Managing Client Care: Disasters

The nurse wants to ensure that the emergency department is prepared for a disaster and is creating an action plan for educating the staff. Which actions should the nurse plan in order to adequately prepare the staff? Select all that apply.

✅Identify specific nursing roles during a disaster. ✅Test the disaster plans before a disaster occurs. ✅Encourage each nurse to create a personal emergency preparedness plan. ✅Begin educating staff on role responsibilities that will occur at the time of a disaster. 📑Rationale: Disasters can happen at any time, without warning. Therefore, it is important that health care facilities have a plan in place. In order to adequately prepare staff for a disaster, the nurse manager should identify specific nursing roles, begin educating staff on what is expected of them during a disaster, test plans before a disaster occurs, and encourage nurses to create a personal emergency preparedness plan for themselves. The nurse manager should not wait until a disaster occurs to create a disaster plan because this can lead to inadequate resources for safe client care.

Following an airplane crash that had only a few survivors, the nurse should anticipate which survivor responses to stress? Select all that apply.

✅Difficulty sleeping ✅Feeling vulnerable ✅Feeling blame or guilt ✅Feeling numb or in disbelief 📑Rationale: Experiencing a disaster can produce both immediate and long-lasting psychosocial effects in the survivors. Coping abilities in the survivors in response to the stress can lead to many different responses. Often survivors will have difficulty sleeping, feel vulnerable that the event could happen again, experience blame for the event and guilt that they survived, or even feel numb or in disbelief that the event happened. Seldom are survivors completely unaffected by a disaster.

The nurse is assisting in developing a plan of action for the emergency department in the event of an internal fire. Which should the nurse include in the plan? Select all that apply.

✅Direct ambulating clients to walk to a safe location. ✅Remove all clients from danger before attempting to extinguish the fire. ✅Move bedridden clients away from the fire area by use of beds or stretchers. 📑Rationale: The nurse has many roles in responding to fires in the health care facility. The nurse should remove all clients and visitors away from the fire. Ambulating clients should be directed towards a safe location, while beds or stretchers can be used to move bedridden clients. Oxygen is considered flammable; therefore, all clients who can breathe without oxygen should not use it. The nurse should not wait for the fire department to arrive, but rather should act immediately to protect clients from harm.

After reviewing the psychosocial implications following a disaster, the nurse is assigned to care for a client who has just witnessed a mass shooting. Upon obtaining subjective information from the client, which actions should the nurse take? Select all that apply.

✅Remain calm and reassuring. ✅Convey caring behaviors towards the client. ✅Establish rapport and actively listen to the client. 📑Rationale: One of the most important roles of the nurse after a community disaster is health assessment, including psychosocial health. It is important that the nurse remain calm and reassuring and convey caring behaviors. The nurse should establish a rapport with the client and actively listen to what the client is saying. Allowing the client to remain alone without support or avoiding discussion of the disaster could be destructive to the psychosocial health of the client.

The nurse is educating a new nurse about mass casualty events (disasters). Which statement by the new nurse indicates a need for further teaching? Select all that apply.

✅"Mass casualty events do not require an increase in the number of staff that are needed." ✅"A mass casualty event occurs only within the heath care facility and could endanger staff." ✅"A mass casualty event occurs if a fight between visitors occurs in the emergency department." 📑Rationale: Mass casualty events, also known as disasters, overwhelm local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crises. This type of event can occur in the health care facility or outside of it. Fights in the emergency department are not termed mass casualty events but are agency security and local enforcement issues. Mass casualty events almost always require an increase in staffing to ensure safe client care.

The emergency department nurse receives a telephone call and is informed that a tornado has hit a local residential area and numerous casualties have occurred. The victims will be brought to the emergency department. Which should be the initial nursing action?

✅Activate the agency emergency response plan. 📑Rationale: During a widespread disaster, many people will be brought to the emergency department for treatment. Health care institutions are required to have an emergency response plan in place and perform practice drills. The initial nursing action should be to activate the emergency response plan. The plan entails the other options, which include preparing triage rooms to take casualties, and obtaining sufficient supplies and medical personnel.

The nurse is caring for a pediatric client who sustained physical injuries following a bombing. Which actions by the nurse should help put the child at ease and decrease the child's and family's stress level? Select all that apply.

