Sixth meeting of the Regional Advisory Panel on Nursing ...applications.emro.who.int/docs/who_em_nur_382_e_en.pdfDr Nada Hafadh welcomed the participants to the meeting and noted that

WHO-EM/NUR/382/E

Report on the

Sixth meeting of the Regional Advisory Panel on Nursing and consultation on disaster nursing and preparedness, mitigation, response and recovery in the Eastern

Mediterranean Region

Manama, Bahrain 28–30 June 2004

WHO-EM/NUR/382/E

Report on the

Sixth meeting of the Regional Advisory Panel on Nursing and consultation on disaster nursing and preparedness, mitigation, response and recovery in the Eastern

Mediterranean Region

Manama, Bahrain 28–30 June 2004

© World Health Organization 2006 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: [email protected]). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email [email protected]).

Document WHO-EM/NUR/382/E/10.06/150

CONTENTS

1. INTRODUCTION.............................................................................................................1

2. OBJECTIVES AND METHODOLOGY ..........................................................................2

3. TECHNICAL PRESENTATIONS ....................................................................................4 3.1 Disaster preparedness, response, and mitigation, an international perspective .......4 3.2 Regional health strategy to strengthen disaster preparedness, mitigation,

response and recovery ..............................................................................................5

4. COUNTRY PRESENTATIONS........................................................................................7

5. GENERAL FRAMEWORK OF CORE COMPETENCIES FOR NURSES TOWARDS DISASTER PREPAREDNESS AND RESPONSE ......................................8

6. NURSING’S CONTRIBUTION TO THE REGIONAL STRATEGY FOR DISASTER PREPAREDNESS AND RESPONSE...........................................................9

7. FIELD VISITS ................................................................................................................10

8. RECOMMENDATIONS.................................................................................................10

Annexes 1. AGENDA ........................................................................................................................12 2. PROGRAMME ...............................................................................................................13 3. LIST OF PARTICIPANTS ..............................................................................................15 4. CURRICULUM ASSESSMENT TOOL ........................................................................21 5. PROPOSED CORE COMPETENCIES..........................................................................32

WHO-EM/NUR/382/E

1. INTRODUCTION

The sixth meeting of the Regional Advisory Panel on Nursing and Consultation on Disaster Nursing Preparedness, Mitigation, Response, and Recovery in the Eastern Mediterranean Region was held in Manama, Bahrain, from 28 to 30 June 2004.

The meeting was inaugurated by Dr Hussein A Gezairy, WHO Regional Director for the Eastern Mediterranean Region, H.E. Dr Nada Abbas Haffadh, Minister of Health, Bahrain, and Her Royal Highness Princess Muna Al-Hussein, WHO Patron for Nursing and Midwifery in the Eastern Mediterranean Region.

Dr Nada Hafadh welcomed the participants to the meeting and noted that the health care sector played a significant role in planning for and managing natural or man-made disasters. Nursing as a major health care discipline was considered to be the backbone for successful emergency preparedness and disaster management in any community. It was believed that nurses had a significant central role in all stages of emergency preparedness, training, disaster management and rehabilitation and this belief was evident in reviewing all the emergencies and disasters that the region had faced in the past. In Bahrain, the Ministry of Health had invested extensively in this field through establishing disaster committees, disaster manuals, policies, training programmes, scheduled drills and equipment. Dr Haffadh concluded by expressing the hope that the Panel’s deliberations would result in concrete and practical recommendations.

Dr Gezairy addressed the participants and noted that the meeting would address an extremely important issue for health care in the Region, by reviewing the situation of disaster nursing preparedness in nursing education and nursing services, integrating nursing contribution in the regional health strategy for disaster preparedness, mitigation, response and recovery, and examining ways to implement the general framework of core competencies for nurses to better prepare nurses and midwives to assume their important role in disaster preparedness and response. Nurses and midwives in a number of countries in the Region were trying with other members of the health team to improve the overall health status while delivering health care under very difficult conditions and circumstances. In this respect, one of the challenges in the meeting would be to develop mechanisms to further develop national nursing capacity for disaster preparedness, response and mitigation, to provide timely care to the victims especially the more vulnerable members of the community, such as the elderly, women, children, the disabled and the poor.

He pointed out that, because nurses would always be involved when a disaster occurs, and because nursing services were a vital component of the health system, the task was to debate how nurses and midwives could be prepared to perform efficiently and effectively to deliver care, adapt to new and rapidly changing situations, and work in a team under pressure. This would require making changes in the management role of nurses in disaster preparedness to ensure coordinated, effective, timely and efficient delivery of nursing care. In addition, it would be necessary to make changes in the educational curricula of the nursing colleges and schools and to develop the capacity of practitioners so that nurses were able to provide effective care without delays for the victims and their families.

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Dr Gezairy cited resolution EM/RC45/R.12 (1998) of the Forty-fifth Session of the Regional Committee for the Eastern Mediterranean on improving the quality of nursing and midwifery in the Eastern Mediterranean Region, in which the Committee urged Member States to continue their efforts to develop national plans for the implementation of the regional strategy for nursing development. He also referred to a Health Assembly resolution in May 2001, on strengthening nursing and midwifery (WHA54.12) and the document on nursing midwifery services strategic directions. He said it was for these reasons that the agenda of the meeting and consultation had been organized around disaster nursing preparedness, mitigation, response, and recovery. He concluded by emphasizing that Member States were in great need of clear, practical and affordable strategies that they could adopt to improve health and ensure quality nursing and midwifery services in general and disaster nursing preparedness in particular, and assured the participants of WHO support in making these strategies a reality.

Her Royal Highness Princess Muna Al-Hussein, WHO Patron for Nursing and Midwifery in the Eastern Mediterranean Region, addressed the meeting and noted that nurses in the Region constituted the largest sector of health workforce and would, with certainty, be on the front lines of any disaster and emergency response. She emphasized that as part of each country’s overall plan for disaster preparedness, all nurses must have a basic understanding of disaster science and an awareness of its key components and an understanding of how people behave during a disaster. This would enable them to form a more planned and effective team work. She explained that the regional vision was to increase the capacity of countries of the Region in their preparedness for disasters and emergencies and mitigation of their consequences. So when the unexpected happens, impact on health and destruction was minimal; and assurance of continuity in relief, rehabilitation and re-development was evident.

