Nurse Education in Practice (2004) 4, 6976

Nurse
Education
in Practice
www.elsevierhealth.com/journals/nepr

FOCUS

Teaching disaster nursing by utilizing the

Jennings Disaster Nursing Management Model
Andrea Jennings-Sanders*

Assistant Professor at Cleveland State University, Cleveland, Ohio, USA

Accepted 26 February 2003

Summary Millions of people are affected by disasters or major incidents annually.

Disaster preparedness has reached a new level of urgency in the UK and other
countries around the world. Thus, nurses need to become involved in disaster
management in order to function effectively in these types of situations. Exposing
nurses to disaster nursing education may result in positive outcomes for populations
involved in a disaster. Currently, there are few models or frameworks to guide nurses
through the process of understanding disaster nursing. The purpose of this paper is to
describe the Jennings Disaster Nursing Management Model and discuss its application
in a Community Health Nursing course.
c 2003 Elsevier Ltd. All rights reserved.

Introduction nurses will now have to become involved in disaster

management in order to function effectively in di-
Millions of people in the UK are affected by disasters saster situations. However, there are very few
or major incidents annually. The British Red Cross models or frameworks to guide nurses through the
cites that an overwhelming number of disasters process of understanding disaster nursing. Nurses in
have occurred in the past few years (The British Red all specialties need to know how to assess, priori-
Cross 2002). These disasters included floods, train tize, provide support, and function effectively in
crashes, earthquakes, and acts of terrorism. The disaster situations. Moreover, incorporating disas-
World Health Organization (WHO) (2002) defines ter-nursing content into nursing curricula is crucial
disaster as a situation where peoples normal in nursing education today. Disaster nursing is de-
means of support for life with dignity have failed as fined as the systematic and flexible utilization of
a result of natural or human-made catastrophe knowledge and skills specific to disaster-related
p.1. Disaster preparedness has reached a new level nursing, and the promotion of a wide range of ac-
of urgency in the UK and in other countries. Thus, tivities to minimize the health hazards and life
threatening damage caused by disasters in collab-
oration with other specialized fields p.1 (Society of
Disaster Nursing 2002). Exposing nurses to disaster
*
Present address: Postdoctoral Fellow, The University of nursing education may result in positive outcomes
Texas Medical Branch at Galveston, Sealy Center on Aging, Room for individuals and populations involved in a disas-
3.244 Jennie Sealy Hospital, 301 University Boulevard, Galves-
ton, TX 77555-0460, USA. Tel.: 1-409-747-0579; fax: 1-409-772-
ter. These outcomes may include decreased mor-
8931. tality rates, improved health status, and decreased
E-mail address: arjennin@utmb.edu. disaster related costs.


1471-5953/$ - see front matter c 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S1471-5953(03)00007-6
70 A. Jennings-Sanders

