CHERRY ANN G ORCINE

BSN4
NURSING DISASTER
CI: ROBERT A. CABANES, RN,PhD

Answer the following:

1) What is the SENDAI Framework for Disaster Risk Reduction?

 The Sendai Framework works hand in hand with the other 2030 Agenda
agreements, including The Paris Agreement on Climate Change, The
Addis Ababa Action Agenda on Financing for Development, the New
Urban Agenda, and ultimately the Sustainable Development Goals.
It was endorsed by the UN General Assembly following the 2015 Third
UN World Conference on Disaster Risk Reduction (WCDRR), and
advocates for:
 The substantial reduction of disaster risk and losses in lives, livelihoods
and health and in the economic, physical, social, cultural and
environmental assets of persons, businesses, communities and countries.
 It recognizes that the State has the primary role to reduce disaster
risk but that responsibility should be shared with other stakeholders
including local government, the private sector and other stakeholders.
 The Sendai Framework focuses on the adoption of measures which
address the three dimensions of disaster risk (exposure to hazards,
vulnerability and capacity, and hazard’s characteristics) in order to
prevent the creation of new risk, reduce existing risk and increase
resilience. The Sendai Framework outlines seven global targets to guide
and against which to assess progress.

2) What are the roles and responsibilities of nurses in implementing the

SENDAI Framework?
 Actively participate in supporting institutions and governments to
prepare in advance for disaster(s) by assessing potential hazards and
vulnerabilities, and by increasing their ability to predict, warn of and
respond to disaster, for example through a national disaster plan and
emergency funds.

3) How can nurses actively engage in and lead on Disaster Risk Reduction
and Disaster Risk Management Policy nationally and globally?
 Develop and/or support a regulatory framework that helps nurses meet
regulatory requirements in a timely manner when deployment is needed
to provide nursing care in an affected jurisdiction.
  Actively engage with governments so that they develop a binding
strategy which is intended to fulfil the four priorities set out in the
Sendai Framework for Disaster Risk Reduction.
 Encourage governments to plan for responding to the basic needs of
nurses in the event of a disaster, ensuring a system is in place that aims
to provide food, water and shelter, as well as continued compensation
and incentives that are normally provided for time worked.
 Actively participate in strategic planning and implementing of disaster
plans to ensure nursing input.
 Actively engage in disaster risk committees and policy-making for
disaster risk reduction, response and recovery.
 Seek continuing professional development opportunities in disaster risk
reduction, response and recovery.
 Be competent to provide disaster relief and meet the health needs
according to the type of disaster and the given situation.
 Be informed of diseases, such as cholera, and changes in social
behaviour, such as theft, that may be associated with disasters and
which may be exacerbated by a deterioration in living conditions, and of
associated physical and mental health, socioeconomic, and nursing or
care needs of individuals and communities, and identify mechanisms to
deal with these situations.
 Be familiar with and raise public awareness of those disasters that their
region and country are most likely to experience.
 Work closely with other health care and allied professionals in
establishing comprehensive and collaborative disaster risk reduction
plans.

4) What is the role of the Red Cross during a disaster?

 Red Cross 143 was formulated to strengthen disaster risk management
capacity at the community level. It aims to assist communities to
prepare, plan, predict and perform in the event of a disaster.

5) Cite example of the following legal and ethical issues:

a) Privacy Issues
 Natural disasters, armed conflict, migration, and epidemics today occur
more frequently, causing more death, displacement of people and
economic loss. Their burden on health systems and healthcare workers
(HCWs) is getting heavier accordingly. The ethical problems that arise in
disaster settings may be different than the ones in daily practice, and
can cause preventable harm or the violation of basic human rights.
Understanding the types and the determinants of ethical challenges is
crucial in order to find the most benevolent action while respecting the
dignity of those affected people. Considering the limited scope of
studies on ethical challenges within disaster settings, we set upon
conducting a qualitative study among local HCWs.
 b) Reporting of Diseases
 Reportable diseases are diseases considered to be of great public health
importance. In the United States, local, state, and national agencies (for
example, county and state health departments or the United States
Centers for Disease Control and Prevention) require that these diseases
be reported when they are diagnosed by doctors or laboratories.
 Reporting allows for the collection of statistics that show how often the
disease occurs. This helps researchers identify disease trends and track
disease outbreaks. This information can help control future outbreaks.