The participants elected Mrs Batool Al-Muhandis (Bahrain) as Chair and Dr Amal Atteya (Egypt) Rapporter. The agenda, the programme and the list of participants are included in Annexes 1, 2, and 3 respectively. The curriculum assessment tool used during the meeting to evaluate the proposed core competencies is included as Annex 4. Annex 5 lists the revised framework of core competencies

2. OBJECTIVES AND METHODOLOGY

Dr Fariba Al Darazi, Regional Adviser for Nursing and Allied Health Personnel, WHO/EMRO, listed the objectives of the meeting, which were to:

• review the current situation of disaster nursing preparedness in education and practice in the Region;

• integrate nursing’ contribution in disaster preparedness, mitigation, response, and recovery;

• discuss and adopt the general framework of core competencies for nurses towards disaster preparedness and response;


• develop and incorporate nursing’s contribution in the regional health strategy for disaster preparedness, mitigation, response and recovery in the Eastern Mediterranean Region; and

• develop a policy framework for disaster nursing preparedness, mitigation, response and recovery to assist Member States in this regard.

The WHO Regional Office for the Eastern Mediterranean, since its establishment in 1949, had been collaborating with Member States in developing their national nursing programme. In 1965 a Regional Expert Advisory Panel of nurses was established and met for the first time in Alexandria. At that time the meetings of the panel focused only on the preparation for and conducting the regional nursing seminars. Following these two meetings, the activities of the Panel became limited. In 1973, the Panel was re-established, and once again, active from 1973 until 1976. During that period, the role of the Panel members was confined to participation in planning and implementation of a regional workshop, as well as responding to the Regional Office for review of certain documents and receiving information relevant to nursing and midwifery. An intercountry meeting on nursing held in September 1987 recommended that the Regional Office “reactivate the Regional Nursing Advisory Panel to provide a regular mechanism for nurse leaders of the Region to discuss issues and plans of action that could be effected, with Regional Office support, to strengthen the relevance of nursing practice and education”. In 1990, the Regional Advisory Panel on Nursing was formed and met for the first time in September 1990.

The role and responsibilities of the Regional Advisory Panel on Nursing are as follows:

• Collection, analysis and exchange of information related to nursing education, service and practice at national and regional levels.

• Identifying needs and priorities requiring action by the Regional Office and Member States for improving the nursing situation and ensuring that nursing has a significant input in the delivery of health care to the people.

• Advising national health authorities and the Regional Office on strategies and courses of action to be adopted in order to foster nursing development, both at country and regional levels.

• Providing inputs into planning, development and possible implementation of WHO regional nursing activities.

• Initiating programmes and projects aimed at implementing innovative ideas that will enhance the progress of nursing and nurses in the Eastern Mediterranean Region.

• Identification of resources – human and material – that could be used by Member States and the Regional Office in the implementation of nursing programmes.

• Acting as a catalyst and advocate in fostering the goals of the nursing profession at national and regional levels.

• Fostering collaboration among various nursing bodies and others concerned with health of the people, both at national and regional levels.


3. TECHNICAL PRESENTATIONS

3.1 Disaster preparedness, response, and mitigation, an international perspective Professor Hiroko Minami, WHO Temporary Adviser

Professor Minami’s presentation stemmed from her work for the last ten years on promoting and developing disaster plans in Japan and other Asian countries. Japan is a disaster-prone country, and after the Hanshin-Awaji earthquake in January 1995, and the Sarin gas attack by a terrorist group on the Tokyo subway system also in March 1995, the Japanese attitude towards disaster preparedness and emergency management underwent a radical change in which they took a first step toward disaster prevention and development of disaster nursing. The Japanese here also experienced various other disasters such as volcanic eruptions and floods which led them to establish the Japan Society of Disaster Nursing. Today three organizations have been working together cooperatively and collaboratively to support nursing colleagues working in the disaster area. Support was given not only for nurses in Japan but also for nurses in Taiwan, Iran, and Turkey under the idea of “Nurses support nurses at the Site”.

According to the World Disaster Report 2000, man-made disasters account for 43% of the disasters in the world. Floods, rainstorms, infectious diseases and earthquakes account for 19%, 17%, 7%, and 5% respectively.

Nursing relief activities after disasters are not new.

• Florence Nightingale made a study of disaster nursing for the first time in history and changed the situation on the basis of her study (in 1854 ~ 1856).

• Jean Henri Dunant was considered the first advocate of systematic relief activities (in 1859). In 1863, the International Committee of the Red Cross was formed.

• In 1963, the National League of Nursing in the United States showed that disaster nursing was rarely taught as a subject and that few instructors were able to teach it.

• In 1990, the United Nations addressed problems of disaster prevention and risk management all over the world.

• Starting in 2001, after the terrorist attacks on 11 September, extensive efforts have been made to advance disaster nursing.

• The International Nursing Coalition for Mass Casualty Education (INCMCE) was established, in which the main focus is education in disaster nursing.

• The International Council of Nurses also provides good information on disaster nursing, which is guided by the ICN Code of Ethics.

• WHO also provides information on emergency, disaster and development strategy. • The International Federation of Red Cross and Red Crescent Societies also provides

immediate disaster relief services as well as educational programmes. • After 1995, some nursing colleges included disaster nursing in their curricula.


Disaster nursing has not yet gained its proper place in the basic and continuing education of nursing professionals. The nursing professionals are required to carry out the following activities when a disaster occurs:

• In the initial phase: life saving and emergency care, maintenance of the environmental hygiene, remains management, prevention of spread of infectious diseases, mental health care, volunteer coordination and support to the affected hospitals and clinics.