The purpose of this paper is to describe the be prepared to understand responses to traumatic
Jennings Disaster Nursing Management Model and disaster events. This training would enable all
discuss its application in a Community Health nurses to individualize appropriate nursing inter-
Nursing course. ventions and decrease post-traumatic stress
disorders.
This is a growing threat of bioterrorism in the UK
and other countries. The following studies discuss
Review of literature how nurses and health care professionals should be
educated in bioterrorism. Shadel et al. (2001),
There are a scarce amount of studies in the liter- conducted focus groups among infection control
ature addressing disaster nursing management. practitioners to determine knowledge about biot-
Moreover, the literature is limited in providing errorism preparedness. The participants in the fo-
models or frameworks that address disaster nursing cus groups affirmed that there is a lack of
management. awareness by employees in health care institutions
The following studies in the literature reveal about a potential threat of bioterrorism and a de-
that there is a great need for nurses and other ficiency in knowledge about the potential conse-
health care professionals to be educated in how to quences of an attack. Participants preferred to
prepare and work in disaster situations. Pearce et have bioterrorism sessions of less than 60 min and
al. (2001) explored issues that needed attention in with the use of a variety of teaching methods such
disaster medicine education from an international as video, Internet, and self-learning texts. Salazar
perspective. Results of the study indicated that the et al. (2002) stressed the importance that occu-
following issues needed to be included in disaster pational health nurses should develop a disaster
medicine education: formal education, standard- plan for biological disasters. Becoming educated
ized disaster-related definitions, integration, about biological weapons in terms of their patho-
evaluation of programs and interventions, inter- physiology, methods of detection, and treatment is
national cooperation, identifying the psychosocial key for nurses to know. The nurses all agreed that
consequences of disaster, meaningful research, their lack of knowledge about this topic is due to
hazard impact, risk and venerability analysis. The the unwillingness of their administrators to allo-
authors recommended that education on disasters cate funds for this type of education. Implications
should be formalized, evaluation of education and of the study suggested that disaster planning would
interventions must be documented, and findings be increase the effectiveness of responses to bioter-
published. Similarly, Noji et al. (2001) stressed the rorism when it occurs. Similarly, OConnell et al.
importance of finding effective models for medical (2002) explored the issues in preparedness for bi-
and response coordination in the event of a disas- ological terrorism for nurses. The authors surmised
ter. Findings suggested that the few models ex- that nurses must be trained so that they are aware
plored needed improvement in the following areas: of the symptoms and presentations of individuals
preplanning (pre-disaster goals), information col- exposed to likely bioterrorist agents. Communica-
lection (assessment), communication (materials ble disease knowledge is also important because it
and methods), and response centers and personnel. will protect the nurses who are giving care to pa-
The authors concluded that a creation of a data tients. In addition to acquiring this knowledge,
clearinghouse on disaster management is needed nurses must communicate effectively with other
for the purpose of sharing information. Nicoll hospitals and health departments. This permits
(2001) cites that training programs for public data sharing and establishes a communicable dis-
health workers addressing the management of a ease surveillance system in a given locality.
major incident or disaster would be advantageous Nurses are sometimes the first responders in a
in the UK in terms of decreasing mortality rates. disaster situation. It is important to understand
Providing health protection via a public health staff their needs and concerns during a disaster event. A
who knows their locality and have confidence of study by French et al. (2002), explored the needs
the people is key. According to the authors, the and concerns that nurses experience when they
numbers of public health trainees are declining in function as disaster responders. Four focus groups
the UK. Thus, it is critical to train nurses in each consisting of emergency room nurses from hospi-
locality in disaster management in order to im- tals who responded after a major hurricane were
prove the health outcomes of people. From the interviewed. Findings indicated that nurses de-
viewpoint of disaster nursing education, Adams et scribed their conflict as family commitment versus
al. (1999) concluded that nurses needed to enroll in professional obligation. The major concerns that
local Red Cross disaster training courses in order to nurses cited were family safety, pet care, and
Teaching disaster nursing by utilizing the Jennings Disaster Nursing Management Model 71

personal safety while at work. Other concerns were community health course. It is a model that will
meeting basic needs such as food, water, sleep, help community nurses plan for and manage di-
shelter, and rest while at work. sasters at their work setting. Nurses in conjunction
When a disaster does occur, it is essential to with other personnel can be involved in each of the
know what nursing interventions are needed. segments of each phase of the model. There are
Coffman (1996) examined the understanding of four phases incorporated in the model: Phase 1
the meaning of parents everyday experiences af- (Pre-disaster), Phase II (Disaster), Phase III (Post-
ter a major natural disaster. In depth interviews disaster), and Phase IV (Positive Client/Population
revealed that parents had feelings of being thank- Outcomes). Phase one through phase three will
ful for being alive, were overwhelmed with bal- have an impact on Phase IV.
ancing needs and roles, being responsible for
children, and finding meaning in the disaster. From
these findings, the authors suggest that nurses Phase I
must implement interventions that address family
needs, support systems, and involve parents as In Phase I (Pre-disaster), an assessment of the
active decision makers after a disaster occurs. work setting in terms of resources and risks is key
for nurses to perform. Identification of resources
such as adequate funds, established shelters, co-
Jennings Disaster Nursing operative agreements with other community
Management Model agencies, previous training related to disaster
education to employees, an existing disaster
The Jennings Disaster Nursing Management Model management plan, and existing disaster assess-
was developed by Jennings-Sanders (see Fig. 1). ment tools is useful information to acknowledge.
The model was initially designed to introduce di- Identification of risks is equally important for the
saster-nursing content to nursing students in a nurse to identify. Risks may include: inadequate

