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Identifying Crucial Equipment and Skills Needed to Evacuate Critically Ill Infants During Disasters: Using Nursing Expertise to Guide Training Targets

Published online by Cambridge University Press:  26 June 2019

Megan M. Gray ,
Anita A. Thomas ,
Brian Burns  and
Rachel A. Umoren
Megan M. Gray*
Affiliation:
University of Washington and Seattle Children’s Hospital, Division of Neonatology, Seattle, WashingtonUSA
Anita A. Thomas
Affiliation:
University of Washington and Seattle Children’s Hospital, Division of Pediatric Emergency Medicine, Seattle, WashingtonUSA
Brian Burns
Affiliation:
Seattle Children’s Hospital, Division of Pediatric Emergency Medicine, Seattle, WashingtonUSA
Rachel A. Umoren
Affiliation:
University of Washington and Seattle Children’s Hospital, Division of Neonatology, Seattle, WashingtonUSA
*
Correspondence: Megan M. Gray, MD Seattle Children’s Hospital Division of Neonatology Mail Stop FA.2.113, PO Box 5371 Seattle, Washington 98145 USA, E-mail: [email protected]
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Abstract

Introduction:

Unexpected disasters, such as earthquakes or fires, require preparation to address knowledge gaps that may negatively affect vulnerable patients. Training programs can promote natural disaster readiness to respond and evacuate patients safely, but also require evidence-based information to guide learning objectives.

Problem:

There is limited evidence on what skills and bedside equipment are most important to include in disaster training and evacuation programs for critically ill infants.

Methods:

An expert panel was used to create a 13-item mastery checklist of skills for bedside registered nurses (RNs) required to successfully evacuate a critically ill infant. Expert nurses were surveyed, and the Angoff method was used to determine which of the mastery checklist skills a newly graduated nurse (ie, the “minimally competent” nurse) should be able to do. Participants then rated the importance of 26 commonly available pieces of bedside equipment for use in evacuating a hemodynamically unstable, intubated infant during a disaster.

Results:

Twenty-three emergency department (ED) and neonatal intensive care unit (NICU) charge RNs responded to the survey with a mean of 19 (SD = 9) years of experience and 30% reporting personal experience with evacuating patients. The skills list scores showed an emphasis on the newly graduated nurse having more complete mastery of skills surrounding thermoregulation, documentation, infection control, respiratory support, and monitoring. Skills for communication, decision making, and anticipating future needs were assessed as less likely for a new nurse to have mastered. On a scale of one (not important) to seven (critically important), the perceived necessity of equipment ranged from a low of 1.6 (breast pump) to a high of 6.9 (face mask). The individual intraclass correlation coefficient (ICC) of 0.55 showed moderate reliability between raters and the average team ICC of 0.97 showed excellent agreement as a group.

Conclusion:

Experts rated the ability to manage physiological issues, such as thermoregulation and respiratory support, as skills that every nurse should master. Disaster preparedness activities for nurses in training may benefit from checklists of essential equipment and skills to ensure all nurses can independently manage patients’ physiologic needs when they enter the workforce. Advanced nursing training should include education on decision making, communication during emergencies, and anticipation of future issues to ensure that charge and resource nurses can support bedside nurses during evacuation events.

Keywords

disasterhospital evacuationinfantnursing training
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 370 - 375
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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