• In the mid-term phase: secondary disaster prevention, assistance to the vulnerable affected by a disaster, health care for residents in temporary housing, development of rapport and mental health care.

• In the long-term phase: relocation support, community building and mental health care. • In the preparation phase: disaster prevention training for residents, establishing medical

networks, establishing a network among nurses, knowledge accumulation and skill development and development of disaster nursing education.

Disasters are classified into natural disasters such as earthquakes, floods and storms and man-made disasters such as conflicts, wars and acts of terrorism, motor vehicle accidents and others.

Disaster nursing, as defined by the Japan Society of Disaster Nursing, comprises “activities to minimize damages caused by disasters and inflicted on lives and health of people affected, by using knowledge and techniques unique to nursing, systematically and flexibly in cooperation with specialists in other fields.”

The capacity of nurses should be strengthened to enable them to perform their roles effectively in the four phases of the disaster cycle.

In the future, more emphasis is needed on:

• medium- to long-term nursing support activities, aimed at providing support to disaster victims who are trying to return to normal healthy life;

• systematic education in disaster nursing and building the knowledge base, i.e. all nurses must learn practical knowledge and skill such as cardio-pulmonary resuscitation and must become experts in providing the type of care necessary in large-scale disasters;

• enhancement of disaster nursing networks at home and abroad.

3.2 Regional health strategy to strengthen disaster preparedness, mitigation, response and recovery Mr Altaf Musani, Technical Officer, Emergency and Health Action, WHO EMRO

A disaster is defined as any sudden or slow onset occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and human services on a scale sufficient to warrant extraordinary response from outside the affected community or area.


In the past 20 years, natural disasters have resulted in approximately 3 million deaths and have negatively affected some 800 million persons worldwide.

The regional strategy on disaster preparedness, mitigation and response aims at:

• reducing risk through decreasing vulnerability (mitigation, awareness and early warning) or increasing the coping capacity (preparedness and response)

• provision of service and support to Member States • investment in preparedness and mitigation activities • fostering a developmental approach based on management of risks • building partnerships with other institutions • adapting to regional dynamics and characteristics.

The WHO programme areas in this field address aspects of preparedness, mitigation, response and recovery. Disaster preparedness includes measures taken in advance of the disaster situation to improve the scope and effectiveness of the response, involving activities such as: developing plans, norms, procedures, policies and functions, public awareness, information systems, data bases (maps, roasters), development of human and material resources, coordination and networking.

Disaster mitigation is geared towards vulnerability analysis and mapping, improved design of new facilities, retrofitting existing facilities, and norms, guidelines, and training. Disaster response encompasses sector coordination, health intelligence, rapid health assessment, promoting standards and guidance, monitoring health status, resource mobilization, and humanitarian relief via medical supplies and equipment. Disaster recovery aims at damage assessment, ensuring links to development processes, mobilizing resources, lessons learned and evaluation, and integration of mitigation measures.

Challenges include:

• shortage of health professionals trained in disaster reduction and risk management concepts

• weak regional and national networks of disaster capacity • limited knowledge and awareness of the risks and threats • policies and plans developed are oriented towards disaster response • lack of implementing systematic evaluations and applied research in disaster settings in

terms of lessons learned and utilizations of best practices • challenges in ensuring mechanisms of coordination where a disaster strikes • lack of strategic partnerships within the Region and at national level to harmonize

disaster reduction and risk management efforts (partnerships are the keys to success).

Discussion focused on the following points.

• How best to capitalize on the roles and responsibilities of nurses in national and health sector disaster preparedness

• Using nursing capacity in disaster response


• How best to develop disaster management skills for nurses • Identifying the core set of competencies needed in response and recovery efforts • How best to use nursing to ensure standards for relief assistance

The participants emphasized the following strategies to strengthen disaster nursing preparedness:

• Training nurses to be able to provide care taking into consideration the psychological aspects; building capacity in the area of disaster preparedness, mitigation and response; utilizing various innovative methods of teaching to prepare nurses in this field.

• Identifying the role of nurses in disaster preparedness, mitigation and response. • Integrating disaster preparedness, mitigation and response in the basic and post-basic

nursing educational programmes and continuing education offerings. • Preparing nurses for the multidisciplinary approach.

4. COUNTRY PRESENTATIONS

Nine countries presented reports on the current status of disaster nursing preparedness in education and practice: Variations among countries were particularly obvious in terms of national, Ministry of Health and nursing professional preparedness in disaster health management. All countries had somehow identified and implemented a system of response in collaboration with civil and defence organizations or nongovernmental organizations such as Red Crescent and Red Cross societies.

The participants were able to appreciate the types and magnitude of disasters in the Region. Some countries suffer complex emergencies compounded with added disasters. Participants agreed that there is a need for equitable, charitable resource mobilization within the Region to assist neighbouring countries.

The discussion that followed generated key principal elements needed to strengthen disaster preparedness. These include:

• integration of multidisciplinary groups • coordination and collaboration within the country with national and international

organizations • networking with all civil and professional organizations, the community and families • disaster preparedness, mitigation, response and recovery is a science and it requires

advanced nursing roles • investment in human resources and training at all levels, basic and advanced thinking

outside the box, creativity and innovations are advised; disaster nursing does not take place in the secure environment of emergency units in hospitals

• policy development and legislation should guide and direct countries towards preparedness for disasters, not only response when disaster strikes

• communication and media utilization • developing strategic and operational plans that are active, tested, re-tested and activated.


Each of the countries participating gave a presentation on the actual situation in their country and disaster nursing preparedness, mitigation, response and recovery. There was consensus that a lot has to be done to strengthen this area.

• Committees are established in most of the countries of the Region to plan, implement and evaluate emergency preparedness; however, their role is not clearly defined.