Figure 1
72 A. Jennings-Sanders

funds, no established shelters, groups with special ple, a 46-year-old disaster victim who complains
needs, lack of cooperative agreements with other of sudden onset of moderate periumbilical ab-
community agencies, lack of disaster education dominal pain needs to be transferred immediately
knowledge, lack of disaster assessment tools, and to a hospital or clinic for lab work, chest X-ray,
lack of existing disaster management plans. and abdominal X-ray in order to ascertain a di-
Knowing the risks at a work setting will equip the agnosis. The nurse in this situation may briefly
nurse to prepare for the planning segment of educate the patient regarding the need for lab
Phase I. In the planning segment of Phase I, it is work and X-rays.
essential to allocate resources appropriately, de- In the case manager role, the nurse serves as a
fine the roles of all people involved, develop co- liaison between the client and community agency.
operative agreements with community agencies, For example, the nurse may be volunteering at the
develop or activate disaster assessment tools/ British Red Cross and obtaining food vouchers for
plan, develop plans to assist special needs groups, disaster victims. In addition, the nurse may have to
and seek volunteer disaster nursing opportunities refer disaster victims to health/community ser-
with such agencies as the British Red Cross. It is vices. In this case, the nurse could make referrals
important here for nurses to incorporate primary to emergency rooms, clinics, or churches that may
preventative interventions in this phase. Primary have a clinic. In order to coordinate the services
prevention is achieved by activities that promote that clients are using, it is essential for the nurse to
optimum health. An example of a primary pre- keep records of why, where, and when clients were
ventative intervention as it relates to disasters referred. Another role of the nurse may be serving
would be providing information on how individuals as liaison between the British Red Cross and dis-
can prepare themselves for a disaster (e.g., tressed family members. The nurse can help es-
knowing emergency routes and obtaining emer- tablish a system in order to track patients that have
gency foods/other supplies). Educating the public been treated and relay this information to the
about potential disasters and what to do in these British Red Cross.
situations can save many lives.
After the assessment and planning phases are
complete, the implementation phase should in- Phase III
clude actually practicing a disaster management
plan based on the information from the assessment In Phase III (Post-disaster), there are three seg-
and planning phases. ments that the nurse is involved in: assessment,
planning, and implementation. In the assessment
segment, the nurse may have to re-evaluate if di-
Phase II saster victims received necessary treatment and
care. Follow-up care or additional referrals may be
In Phase II, the disaster actually occurs and nurses needed. Tertiary preventive interventions are in-
in this phase may take on many roles such as corporated in this segment. Tertiary prevention is
caregiver, educator, and case manager. As care- achieved by decreasing the disability from existing
giver, the nurse is responsible for triaging and illness through rehabilitation. For example, a 74-
prioritizing care for clients. It is important for the year-old disaster victim who suffered from a bro-
nurse to take a holistic approach when caring for ken wrist in a disaster situation will need further
disaster victims. The emotional, physical, psy- follow-up in terms of pain management and phys-
chosocial, and cultural aspects of health should be ical therapy. The nurse in this situation may edu-
considered. This type of holistic nursing practice cate the client about the different modes of pain
draws upon nursing knowledge, clinical experi- management and explain the purpose of physical
ence, theories, intuition, and creativity. The ul- therapy.
timate goal for nurses working in disaster In addition, assessment involves examining the
situations is to improve the well-being of disaster strengths and weaknesses of the existing disaster
victims. management plan. In the planning phase, weak-
As an educator, the nurse must incorporate nesses of the existing disaster plan should be
secondary levels of prevention in this phase. strengthened leading to a revised or new disaster
Secondary prevention is referred to activities re- plan. In the implementation segment of Phase III,
lated to early diagnosis and prompt treatment of findings describing the existing disaster plan should
health problems. Thus, nurses must be able to be documented and disseminated in the literature.
recognize that there is a problem and assist the The new or revised disaster plan should be prac-
client in receiving prompt treatment. For exam- ticed in the work setting.
Teaching disaster nursing by utilizing the Jennings Disaster Nursing Management Model 73

