safety, escape route
-Disaster preparedness plan for self and family

-Establish logistics for the care of victims √
-Perform holistic care √
-Help desk for enquiries √
-Form critical incident support team √
-Perform holistic care √
-Familiar with different available resources, support network and referral
for victims and families

-Liaison with related social support √
-Multidisciplinary approach to care √ √
8. Psychological
Care (9)
-Psychological first aid and crisis intervention √ √ √ √
-Psychological assessment and counseling therapies for stressed staff and
victims (form sharing groups)
√ √ √ √
-Knowledge and skills in psychological/social aspect √
-Adopt a multidisciplinary approach to care √ √
-Introduce coping skills and knowledge on disaster care √
-Post-Traumatic Stress Disorder care √
9. Care of Vulnerable
Populations (6)
-Care of neglected groups with special needs √ √
-Work in a multidisciplinary approach to care (voluntary service referral) √ √
-Understanding the needs of vulnerable populations √
-Special care and education for populations particularly vulnerable to
disasters, i.e., those with chronic illness, pregnant women and the fragile
elderly, people with sensory disabilities
√ √
-Ability to identify vulnerable populations √
Int. J. Environ. Res. Public Health 2014, 11 3298
Table 2. Cont.
The 4 areas and 10 domains of the ICN Framework of Disaster Nursing Competencies Focus group interviews Written inquiry
(total = 15)
(n = 6)
Critical care
(n = 5)
(n = 4)
(n = 10)
Critical care
(n = 10)
(n = 10)
10. Long-Term
Individual, Family
and Community
10.1. Individual and
Family Recovery (7)
10.2. Community
Recovery (8)
-Evaluation and planning in prevention and management during and
after a disaster
√ √
-Restoration of normal service √
-Work and support by resources in a multidisciplinary approach to care √
-Knowledge and skill in psychological and long-term care √
-Participate in the development of an ordinance and community-wide
policies to speed up recovery from disaster

-Collaboration between community and family for post-disaster

-Learn and share √
-Systematic long-term care for disaster recovery √
-District support and resource allocation √
Int. J. Environ. Res. Public Health 2014, 11 3299
From the written inquiry, nurses of the three specialties identified that the „„risk assessment and
management” and „„adherent to infection control principles” as important in disaster prevention. Only
the community healthcare nurses considered „„vaccination and epidemiology” as required
competencies in disaster prevention. Whereas, the medical/surgical nurses expressed their concern on
the „„plan of manpower deployment”, the critical care nurses concern about „„occupational health and
safety”, and the community nurses highlighted the significant of „„public health policy in disaster
prevention planning”.
3.3. Preparedness Competencies
In the interviews, “the knowledge of legal and ethical aspects of disaster care” was not addressed by
any of the nurses. While all nurses across the three specialties were well aware of the importance of
“developing good communication skills” and that “debriefing and incident reporting” was necessary.
Education and preparedness for disaster related to “drills, audits or talks”, and the “knowledge and skills
in different disaster situation” were reported by nurses in all three specialties as required competencies.
The findings from written inquiry were somewhat different. All nurses recognized that
„„professional obligation” and „„code of conduct” are the required competencies in disaster care.
The medical/surgical nurses considered „„legal liability” and „„professional code of conducts” should
be reinforced in disaster care. Critical care nurses acknowledged „„human dignity” and „„absence of
discrimination” in disaster care, while the community nurses opined that there is need for „„a complaint
system” and knowledge of „„legal practice”. Nurses from all three specialties considered the need for
„„communication skills and reporting systems” and recommended the „„use of various tools for
communication and information sharing”. Only the medical/surgical nurses were able to point out the
importance of „„updating information about new diseases”, „„training in information technology and
communication skills”, „„skills in psychological intervention”, and „„understanding the nature of
disaster” as essential competencies.