✅Tell the truth about the child's status. ✅Communicate an attitude of confidence. ✅Encourage family caregivers to stay with the child. ✅Establish a trusting relationship with the child and the parents. 📑Rationale: After a disaster, it is important to tell the truth about the child's status to the parents and the child; this will establish trust. An attitude of confidence helps ease stress levels. The family caregivers should be encouraged to stay with the child to eliminate additional anxiety, such as separation anxiety. Establishing a trusting relationship is needed during times of stress. Communication should not be limited because that can increase the levels of stress.

Which factors should the nurse consider when developing a critical incident stress debriefing (CISD) plan for employees of a level 1 trauma center? Select all that apply.

✅CISD promotes effective coping strategies. ✅CISD occurs in small group settings for staff. ✅CISD may help prevent posttraumatic stress disorder. ✅CISD is only one component of a much larger stress management program. 📑Rationale: Critical incident stress debriefing (CISD) is only one component of a much broader critical incident stress management program. The nurse should consider the benefits of CISD when creating a plan, which includes talking and expressing feelings about an event in a safe and calm setting. Health care professionals are exposed to stressful incidents on a daily basis. CISD promotes effective coping strategies, occurs in small group settings, and is part of a much larger stress management program. Lack of debriefing can lead to posttraumatic stress disorder. CISD does not exacerbate the stress response or make symptoms worse, but rather helps alleviate the stress through talking in a calm environment.

A group of nurses are reinforcing instructions on health and safety management to survivors of a hurricane before they leave their temporary shelter and return home. Which instructions should the nurses include? Select all that apply.

✅Wash hands with soap and water frequently. ✅Bring water to a rolling boil for 3 to 5 minutes and cool before drinking. ✅Add 16 drops of chlorine bleach to a gallon of water and let stand for 30 minutes before drinking. 📑Rationale: The American Red Cross often provides temporary shelters for those who have been displaced during a disaster. It is a priority that nurses teach survivors about safety measures before they return to their homes. The nurse should teach the client that water can be used but that special measures need to be taken before use. Hands need to be washed frequently with soap and water to prevent disease transmission. Water needs to be brought to a rolling boil for 3 to 5 minutes before drinking to prevent ingestion of a harmful organism. In addition, 16 drops of chlorine bleach can be added to a gallon of water and left to stand for 30 minutes to make it safe for drinking. Water can be distilled manually and it is safe to drink.

The nurse has just finished taking a course on disaster preparedness. Which statements by the nurse indicate that the teaching has been effective? Select all that apply.

✅"Nurses test plans by participating in disaster drills." ✅"Nurses play key roles before, during, and after a disaster." ✅"Nurses assist in developing internal and external emergency response plans." 📑Rationale: The roles and responsibilities of health care personnel in a mass casualty event or disaster are defined within the institution's emergency response or preparedness plan. Nurses test emergency plans by participating in disaster drills, playing key roles before, during, and after a disaster. After analyzing and evaluating these plans, nurses assist in developing internal and external emergency response plans that are most appropriate for their institution.

A nurse is participating in a disaster drill. A participant wearing a yellow tag asks the nurse, "What does the yellow tag mean?" Which response by the nurse is accurate?

✅"The yellow tag means you will be seen in 30 minutes to 2 hours." 📑Rationale: After a disaster, prehospital care of victims is prioritized according to a triage system that is different from regular emergency department triage. Those with life-threatening conditions and a good chance of survival are cared for first. When there are more victims of a disaster than medical personnel to treat them, those who are likely to survive are treated first; these patients are given red, yellow, or green tags (some classifications also include a white tag). A red tag means immediate treatment, a yellow tag means a major injury and will be seen within 30 minutes to 2 hours, a green tag means a "walking wounded" injury and the wait can be more than 2 hours, a white tag means no medical treatment is needed and the client can be discharged.

The nurse is presenting a lecture on disasters and posttraumatic stress disorder (PTSD) to a group of new unlicensed assistive personnel (UAP). Which statements by the UAP indicate that teaching has been effective? Select all that apply.

✅"PTSD can potentially last a lifetime." ✅"Clients can be easily startled and have difficulty sleeping." ✅"Flashbacks occur, causing the client to relive the experience." 📑Rationale: Experiencing a traumatic event such as a disaster can produce both immediate and long-lasting psychosocial effects in people personally affected by the event. PTSD is a serious result of experiencing a traumatic event, and can potentially last a lifetime. Those with PTSD often report being easily startled and having trouble sleeping at night, which they didn't experience before the event. Clients will often report troubling flashbacks, which force them to relive the experience. PTSD can happen to anyone who experiences an extremely stressful event, and does not specifically occur in clients who have a history of depression.