• Some committees are well structured; others are vaguely defined. • The immediate impact and late impact on health after disasters is not clearly identified

as well as the effect on vulnerable people. • Preparedness should cover the physical, moral and emotional health aspects. • Protection and safety of the staff needs to be emphasized. • Shortage of qualified human resources and well defined roles as well as lack of

standardization of training in disaster preparedness and response hampers efforts. • The role of each sector is not clearly defined. • Lack of communication and lack of transportation usually affect proper implementation. • Facilities, budget, infrastructure, supplies and materials are in short supply. • Promptness, efficiency, and intersectoral coordination need to be strengthened. • Although plans exist, drills are sometimes missing and there is a lack of well defined

regulations. • Training in disasters varies from basic life support to more advanced care provision.

The participants emphasized the need for network development for sharing of information and experiences among the countries of the Region in disaster nursing and the importance of coordination, participation, capacity-building and awareness in disaster nursing.

5. GENERAL FRAMEWORK OF CORE COMPETENCIES FOR NURSES TOWARDS DISASTER PREPAREDNESS AND RESPONSE

The document Nursing and midwifery services: strategic directions 2002–2008, published by WHO in 2002, delineates as one of the expected results under key result area 3 “practice and health system improvement” the following expected result: “innovative approaches identified, adapted and disseminated to bridge gaps between the health system and the needs of the community especially in terms of home-based care, palliative care, health promotion, disease prevention, rehabilitation and emergency care.”

The Department of Humanitarian Action in Crisis (HAC) and the Health Services Provision Department (OSD) at headquarters has undertaken the development of core competencies for disaster nursing. The need for this work arose because of lack of education on disaster preparedness in many disaster-prone countries and conflict areas. In a disaster situation, health services are more required than in stable conditions to respond efficiently to the needs of the population. Nurses will be always involved when a disaster occurs; however, to date nurses have been insufficiently prepared in this area, and there is urgent need to prepare health professionals to respond efficiently towards a disaster situation (natural or man-made).


The proposed core competencies were developed based on the International Council of Nurses (ICN) framework of competencies for the general nurse in a mass casualty incident identified by Stanley et al. (2003).

The participants in the meeting evaluated the proposed core competencies using the curriculum assessment tool included in Annex 4. Participants’ responses with regard to the assessment of the proposed core competencies are outlined in Annex 5.

The general comments of the participants on the core competencies are as follows.

• The curriculum of disaster nursing should be community-oriented and student-centred using real case experiences

• The general competencies should be aligned horizontally and the specific ones should be put vertically.

• The competencies should be action-oriented and stated in such a way to make them educationally measurable.

• The term “population affected” should be used instead of “victim-patient”. • The functional role of nurses in disaster response should be described.

6. NURSING’S CONTRIBUTION TO THE REGIONAL STRATEGY FOR DISASTER PREPAREDNESS AND RESPONSE

This session, which was facilitated by Mr Musani, addressed a number of key questions on areas of preparedness, mitigation, response and recovery in order to meet the following objectives:

• Define nursing’s contribution to the overall regional health strategy for disaster, reduction and risk management in the Region.

• Review and assess the regional strategy for its correctness, appropriateness and relevance to disasters experienced in the Region.

The strategy is a framework which addresses four areas of work (preparedness, mitigation, response and recovery), emphasizes partnerships and, it is hoped, will be endorsed by other United Nations and international organizations. The regional strategy will be presented to the Regional Committee for endorsement and will also be shared during the 2005 Kobe Conference (ISDR).

The major points for discussions were as follows.

• Nurses can play a vital role in not only service provision during an emergency but more importantly in the shaping of health leadership and the development of national disaster preparedness programmes.

• Disaster reduction programmes must address the basic level of preparedness at the community level; ensuring that communities know their risk.


• Building capacity for nurses and the medical staff in preparedness and mitigation is essential in order to develop and sustain a disaster reduction programme in countries.

• Disaster programmes must draw from lessons learned and evaluations from previous major disasters.

• Disaster programmes should have a component of applied/operational research in order to assess health needs in a crisis and also evaluations.

• Chief nurses and/or directors of nursing are encouraged to meet and plan with the national disaster coordinators in their respective countries.

• Disaster health programmes need to engage the national red cross/crescent societies and civil defense.

• Disaster programmes should address existing legislation on the protection of health care professionals working in a relief environment.

• Organizations such as WHO should ensure that information, guidelines, tools, etc are readily available to national disaster programmes.

7. FIELD VISITS

Participants made field visits to various educational institutions, including the College of Health Sciences and the WHO collaborating centre for nursing development and health service delivery organizations in Bahrain to learn about development of nursing education at the basic and specialty level as well as the role of the nurse in different settings at the primary health care level, including mental health. In addition, participants visited the Directorate of Training at the Ministry of Health to learn about the continuing education system in nursing and other health professions and also visited the Office of Nursing Licensure to learn about the system of nursing and midwifery regulation in Bahrain.

8. RECOMMENDATIONS

1. Member States should include disaster nursing in pre-service nursing curricula and develop continuing education programmes to build the capacity of nurses and midwives in disaster nursing preparedness, response and mitigation.

2. Member States should develop mechanisms to involve nurses in decision-making and strategic planning related to emergency and disaster preparedness, planning and management.

3. Member States should adopt the set of core competencies for nurses in emergency and disaster preparedness and utilize it for developing educational programmes in disaster nursing.

4. WHO should support countries in their efforts to develop and strengthen disaster nursing practice and education and should document and publish case studies from countries that have experienced disasters in the Region.


5. WHO should establish a database of nurses and midwives from the Region with expertise in disaster nursing, and should develop mechanisms to utilize this expertise on an emergency basis in countries experiencing disasters.

6. WHO should develop manuals and guidelines on disaster management.

7. WHO should develop mechanisms to ensure coordination in training of nurses on disaster preparedness, response and mitigation through existing and future training programmes.