Phase IV are two-story flats. The town is located on the

coastline and although a flood has not occurred
Phase IV (Client/Population outcomes) is the final there in while, the potential is high. It should be
phase of the model. The activities of Phase I noted that coastal storms in the past have led to
through Phase III impact on the outcomes of cli- overtopping and breaching of coastal flood de-
ents/populations. When using the Jennings Disas- fences due to storm surges. The coastal town has a
ter Nursing Management Model it is expected to population of 750 people. The majority of the
yield positive client/population outcomes such as: population is Caucasian (95%) and the remaining
decreased mortality rates, decreased health care population consists of Asians (5%). It should be
costs, decreased disaster related costs, improved noted that of the Caucasian group, there is a sub-
health status, increased disaster nursing knowl- stantial amount of Eastern European people who
edge, increased effectiveness of the disaster speak a variety of languages. There are a growing
nursing plan, and increased collaborative rela- number of people over the age of 65 and a signifi-
tionships between nurses and other community cant amount of school-aged children. This town is
agencies. located approximately one hour from a medium
sized city, which is equipped with major emer-
gency medical services. This town has a town
council, a small fire and police department, two
Teaching disaster nursing content:
ophthalmologists, four physicians with private
application of the Jennings Disaster practices, two dentists, two grocery stores, three
Nursing Management Model churches (two with already existing nursing clin-
ics), and three schools. Each one of the schools and
The disaster nursing module is included in a Com- churches are separated from one another by some
munity Health course, where the Jennings Disaster distance.
Nursing Management Model is introduced to nursing Since autumn was approaching and this is the
students. An explanation of the model is given to rainy season, the nurses began to inquire about the
nursing students by the professor via lecture form. towns emergency plan for flooding. They found
The nursing students are then divided into groups out that the town council were working on a di-
of four or five and given a case study involving a saster plan but temporarily stopped because of fi-
disaster situation. After discussing the case study nancial concerns. In addition the firefighters and
as a group they are asked to apply the Jennings policemen had recently received specialized di-
Disaster Management Model to the case study. Each saster flood training. They decided to join in on the
group is given the same case study and given a planning phase. Using the Jennings Disaster Nursing
specified time to respond to the case study. Each Management Model, how would these nurses pre-
person elects a spokesperson to discuss how they pare and manage a disaster like a flood in their
would handle the case scenario. During the dis- community setting.
cussion, the professor is completing a critique form
which rates each group in the following areas: (1)
critical thinking, (2) nursing knowledge, (3) ap- Application of model
propriate application of the Jennings Disaster
Nursing Management Model, and (4) creativity. Phase I pre-disaster
Each of the above areas is rated on a scale of one to
five. One being the lowest score and five being the Assessment
highest score. The professor provides oral and Resources. There are several resources in this
written feedback to each group. town that may be utilized if a disaster occurs. The
availability of potential shelter areas (e.g., chur-
ches and schools) are available but this is depen-
Case study dent upon where the flooding occurs. The fact that
the town council has engaged in the process of
A group of four nurses and one physician recently implementing a disaster plan is a good starting
opened up a medical clinic in a small church in a point. The firefighters and policemen were trained
coastal town 45 miles from Bristol. Two of the in disaster management, therefore making them
nurses specialized in adult care, one in obstetrics knowledgeable about disaster management. There
and gynecology and one in pediatrics. The physi- are enough physicians and nursing personnel from
cian specialized in adult medicine. Most of the various specialty areas to make a team effort in
homes in this town were built in the mid 1800s and caring for clients involved in a local disaster. Fi-
74 A. Jennings-Sanders