3.4. Response Competencies
The interviews revealed that nurses from all three specialties regarded that „„allocation and
distribution of resources” during a disaster needed to be addressed, and they were concerned about
„„psychological care and crisis intervention” in a disaster. Both medical/surgical and community
nurses regarded it necessary to have „„knowledge of prioritizing care”. Critical care nurses suggested
the use of „„reminder cards for management of specific disasters”, in order to enable efficient triage
and prioritize care. Only the community nurses aware of the fact that the establishment of „„escape
routes and personal safety” as disaster preparedness for the community. They also acknowledged that
there is a need to care of „„vulnerable groups as a neglected population with special needs”.
From the written inquiry, the medical/surgical nurses addressed the need to establish „„logistic for
care of victims”, „„perform holistic care”, and „„help desk for enquires”. The critical care and
community nurses stressed the need for „„multidisciplinary approach to care”. Community health
nurses emphasis the need for psychological care, including „„introduce coping skills and knowledge on
disaster care”, and „„post-traumatic stress disorder care”.
Int. J. Environ. Res. Public Health 2014, 11 3300
3.5. Recovery and Rehabilitation Competencies
The findings of the interviews showed that only medical/surgical nurses talked about the important
to have a plan for „„evaluation and planning in management during and after a disaster”. The findings
of the written inquiry revealed that nurses in all three groups addressed the competencies of post-
disaster care. Medical/surgical nurses identified the need to learn „„restoration of normal services.
Critical care nurses noted the significance of „multidisciplinary approach‟ in the recovery stages of a
disaster and the „knowledge of psychological care for victims‟. The community nurses emphasis the
„collaboration between community and family for post-disaster recovery‟, systematic long-term care
for disaster recovery”, and „„district support in resources allocation”, as well as „„evaluating and
planning for future disaster management”.
4. Discussion
There is a global need for all healthcare workers to be prepared and be competent in disaster care.
Previous studies have found that most nurses were not adequately prepared [8,9]. The findings of the
study indicated that nurses were not aware of their roles in preparing the community or the vulnerable
population for disaster. In order to be prepared and be competent for disaster, all nurses should be
equipped with knowledge and skills for disaster care through continue education and training.
„„Disaster nursing” has not yet been established as a core topic/subject to be included in nursing
programs in Hong Kong, though it is a global demand for the inclusion of this component of disaster
care in our education program. The findings of this study provide a clearer picture of the inadequate
preparations of nurses for disaster, in that it provides nurse educators and/or health care administrators
a guide to delineate a tailor-made education program for nurses.
The results of this study showed that Hong Kong nurses have some understanding of the needed
competencies in „„prevention, preparation, response, and recovery” phases of disaster care. In fact, the
ICN has suggested in its disaster nursing framework that more attention is needed related to planning
and preparation, as well as the understanding of the whole disaster management process. It is reflected
that although there were quite a number of studies have focused on disaster response, there are also
some studies conducted in Hong Kong on the disaster preparedness of families with young
children [15] and elderly people [16] in Hong Kong. For post-disaster care, a study was also conducted
that explore the experience of China nurses after the Sichuan earthquake rescue [17].
In the stage of „„prevention and mitigation phase” of disaster care, the most neglected competencies
were the „„preparation of health staff and the public in preventing disaster”, „„regular review of
protocol”, and „„quality and safety guideline”. In the „„preparedness” phase, the less mentioned
competencies were „„practice according to professional standard”, „„updating information about new
diseases”, „„training in information technology and communication skill”, „„skills in psychological
intervention”, and „„understanding of the nature of disaster”. During the response phase, the
competencies related to „„forming critical incident support team”, familiar with different resources,
support network, and referral for victims and families‟, and the „„ability to identify vulnerable
populations”, „„post-traumatic stress care”, and „„care of special population with special needs”, were
not attended to. In the recovery phase, the competencies of „„evaluation and planning of management
Int. J. Environ. Res. Public Health 2014, 11 3301
after a disaster”, „„restoration of normal service”, „„collaboration between community and family for
post-disaster recovery”, „„systematic long-term care for disaster recovery” require more attention. If
health workers are to prepare for disasters, all these competencies needed to be included in the all
nursing curriculum and continuing nursing program.