Annex 1

AGENDA

1. Opening session

2. Objectives and method of work

3. The role and responsibilities of the Regional Advisory Panel on Nursing

4. Review of the current status of disaster and emergency nursing preparedness in education and practice in the Region

5. Disaster and emergency nursing preparedness, response and mitigation: an international perspective

6. Experience of international relief agencies in disaster and emergency nursing preparedness and response

7. Discussion and adoption of the general framework of core competencies for nurses towards disaster preparedness and response

8. Review of the regional strategy for disaster and emergency preparedness and response

9. Nursing’s contribution to the regional strategy for disaster and emergency preparedness and response

10. Developing a policy framework for emergency and disaster nursing preparedness and response in the Region

11. Guidelines for the preparation of the countries progress report on nursing and midwifery in preparation of the regional report for WHA 2006

12. Adoption of the final recommendations and plan of action

13. Closing session


Annex 2

PROGRAMME

Monday, 28 June 2004

08:30 – 09:00 Registration 09:00 – 10:30 Opening session

Address by H.E. Nada Abbas Hafadh, Minister of Health, Bahrain Address by Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean Address by Her Royal Highness Princess Muna Al-Hussein, WHO Patron for Nursing and Midwifery in the Eastern Mediterranean Region

10:30 – 11:00 Introduction to the meeting and consultation: Introduction of Participants Election of Officers Expected outcomes and method of Work Roles and responsibilities of the Regional Advisory Panel for Nursing (Dr F. Al-Darazi)

11:00 – 12:15 Plenary Session 1 Disaster nursing preparedness, response, and mitigation: an International perspective (Professor H. Minami) A Regional health strategy to strengthen disaster preparedness, mitigation, response and recovery in the Eastern Mediterranean Region (Mr A. Musani) Discussion

12:15 – 14:30 Plenary Session 2 Country presentations: current status of disaster nursing preparedness in education and practice in the Region

14:30 – 17:45 Plenary Session 2 (cont’d) Country presentations: current status of disaster nursing preparedness in education and practice in the Region

Tuesday 29 June 2004

08:30 – 09:15 Plenary Session 2 Country presentations: current status of disaster nursing preparedness in education and practice in the Region

09:15 – 09:30 Synthesis Country reports – Dr C. Ghazi 09:30 – 10:15 Lessons learnt in disaster preparedness and response 10.15 – 10:45 Group Work 1 Introduction to Group Work 1

General framework of core competencies for nurses towards disaster preparedness and response (Dr Fariba Al-Darazi)

10:45 – 11:45 Group Work 1


General framework of core competencies for nurses towards disaster preparedness and response

11:45 – 13:45 Group reports and discussion 13:45 – 14:45 Group Work 2

Nursing’s contribution to the regional health strategy for disaster preparedness and response

14:45 – 16:30 Group reports and discussion

Wednesday 30 June 2004

08:00 – 08:15 Synthesis of Day 2 08:15 – 09:00 Plenary Session 4

Guidelines for the preparation of countries progress report on nursing and midwifery in preparation of the regional report for WHA 2006 Discussion

09:00 – 09:30 Reading of the report and recommendations 09:30– 11:00 Discussion of the report and recommendations 11:00 – 14:00 Field visits to:

WHO Collaborating Centre for Nursing Development at the College of Health Sciences PHC Centre: Nurses role Community mental health nursing Nursing Continuing Education Nursing Regulation Other health/ educational facilities based on participants’ interest

14:00 – 14:30 Closing Session


Annex 3

LIST OF PARTICIPANTS

Members of the Regional Advisory Panel

Mrs Batool Al-Mohandis Nursing Division College of Health Sciences Ministry of Health Manama BAHRAIN Dr Amal Kadry Atteya Assistant Professor, Critical Care Nursing Faculty of Nursing University of Alexandria Alexandria EGYPT Mrs Sadat S.B. Maddah Director of Nursing Faculty and Advisor to the Dean University of Social Welfare and Rehabilitation Teheran ISLAMIC REPUBLIC OF IRAN Ms Awatef Al-Qattan Kuwait KUWAIT Mr Elie A’araj President, Order of Nurses Beirut LEBANON Ms Shariffa Saif Al-Jabry Director of Nursing Affairs Ministry of Health Muscat OMAN Mrs Muneera Hamdan Al-Osimy Director of Nursing Ministry of Health Riyadh SAUDI ARABIA


Dr Sawsan Majali Director of Nursing Programme Dar El Hekma College Jeddah SAUDI ARABIA Mr Hammouda Rouis Ecole de la sante Sousse TUNISIA Mrs Fatima Al-Rifai Director, Federal Department of Nursing Ministry of Health Abu Dhabi UNITED ARAB EMIRATES Mrs Asli Ashkir Department of Maternal and Child Health Ministry of Health Abu Dhabi UNITED ARAB EMIRATES

Participants AFGHANISTAN Mrs Gul Jan Jalal Head of Nursing Department of Intermediate Medical Institute Kabul BAHRAIN Dr Mouza Suwaileh Chairperson, Nursing Division College of Health Sciences Director of WHO Collaborating Centre for Nursing Development Ministry of Health Manama Mrs Fatema Abdel Wahed Chief of Nursing Services Primary Care and Public Health Health Centre Directorate Manama


DJIBOUTI Mr Ali Houssein Gueddi Chief, Nursing Section Djibouti Nursing School Djibouti EGYPT Dr Baheya Fouad Hassan Undersecretary for Central Nursing Administration Ministry of Health and Population Cairo Dr Hashim Ahmed Allam National Disaster Coordinator Under-secretary of State for Emergency Medicine Ministry of Health and Population Cairo ISLAMIC REPUBLIC OF IRAN Mrs Fereshteh Sistanayee Director of Nursing Ministry of Health and Medical Education Teheran Dr Ali Asghar Farshad National Disaster Coordiantor Ministry of Health Teheran IRAQ Ms Firyal Abdul Jalil Director of Nursing Ministry of Health Baghdad JORDAN Dr Linda Haddad Dean, Faculty of Nursing Director, WHO Collaborating Centre for Nursing Development Jordan University of Science and Technology Irbid