nally, a hospital with major emergency medical the nearby hospital is a very important initial step
services is accessible by helicopter in 15 min. in the planning process. In addition, the local
Risks. There are multiple risks such as not having British Red Cross Chapter, Department for Trans-
any established shelters in the town. There is some port, and Environment Agency should be targeted.
financial uncertainty as evidenced by the town Defining roles. Everyone in the town should re-
council coming to a standstill regarding the disaster ceive general disaster planning guidelines regard-
plan. The major concern is funding and who will ing floods. Citizens of the town who volunteer in
provide this funding for such a plan. Currently, times of a disaster may serve as transporters, as-
there is no existing nursing disaster management sistants to medical personnel, and debris removers.
plan. The firefighters and policemen seem to be All medical/nursing personnel should have well-
interested in disaster management. However, no defined roles and functions. Non-medical personnel
other professionals in the town seem to be in- such as firefighters and policeman should also have
volved. Currently, there is not a plan to make defined roles and functions.
special accommodations for the elderly and school- Development and activation of disaster man-
aged populations. There has not been any formal agement assessment tools. These tools should be
collaborative agreements with community entities. used to help plan for a disaster, assess damage of
Weather specialists have predicted future floods the town after a disaster, and assess the health
for this town. This town is approximately one-hour status of clients involved in a disaster. Assessment
away (driving time) from a major city and its tools from the firefighters disaster-training seminar
amenities, which may problematic in emergency should be considered. Additional assessment tools
situations. The town consists of people with various can be accessed from the British Red Cross and
ethnic backgrounds and English is not the first Environment Agency Internet sites.
language for most of these people. Development of disaster management education
programs. (1) It is essential that the people in the
Education town be given general disaster education training
It is important for nurses to incorporate primary that includes preparing for a flood, what to do
preventative interventions in this phase. Examples during a flood, and what to do after a flood. (2) It is
may include educating the people of the town re- equally important that the key medical and non-
garding useful emergency numbers to keep on medical people receive more intensive specialized
hand, having a few sandbags or floorboards pre- training on disaster management.
pared to block doorways, having a flood kit, es- Development of volunteer opportunities. On a
tablishing a disaster plan with loved ones, being regular basis, nurses should try to encourage the
aware how to turn off electricity and gas switches, people in the town to volunteer their time to pre-
storing valuables, having extra medications, and pare for a possible disaster occurrence. Due to the
contacting the insurance company to ensure ade- cultural diversity of the town, volunteers serving as
quate flood coverage. bilingual interpreters will be a necessity. Encour-
aging medical personnel (e.g., nurses and physi-
Planning cians) in the town to become involved in the British
Allocation of resources. Lobbying to get funds to Red Cross for specific training is important.
support the disaster management plan from private Implementation. Implement all of the above as-
and government sources is key. Having fund raisers pects in the planning phase and practice the di-
is a good way to help support the disaster man- saster plan on a regular basis.
agement plan. Designating the church where the
nurses and physician are practicing as the primary
shelter and medical facility in disaster situations Phase II
establishes a shelter area. In addition, selecting
another church or school as an alternate shelter Roles of the nurse
site is a good backup plan. A dedicated team of Caregiver. The nurse as a caregiver will have to tri-
medical professionals and volunteers to assist the age clients as they come into the clinic at the church
elderly and children in a disaster situation is im- or school. A decision will be made whether a client
portant to establish. can be taken care of in the clinic or transported to
Planning cooperative agreements. Making the hospital. It is important that the nurses focus on
collaborative agreements with the town council, all aspects of care, meaning physical, emotional,
police, firefighters, physicians, nurses, ophthal- psychosocial, and cultural. For this particular case
mologists, grocery store owners, administrators of study, the nurses will have to provide culturally
the two local schools, and dentists in the town, and competent care to several ethnic populations.
Teaching disaster nursing by utilizing the Jennings Disaster Nursing Management Model 75

Educator. As an educator, the nurses responsi- Phase IV client/population outcomes

bilities during this phase would be to orchestrate
secondary levels of prevention. For example, if a Some of the positive client/population outcomes
person has a broken arm, then the nurse will need that would be expected in this case scenario are:
to immobilize that arm and refer that person to the decreased mortality rates, improved health status,
nearby hospital for X-ray services. Nurses admin- decreased healthcare costs, decreased disaster-
istering tetanus injections for those people who related costs, increased knowledge, improved ef-
have stepped on sharp objects is another example fectiveness of the disaster management plan, and
of a secondary level of prevention. increased collaborative relationships.
Case manager. A major role of the nurse case
manager in this situation would be to refer clients
to community services such as the British Red Conclusion
Cross. Referrals also could be made to the oph-
thalmologists and dentists depending on the need. Disasters should never be considered as routine.
In more serious cases, the client may have to have Nurses in all settings must prepare for external and
follow-up appointments at the hospital. All refer- internal disasters (e.g., flood and bomb threat) as
rals must be documented in order for the nurse to much as possible. