Disaster Response, Emergency Preparedness, Nursing Education



  1. Smithers, Bonnie
  2. Tenhunen, Monica L.


Abstract: As a component of disaster response, nurses need to understand their roles in preparing for and responding to a disaster. Limited evidence regarding educating undergraduate nursing students for disasters exists. An interdisciplinary disaster drill was developed and implemented at a university nursing program. Challenges in preparing the students without giving specific details and ways of providing a more realistic experience continue to be addressed. Continued evaluation of the simulation and making identified changes to the interdisciplinary disaster drills will improve student learning and help to prepare future nurses for disasters.


Article Content

Nurses are a main source of health care providers in disaster situations. As such, nurses are responsible for understanding their roles in preparedness, planning, and availability for disasters. The International Council of Nurses released a statement indicating that all nurses should be systematically trained to be effective in emergencies and should work in partnership with other disciplines to achieve this goal (International Council of Nurses, 2009). The American Nurses Association supports the position that nurses should develop competence to respond and initiate client care through participation in interdisciplinary drills and exercises (American Nurses Association, 2008). The American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Nursing Education state that graduates should be able to use clinical judgment and make decisions during disaster situations (AACN, 2008).


An integrative review determined there were no uniform competencies for preparation and that most programs used multiple technologies and methods to provide disaster preparedness education (Jose & Dufrene, 2014). Studies on educating undergraduate nursing students primarily used senior nursing students as responders; if other nursing students were involved, they participated as survivors of the event (Hutchinson et al., 2011; Kaplan, Connor, Ferranti, Holmes, & Spencer, 2012; Morrison & Catanzaro, 2010). Most drills included debriefing for both students and faculty to discuss the event (Austin, Hannafin, & Nelson, 2013; Hutchinson et al., 2011; Kaplan et al., 2012; Morrison & Catanzaro, 2010).



After completing a literature review about disaster drills that included the 2013 International Nursing Association for Clinical Simulation and Learning (INACSL) standards, faculty at our university nursing program decided to develop and implement a disaster drill during the fall semester. In developing a plan for a disaster drill, we selected a tornado, a likely scenario for our geographic area (Federal Emergency Management Agency, n.d.). We developed student learning outcomes for both didactic and simulation portions of the disaster education based on AACN (2008) Essentials. As this was not a research project, no institutional review board review was completed.


Based on interdisciplinary resources available on the campus, department chairs were asked to participate in the development, planning, and implementation of the drill. Social work, safety, university police, drama, health and human performance, and the media department joined the planning. Meetings were held bimonthly with department representatives during the spring and summer semesters to clarify ideas, roles, and responsibilities for the drill. A list of potential injuries for the disaster was developed based on the literature review and expert opinion from the planning committee. These injuries included impalement, blunt force trauma, broken bones, mental health issues, and death. An obstetrical emergency was developed by nursing faculty using the simulation manikin.


The first drill was held in a large open room in the nursing building. This room was fitted with props to represent an open field. Final semester nursing students in the community and rural health nursing course were the responders. Their preparation included reading on disaster management and completion of an online American Red Cross course. In addition, students were provided an in-class presentation on disaster response by an American Red Cross representative. Third-semester nursing students were designated survivors or the deceased and were moulaged to represent various injuries.


In the second drill, which took place at the football stadium on campus, community health nursing students were again the responders. Based on feedback from the first drill, they read further on disaster preparedness and had an in-class presentation on disaster response, including triage and ways to use multiple types of commonly found equipment for emergency purposes. Third-semester nursing students and students in the campus first aid courses were the survivors and the deceased for this drill. They were moulaged appropriately and given props to represent their identified conditions.



We are continuing to hold annual drills at the university. For each drill, responders are divided into two groups based on their previous performance in clinical and existing relationships (e.g., sisters are placed in different groups). This is intended to challenge students and promote the development of leadership skills. The first group is given a specific time to arrive in preparation for the event and responds to a tornado alarm. The second group is not allowed in the vicinity and is contacted by a telephone tree by first responders when they feel they need more assistance.


Students are aware of when and where the disaster drill is to take place and arrive to help very soon after being contacted. As this is not realistic to response times in actual disaster events, the faculty drill coordinator has solicited ideas from all involved groups on how to improve the situation, but no clear option has been identified.


Debriefing is held with all nursing students immediately after both disaster drills to obtain feedback on positive and negative aspects of the experiences. A debriefing session is then held for responders to discuss their role during the drill. On the day of the drill, nursing students complete a simulation effectiveness tool, developed by CAE Healthcare (2005), which asks for overall reflections and an evaluation on how they performed. Course examinations contain questions regarding content learned in the didactic portion of the course, and faculty evaluate students during the drill and debriefing sessions to determine if students met the objectives. Approximately one week after each drill, a meeting with the department representatives is held to debrief and start planning for the next drill.



In the debriefing after the first drill, students voiced concern about the failure to clearly identify available resources and to indicate the extent faculty served as resources during the drill. In the following drill, students were provided more information on resources, and faculty were given specific scripts in case they were questioned by students.


As students still expressed concern regarding the faculty role during the drill, it was decided in the planning committee debriefing that, in the future, faculty will not be in the immediate area of the drill. They are still able to observe but are not accessible to students. Review of the simulation effectiveness tools indicates that students continue to desire more information about the drill prior to its occurrence. The balance between providing information and not overpreparing students continues to be a challenge.



All nurses should be educated in disaster preparedness and response. Challenges to the development and implementation of our disaster drill remain due to a lack of clear recommendations. We continue to review guidelines for best practices, including updated INACSL standards, to assist in the process. Issues that occurred in the first drill were not fully anticipated and had to be corrected for subsequent drills. This project adds to the limited evidence and practice on developing standard methods of educating undergraduate nursing students. Continued evaluation and change to the interdisciplinary disaster drills will improve student learning and contribute to disaster preparation for future nurses.




American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Retrieved from[Context Link]


American Nurses Association. (2008). Adapting standards of care under extreme conditions: Guidance for professionals during disaster, pandemics, and other extreme emergencies. Retrieved from[Context Link]


Austin E. N., Hannafin N. M., & Nelson H. W. (2013). Pediatric disaster simulation in graduate and undergraduate nursing education. Journal of Pediatric Nursing, 28, 393-399. doi:10.1016/j.pedn.2012.12.004. [Context Link]


CAE Healthcare. (2005 original SET; Leighton, Ravert, Mudra & Macintosh, 2015). Simulation effectiveness tool-modified (SET-M). Retrieved from[Context Link]


Federal Emergency Management Agency. (n.d.). Disaster declarations for 2015. Retrieved from[Context Link]


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Kaplan B. G., Connor A., Ferranti E. P., Holmes L., & Spencer L. (2012). Use of an emergency preparedness disaster simulation with undergraduate nursing students. Public Health Nursing, 29(1), 44-51. doi:10.1111/j.1525.1446.2011.00960.x [Context Link]


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