Mrs Hiyam Al-A’araj Director of Nursing Ministry of Health Amman LEBANON Dr Amal Mansour Ministry of Public Health Beirut LIBYAN ARAB JAMAHIRIYA Mrs Maryouma Mohamed Khozam Government nursing focal point Tripoli MOROCCO Mr Ismail Aachati Adviser to the Minister of Health Ministry of Health Rabat QATAR Dr Nabila Al-Meer Director of Nursing, Hamad Corporation Doha SOMALIA Mr Omar Mohamud Ibrahim President of Somali Nursing Association Mogadishu SUDAN Mrs Asma Abdel-Gadir Eltigani Senior Nurse Khartoum


TUNISA Mr Faisal Alawi Head of Nursing Continuing Education Ministry of Health Tunis REPUBLIC OF YEMEN Mr Nasr Ali Head of Nursing Continuing Education Directorate of Nursing Ministry of Public Health and Population Sana’a Dr Ali Saryah National Disaster Coordinator Ministry of Public Health and Population Sana’a

WHO Patron for Nursing and Midwifery in the Eastern Mediterranean Region Her Royal Highness, Princess Muna Al-Hussein JORDAN

Other Organizations Ms Jennifer Hayward Head Nurse, Health Services Unit International Committee of the Red Cross (ICRC) Geneva SWITZERLAND

Observers BAHRAIN Mrs Badriya Al-Kuwaiti Deputy Chief of Nursing Services, Ministry of Health Manama Maj. Badria Salman Director of Nursing, Bahrain Defence Force Hospital Riffa Mrs Fatima Al-Ansari Manama Mr Abdul Jabbar Ali Essa Manama


Maj.Somaya Hussein Abdulrahman Head of Quality Management, Military Hospital Bahrain Defense Force Medical Services Riffa Mrs Hakeema Ghuloom Head of Nursing Continuing Education Mrs Amina Matooq Head of Emergency Nursing Program Mrs Rola Al-Safar Head of Cardiac Care Nursing Mrs Layla Murad Nurse Registrar Ministry of Health Mrs Seham Al-Shaikh Bahrain Nursing Society JAPAN Professor Aiko Yamamoto Disaster Nursing, Hyogo University Tokyo Ms Asako Okamoto Department of International Affairs, Japanese Nursing Association (JNA) Tokyo

WHO Secretariat Dr Hussein A. Gezairy, Regional Director, WHO/EMRO Dr Fariba Al-Darazi, Regional Adviser for Nursing and Allied Health Personnel, WHO/EMRO Mr Altaf Musani, Technical Officer, Emergency and Humanitarian Action, WHO/EMRO Dr Hiroko Minami, Temporary Adviser (President, Japanese Nursing Association, Tokyo, JAPAN) Dr Cheherazade Ghazi, Temporary Adviser (Nursing Consultant, EGYPT) Mrs Roya Sadrizadeh, Short-term Professional, WHO Afghanistan Mrs Asia Osman, Officer-in-charge, Hargeisa WHO sub-office, Somalia Mrs Hanaa Ghoneim, Senior Administrative Assistant, WHO/EMRO Mrs Sherifa Mokhtar, Secretary, WHO/EMRO Mrs Naglaa Salah, Secretary, WHO/EMRO

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Sub-Competencies Value of sub-competencies

Curricular content

Curricular content, teaching-learning and evaluation methods

From your point of view, how valuable is each sub-competency listed under each of the following competencies in the education of nurses to prepare for provision of health services towards disaster preparedness and response in your country? 0 for not valuable 1 for low 2 for medium 3 for high valuable

Identify to what degree the content related to this sub-competency is included in your present curriculum. 0 for absent 1 for weak or insufficient for attainment of competency; 2 adequate for minimum development of competency; 3 for strong or sufficient for competency development

If the sub-competency is included in the curriculum, please list the related curricular content and the teaching-learning methods used in preparing students to attain this sub-competency. When listing teaching-learning methods, please choose from one or more of the options listed below: Expository teaching: lecture, demonstration, audiovisual presentation Interactive teaching: discussion, question and answer sessions. Cooperative learning: small group or paired learning. Inquiry teaching/problem-solving: problem-based or case-based learning Self-learning: programmed learning modules; study guides; independent learning activities. Simulated or real life: participation in simulation exercises or working in real disaster situations. Other methods: please specify

List evaluation methods used to assess and evaluate student performance WE Written exam PE Practical exam GP Group project IP Individual project O Other

Non

e

Low

Med

ium

Hig

h

Abs

ent

Wea

k

Ade

quat

e

Stro

ng

Content Year Ex

posi

tory

Inte

ract

ive

Coo

pera

tive

Inqu

iry, P

robl

em

Solv

ing

Self-

lear

ning

Sim

ulat

ed o

r rea

l lif

e ac

tiviti

es

Oth

er m

etho

ds

WE, PE, GP, IP, O (please specify)

Annex 4

CU

RR

ICU

LU

M A

SSESSM

EN

T TOO

L

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Competency 1. Demonstrates understanding of the challenges to ethical decision-making, critical thinking and care prioritization in conflict and disaster situations

Value

Circle appropriate number

Curricular content


Content

List related content and corresponding year in the training programme

Teaching-learning methods Check appropriate box

Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

1a: Use an ethical and nationally approved framework to support decision-making and prioritizing needed in a disaster situation.

0 1 2 3 0 1 2 3 A B C D E F G

1b: Use clinical judgement and decision making skills in assessing the potential for appropriate, timely individual care during a disaster situation.

0 1 2 3 0 1 2 3 A B C D E F G

1c: Use clinical judgement and decision making skills in assessing the potential for appropriate, timely individual care after a disaster situation.

0 1 2 3 0 1 2 3 A B C D E F G

1d: Describe at the pre-disaster, emergency and post-disaster phases the essential nursing care for individuals, families, special vulnerable groups (e.g. pregnant women, children, elderly, disabled) and communities.

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Competency 2. Applies principles of care provision and management in a disaster situation

Value


Curricular content


Content



Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

2a: Applies relevant knowledge and skills of nursing practice in a disaster situation.