None of the nurses in this study mentioned their own preparation and that of their families for
disaster. A study in Hong Kong have found that the nurses‟ preparedness of their families affect their
willingness to report to work during disaster [8]. Nurses, as well as all other health professionals,
should be aware of the importance of being prepared individually and in their families, so that they can
be ready to provide care during disaster, and to protect life. The message of being prepared for disaster
should be conveyed to all members in the community through public education.
The special needs of vulnerable groups should be attended to in disaster to reduce damaging effects
on health of the population and the death toll. Nurses should understand the risks and the needs of
these special populations in their serving community and equip themselves to support them in disaster.
Nurses should identify the vulnerable populations in the community, assist them in their special needs
with special items available at home, the basic survival skills, where and how to get help. Checklists
and education talks should also be developed and offered targeted these vulnerable groups.
5. Conclusions
This study explored the perceived disaster competencies of Hong Kong nurses and provides the
needed background to inform educational needs. The findings of the study also provide hospital
administrators the need to develop continuing education to prepare their nurses with the competencies
for disaster care in their respective specialties. The study also shows that a context appropriate set of
disaster nursing competencies is needed for Hong Kong nurses. The ICN framework can be used as a
guide; with further modification and refinement to increase the applicability and validity of the
competencies for the community we served [10,18].
With the increase frequency of disaster happenings globally, the need for education and training
preparation is to be emphasized. A set of core competencies has also been defined as a starting point
for delineating expected competency of health professionals in disaster medicine and public
health [19]. Nurses should be well adequately prepared with knowledge and skills for management of
disasters, starting early from their basic training and reinforcement in their on-the-job continuing
training. Nurses, in all specialties, should be equipped for all competencies for disaster prevention,
preparedness, response, and recovery phases. The public should also be prepared through disaster
awareness promotion activities and health talks. The development of a comprehensive disaster nursing
curriculum can protect our people in the community we served and shouldering the international
responsibilities during disaster events in our nearby countries. In fact, disaster simulation has been
used as an educational strategy to prepare nursing students for disaster respond, and has been
incorporated into the undergraduate nursing curriculum [20], The simulation was found to increase
nursing students‟ understanding of disaster preparedness, increase their ability and confidence to
handle disastrous situations and working in teams.
Int. J. Environ. Res. Public Health 2014, 11 3302
In this early stage of developing disaster nursing in different societies, exploration of educational
need, further research, and establishment of a set of core competencies for disaster nursing appropriate
for the societal context are essential.
6. Limitations
The disaster nursing competencies standard delineated by ICN, and referenced by all nurses
worldwide, was adopted as the framework to evaluate the perceived competencies of nurses in Hong
Kong for disaster. The categorization of key competencies reported by nurses align with the ICN
framework of disaster nursing competencies may be arbitrary, but was merely a practical way to
estimate the nurses‟ level of competencies, further research is needed to identify nurses‟ competent
level in meeting the needs for disaster nursing. This study focused on nurses from three specialties
may not be generalizable to other nurses and further study is needed to include other nurses from other
This research received no specific grant from any funding agency in the public, commercial, or not-
for-profit sectors
Author Contributions
Alice Yuen Loke and Olivia Wai Man Fung both have substantial contributions to conception and
design, Olivia Wai Man Fung for acquisition of data, Olivia Wai Man Fung and Alice Yuen Loke
analysis and interpretation of data together; Olivia Wai Man Fung drafting the article, Alice Yuen Loke
revising it critically for important intellectual content; and both Alice Yuen Loke and Olivia Wai Man
Fung approved the final version submitted for published.
Conflicts of Interest
The authors declare no conflict of interest.
1. Usher, K. Editorial: Are we ready? Preparing nurses to respond to disasters and emerging
infectious diseases. J. Clin. Nurs. 2010, 19, 143–144.
2. Arbon, P.; Bobrowski, C.; Zeitz, K.; Hopper, C.; Williams, J.; Thitchener, J. Australian nurses
volunteering for the Sumatra-Andaman earthquake and tsunami of 2004: A review of experience
and analysis of data collected by the Tsunami Volunteer Hotline. Australas. Emerg. Nurs. J. 2006,
9, 171–178.
3. Weiner, E.; Irwin, M.; Trangenstein, P.; Gordon, J. Emergency preparedness curriculum in
nursing schools in the United States. Nurs. Educ. Perspect. 2005, 26, 334–339.
4. Davies, K. Disaster preparedness and response: More than major incident initiation. Br. J. Nurs.
2005, 14, 868–871.
Int. J. Environ. Res. Public Health 2014, 11 3303
5. Subbarao, I.; Lyznicki, J.; Hsu, E.B.; Gebbie, K.M.; Markenson, D.; Barzansky, B.; Armstrong, J.H.;
Gassimatis, E.G.; Coule, P.L.; Dallas, C.E.; et al. A consensus-based educational framework and
competency set for the discipline of disaster medicine and public health preparedness. Disaster
Med. Public Health Prep. 2008, 2, 57–68.
6. Daily, E.; Padjen, P.; Birnbaum, M. A review of competencies developed for disaster healthcare
providers: Limitations of current processes and applicability. Prehosp. Disaster Med. 2010, 25,
7. Wright, D. The Ultimate Guide to Competency Assessment in Health Care, 2nd ed.; Creative
Healthcare Management: Minneapolis, MN, USA, 1998.
8. Fung, W.M.O.; Loke, A.Y.; Lai, K.Y.C.. Disaster preparedness among Hong Kong nurses. J. Adv.
Nurs. 2008, 62, 698–703.
9. Fung, O.W.M.; Lai, C.; Loke, A.Y. Nurses‟ perception of disaster: Implications for disaster
preparation. J. Clin. Nurs. 2009, 18, 3165–3171.
10. World Health Organization (WHO); International Council of Nursing (ICN). ICN Framework of
Disaster Nursing Competencies; World Health organization: Geneva, Switzerland, 2009.
11. Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents.
Available online: (accessed on
17 March 2014).
12. WHO Collaborating Center for Nursing in disasters and Health Emergency Management.
University of Hyogo. Core Competencies Required for Disaster Nursing. http://www.coe- on 17 March 2014).
13. Krueger, R.A. Analyzing and Reporting Focus Group Results; SAGE Publications, Inc.: London,
UK, 1998.
14. Lincoln, Y.S. Naturalistic Inquiry; SAGE Publications Inc: Newbury Park, CA, USA, 1985.
15. Fung, O.W.M.; Loke, A.Y. Disaster preparedness of families with young children in Hong Kong.
Scand. J. Public Health 2010, 38, 880–888.
16. Loke, A.Y.; Lai, C.; Fung, O.W.M. At home disasters preparedness of elderly people in Hong
Kong. Geriatr. Gerontol. Int. 2012, 12, 524–531.
17. Liu, X.W.; Fung, O.; Loke, A.Y. The experience of Chinese nurses in the earthquake rescue.
Chin. Nurs. Res. 2012, 26, 1935–1938.
18. Bond, E.F.; Beaten, R. Disaster nursing curriculum development based on vulnerability
assessment in the Pacific Northwest. Nurs. Clin. North Am. 2005, 40, 441–451.
19. Walsh ,L.; Subbarao, I.; Gebbie, K.; Schor, K.W.; Lyznicki, J.; Strauss-Riggs, K.; Cooper, A.;
Hsu, E.B.; King, R.V.; Mitas, J.A., II; et al. Core competencies for disaster medicine and public
health. Disaster Med. Public Health Prep. 2012, 6, 44–52.
20. Kaplan, B.G.; Connor, A.; Ferranti, E.P.; Holmes, L.; Spencer, L. Use of an emergency
preparedness disaster simulation with undergraduate nursing students. Public Health Nurs. 2012,
29, 44–51.
© 2014 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article
distributed under the terms and conditions of the Creative Commons Attribution license

Be the first to post a comment.

Add a comment