c) Disclosure of Health Information

There should always be a strong presumptionto respect confidentiality and avoid
breaking confidences when at all possible. The duty of confidentiality is based
on four major arguments:

The principle of respect for autonomy or respect for persons

 Respect for autonomy, or respect for persons, calls for us to allow others to
decide who they want to know certain details about themselves. Respecting
others and caring for them should create in us a disposition to respect their
wishes that certain intimate details of their lives remain confidential. We
show them disrespect when we make that decision for them by telling their
"secrets" (deontological ethics).
 One could ask whether good people should really even have aspects of their
lives which they would not want other people to know about. Two points are
worth noting: we all fall short of our ethical ideals, and we make mistakes
that we prefer others not know about.
 Some persons are courageous enough to be honest about these things, but
most of us aren't. What is important here, however, is that respecting
others requires that we let them decide whether to reveal these things and
to whom they feel they need to reveal these things.
 

Implicit promise

 Confidentiality in the therapeutic relationship is assumed. Therefore, an

implied promise exists between the patient and her physician. Absent a prior
warning by the physician to the contrary, to break confidentiality is to
break a promise made to the patient.
 

Trust is undermined
  Under circumstances of trust, such as disclosures made in most patient-
provider relationships, the patient is betrayed when confidences are broken.
They have confided in us assuming that we will not disclose what they have
told us. To do so would do violence to that trust. Trust is essential for
communities of people to function effectively. Without trust and fidelity,
communities (and the persons within them) suffer.
 

Consequences of not maintaining confidentiality to persons and to society

 An expectation exists in society that confidence will be kept in medical

settings. This expectation makes people trust those who care for them in
times of illness. Because the expectation exists, and because of the
inequality in intimate disclosures, medical care providers have a special
obligation to be trustworthy and loyal.
 The effectiveness of medicine often depends upon patients revealing
intimate details and secrets of their lives. The breaking of confidences
would have a negative effect on medicine because patients would be less
likely to entrust these intimate details to their providers if they might be
revealed to others (utilitarian ethics). Thus routinely breaking confidence
harms the therapeutic relationship.
 For example, people who are at risk for HIV may not seek testing if they
think that information will be available to anyone other than the doctor.
Without the assurance of confidentiality, no identification of people at risk
can occur.

d) Quarantine and Isolation

 Quarantine and isolation are legal, public health authorities that may
be, but rarely are, implemented to prevent the spread of
communicable diseases. Ill people may be isolated to protect the public
by preventing exposure to infected people.
 State and local governments are primarily responsible for maintaining
public health and controlling the spread of diseases within state
borders. Among other state public health emergency preparedness
powers, every state, the District of Columbia and most territories
have laws authorizing quarantine and isolation, usually through the
state’s health authority. The federal government has authority as well,
through the Centers for Disease Control and Prevention (CDC), to
monitor and respond to the spread of communicable diseases across
national or state borders.
 In response to the COVID-19 pandemic, states have used their
authority to create quarantine or isolation requirements on certain
individuals or populations to slow the spread of this disease. This
includes orders for individuals returning or traveling from foreign
 countries, states and other areas with high rates of COVID-19
transmission to quarantine for a certain amount of time or until they
are able to confirm their status through testing. It also includes
quarantine orders for individuals who may have been exposed to the
virus, who work in high-risk settings, individuals experiencing
symptoms of COVID-19 and individuals who test positive for the virus.

e) Vaccination
 Humanitarian emergencies result in a breakdown of critical health-
care services and often make vulnerable communities dependent on
external agencies for care. In resource-constrained settings, this may
occur against a backdrop of extreme poverty, malnutrition, insecurity,
low literacy and poor infrastructure. Under these circumstances,
providing food, water and shelter and limiting communicable disease
outbreaks become primary concerns. Where effective and safe
vaccines are available to mitigate the risk of disease outbreaks, their
potential deployment is a key consideration in meeting emergency
health needs. Ethical considerations are crucial when deciding on
vaccine deployment. Allocation of vaccines in short supply, target
groups, delivery strategies, surveillance and research during acute
humanitarian emergencies all involve ethical considerations that often
arise from the tension between individual and common good. The
authors lay out the ethical issues that policy-makers need to bear in
mind when considering the deployment of mass vaccination during
humanitarian emergencies, including beneficence (duty of care and the
rule of rescue), non-maleficence, autonomy and consent, and
distributive and procedural justice.

f) Resource Allocation
 Resource Allocation is the process of assigning and managing assets in
a manner that supports an organizations strategic planning goals.
 When disaster strikes, effective management of resources can
significantly influence the overall outcome of the response. If the
number of victims and the complexity of their injuries are low and
resources are abundant, resource allocation will have little impact on
the disaster outcome. However, if there is a high number of victims
with complex injuries and available resources are limited, how those
resources are used will determine the outcome for some individuals.

 Historically, decisions regarding disaster resource allocation and

triage have largely been in the domain of emergency medicine;
however, Roccaforte and Cushman observe, “The pinnacle of the
medical response to any disaster takes place in definitive care areas
[DCA] (operating rooms, intensive care units). Thus, a critical
 component of disaster planning must be the preservation of DCA
capability and effectiveness” (1). Given this, it is essential that critical
care physicians understand and are skilled in resource management
during surges in demand for critical care.

This chapter from SCCM's Fundamental Disaster Management, Third

Edition seeks to:

 Describe the types and characteristics of surges.

 Summarize key events in the history of triage.
 Identify what critical care resources may have to be allocated or
triaged during a disaster.
 Explain the differences between resource allocation, rationing,
and triage.
 Describe the types of triage.
 Discuss the impact of triage.
 Identify important considerations in developing and implementing
a triage protocol.
 Discuss the ethical issues related to triage and allocation of
scarce resources.

,g) Professional Liability

 Professional Liability — a type of liability coverage designed to
protect traditional professionals (e.g., accountants, attorneys) and
quasi-professionals (e.g., real estate brokers, consultants) against
liability incurred as a result of errors and omissions in performing
their professional services.

6) How do you manage psychosocial effects of disasters ?

 We have learn a great deal in recent years about how people tend to
respond to disasters and this has pointed us in the direction of how we
should assist people.
 In the initial weeks after a major event, many people experience
distress, including anxiety, distressing memories, sleep disturbance,
nightmares, and restlessness. This is very common and is an
understandable reaction to stress.
 The management of psychosocial effects begins with a sound plan to
mitigate the adverse impact of the disaster on the emotional, cognitive,
and behavioral capacity of the individual. Involvement of mental health
professionals, such as psychiatric nurse practitioners and clinical nurse
specialists, should begin with the development of the community or
agency disaster plan. Management of the psychosocial effects of
disaster will continue long after the initial impact. Psychological first aid
is an evidence-informed approach designed to reduce distress in the
 immediate aftermath of a disaster and foster adaptive functioning and
coping. Major depression and PTSD can be disabling consequences of
exposure to disaster among those of any age group, thus, early diagnosis
and treatment are critical to the prevention of future disability. There
is a growing body of research identifying that effective treatment for
PTSD and cognitive behavioral approaches along with exposure therapy
are most likely to be beneficial.
 We also know, however, most mental health problems typically reduce
over time. As people learn that the threat has passed, they typically get
over the initial distress. Several months after a disaster, most people
are able to psychologically adapt and recover. However, there is usually a
significant minority who will have persistent problems.