0 1 2 3 0 1 2 3 A B C D E F G

2b: Applies critical thinking and problem-solving skills.

0 1 2 3 0 1 2 3 A B C D E F G

2c: Acts as a resource for individuals, families and communities in coping with changes in health, disability and with death.

0 1 2 3 0 1 2 3 A B C D E F G

2d: Demonstrates understanding of disaster planning, the involvement of different health professionals and the community.

0 1 2 3 0 1 2 3 A B C D E F G

2e: Takes on leadership responsibilities in the delivery of nursing and health care during and after a disaster.

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Competency 3. Carries out a relevant and systematic health and nursing assessment

Value


Curricular content


Content



Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

3a: Carries out a relevant and systematic health and nursing assessment during and after a disaster situation.

0 1 2 3 0 1 2 3 A B C D E F G

3b: Assess the safety issue for self, the response team and victims in any given response situation in collaboration with other involved teams.

0 1 2 3 0 1 2 3 A B C D E F G

3c: Identify possible indicators of a mass exposure (e.g. gathering of a large number of people with the same symptoms).

0 1 2 3 0 1 2 3 A B C D E F G

3d: Describe general signs and symptoms of exposure to selected chemical, biological, radiological, nuclear and explosive agents (CBRNE).

0 1 2 3 0 1 2 3 A B C D E F G

3e Describe general signs and symptoms of the most important communicable diseases (e.g. ARI, diarrhoea, malaria, vaccine preventable diseases) and malnutrition.

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Competency 4. Implementation of nursing care in a disaster situation

Value


Curricular content


Content



Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

4a: Implements nursing care with limited resources (e.g. material, staff) in a disaster situation to achieve the identified outcomes.

0 1 2 3 0 1 2 3 A B C D E F G

4b: Responds effectively in unexpected or rapidly changing situations.

0 1 2 3 0 1 2 3 A B C D E F G

4c:Responds effectively to any emergency situation.

0 1 2 3 0 1 2 3 A B C D E F G

4d: Evaluates and documents progress towards expected outcomes

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Competency 5. Applies nursing techniques appropriate towards a safe environment

Value


Curricular content


Content



Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

5a: Ensures the safe administration of therapeutic substances via different application routes.

0 1 2 3 0 1 2 3 A B C D E F G

5b: Demonstrates the safe administration of immunisation.

0 1 2 3 0 1 2 3 A B C D E F G

5c: Implements infection control procedures.

0 1 2 3 0 1 2 3 A B C D E F G

5d: Assess the need to initiate appropriate isolation and decontamination procedures available, ensuring that all parties understand the need

0 1 2 3 0 1 2 3 A B C D E F G

5e: Demonstrates knowledge and skill related to personnel protection and safety and barrier nursing, including the use of Personal Protective Equipment (PPE).

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Competency 6. Communication and interpersonal relationships

Value


Curricular content


Content



Evaluation

List method(s)

0 1 2 3 0 1 2 3 A B C D E F G

6a: Locates and describe the emergency response plan for the place of employment and its role in community, state and regional plans.

0 1 2 3 0 1 2 3 A B C D E F G

6b: Describes the use of emergency communication equipment (including the proper use of a radio set)

0 1 2 3 0 1 2 3 A B C D E F G

6c: Demonstrate appropriate emergency documentation of assessments, interventions, nursing actions and outcomes during and after a disaster.

0 1 2 3 0 1 2 3 A B C D E F G

6d: Initiates and develops therapeutic relationships through the use of appropriate communication and interpersonal skills with patients and their families.

0 1 2 3 0 1 2 3 A B C D E F G

6e: Identify reactions of fear, panic and stress that victims, families and responders may exhibit during a disaster.

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Competency 7. Health promotion

Value Circle appropriate number

Curricular content Circle appropriate number

Content List related content and corresponding year in the training programme


Evaluation List method(s)

7a: Identify possible threats and their impact on the general public.

7b: Describe community health issues related to the impact of the disaster towards water, food supplies, shelter and protection of displaced persons (e.g. CBRNE events, natural disasters).

7c: Works collaboratively with other professionals and the community.

7d: Applies knowledge of resources available for health promotion and health education.

7e: Evaluates learning and understanding about health practices.

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Competency 8. Health care systems and policy in a disaster situation






8a: Actively participates in the development of disaster response plans in various settings.

8b: Defines the four phases of disaster management: preparedness, response, recovery and mitigation.

8c: Describes the legal authority of public health agencies to take action to protect the community from threat, including isolation, quarantine and required reporting and documentation.

8d: Recognizes the impact the disaster may have on access to resources and identify how to identify additional resources.

8e: Discuss the impact of the disaster towards the outbreak of communicable diseases and the different levels of the PHC system to prevent or address these outbreaks.

8f: Discuss the diversity of emotional, psychosocial and a socio-cultural response

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to disasters on one’s self and others.

8g: Describe the importance of HIV/ AIDS–prevention, protection and treatment specifically in a disaster situation (e.g. limited number of protective gloves, single use equipment)

Additional core competencies






3

3

3

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Annex 5

PROPOSED CORE COMPETENCIES

General • Accepts accountability and responsibility for one's own professional judgement and actions. • Consults with other health care professionals and relevant organisations/agencies when individual or group needs fall outside the scope of nursing practice.

No change No change

Competency 1: Demonstrates understanding of the challenges to ethical decision-making, critical thinking and care prioritization in conflict and disaster situation.

• Demonstrates understanding of the challenges to ethical decision-making and care prioritisation in war, violence, conflict and natural disaster situations. • Use an ethical and nationally approved framework to support decision-making and prioritizing needed in a disaster situation. • Use clinical judgment and decision-making skills in assessing the potential for appropriate, timely individual care during and after a disaster.

Competency 1: To be removed as it is the same as the main function, to be deleted

• Use an ethical and nationally approved framework to support decision-making and prioritization needed in a disaster situation.

No change

• Use critical thinking and problem solving skills in planning the essential nursing care for individuals, families, special groups (e.g. children, pregnant women, elderly, disabled) and communities at the pre-disaster, emergency and post-disaster phases

Competency 2 Applies principles of care provision and management in a disaster situation

Competency 2 No change Moved from item 4 competency 1 to here Describe at the pre-disaster, emergency and post-disaster phases the essential nursing care for individuals, families, special groups (e.g. children, pregnant women, elderly, disabled) and communities


• Apply relevant knowledge and skills of nursing practice in a disaster situation. • Apply critical thinking and problem-solving skills. • Act as a resource for individuals, families and communities in coping with changes in health, disability and with death. • Demonstrates understanding of disaster planning the involvement of different health professionals and the community. • Takes on leadership in the delivery of nursing and health care during and after a disaster.

No Change To be deleted No change

• Design a disaster plan involving other health professionals and significant community groups.

• Takes on a leadership role in the delivery of health care during and after a disaster whenever necessary.

Competency 3 Carry out a relevant and systematic health and nursing assessment

• Carry out a relevant and systematic health and nursing assessment during and after a disaster situation. • Assess the safety issues for self, the response team and victims in any given response situation in collaboration with other involved teams. • Identify possible indicators of a mass exposure (e.g. gathering of a large number of people with the same symptoms). • Describe general signs and symptoms of exposure to selected chemical, biological, radiological, nuclear and explosive agents (CBRNE). • Describe general signs and symptoms or the most important communicable diseases in a disaster situation (e.g. malaria, ARI, diarrhoea, vaccine preventable diseases) and malnutrition.

Carry out a relevant and systematic safety and health assessment during and after a disaster for self, the response team and the victims Delete Delete Delete

• Recognize general signs and symptoms of mass exposure to selected chemical, biological, radiological, nuclear and explosive agents (CBRNE). • Recognize general signs and symptoms of the most important communicable diseases in a disaster situation (e.g. malaria, ARI, diarrhoea, vaccine preventable diseases) and malnutrition

Competency 4 Implementation of nursing care in a disaster situation

• Implements nursing care with limited resources (e.g. material, staff) in a disaster situation to achieve the identified outcomes. • Responds effectively in unexpected or rapid changing situations.

Implement nursing care in a disaster situation with available resources (e.g. material, staff) to achieve the identified outcomes. Delete Delete


• Responds effectively to any emergency situation.

• Evaluates and documents progress towards expected outcomes.

Delete

• Perform nursing activities according to scientific principles in an unexpected or rapid changing situations.

As it is

Competency 5 Applies nursing techniques appropriate towards a safe environment

• Ensures the safe administration of therapeutic substances via different application routes. • Demonstrates the safe administration of immunisation. • Implements infection control procedures

. • Assess the need to initiate appropriate isolation and decontamination procedures available, ensuring that all parties understand the need. • Demonstrates knowledge and skill related to personnel protection and safety and barrier nursing, including the use of Personal Protective Equipment (PPE).

Applies nursing techniques appropriate to the maintenance of a safe environment

• Ensure the safe administration of treatment and therapeutics • Ensure safe administration of immunisation.

• Implement universal precautions for the control of infection

Delete Delete

Competency 6 Communication and interpersonal relationships

• Locates and describe the emergency response plan for the place of employment and its role in community, state and regional plans. • Describes the use of emergency communication equipment (including the proper use of a radio set). • Demonstrate appropriate emergency documentation of assessments, interventions, nursing actions and outcomes during and after a disaster. • Initiates and develops therapeutic relationships through the use of appropriate communication and interpersonal skills with patients and their families. • Identify reactions of fear, panic and stress that victims, families and responders may exhibit during a disaster situation.

Apply principles of communication and interpersonal relationship in a disaster situation. Delete

• Use effectively the emergency communication equipment during a disaster. • Prepares appropriate emergency documentation of assessments, interventions, nursing actions and outcomes during and after a disaster.

Same

• Respond to reactions of fear, panic and stress that victims, families and others may exhibit during a disaster situation.


Competency 7 Health promotion

• Identify possible threats and their impact on the general public. • Describe community health issues related to the impact of the disaster towards water, food supplies, shelter and protection of displaced persons (e.g. CBRNE events, natural disasters). • Works collaboratively with other professionals and the community. • Applies knowledge of resources available for health promotion and health education. • Evaluates learning and understanding about health practices.

Participate actively in health maintenance and promotion Same

• Recognize community health issues related to the impact of the disaster towards water, food supplies, shelter and protection of displaced persons (e.g. CBRNE events, natural disasters).

Same Same Same

Competency 8 Health care systems and policy in a disaster situation

• Actively participates in the development of disaster response plans in various settings. • Defines the four phases of disaster management: preparedness, response, recovery and mitigation. • Describes the legal authority of public health agencies to take action to protect the community from threat, including isolation, quarantine and required reporting and documentation. • Recognise the impact the disaster may have on access to resources and identify how to identify additional resources. • Discuss the impact of the disaster towards the outbreak of communicable diseases and the different levels of the PHC system to prevent or address these outbreaks. • Discuss the diversity of emotional, psychosocial and a socio-cultural response to disasters on one’s self and others. • Describes the different categories of a TRIAGE and knows the different systems. • Describe the importance of HIV/AIDS – prevention, protection and treatment specifically in a disaster situation (e.g. limited number of protective gloves, single use equipment).

Is aware of Health care systems and policy in a disaster situation Same Same

• Recognize the legal authority of public health agencies to take action to protect the community from threat, including isolation, quarantine and required reporting and documentation. • Recognise the impact of the disaster on access to resources and how to identify additional resources. • Recognise the impact of the disaster towards the outbreak of communicable diseases and the different levels of the PHC system to prevent or address these outbreaks.

Delete

• Recognizes the different categories of a TRIAGE and knows the different systems.

Delete

Documents

Sixth meeting of the Regional Advisory Panel on Nursing ...applications.emro.who.int/docs/who_em_nur_382_e_en.pdfDr Nada Hafadh welcomed the participants to the meeting and noted that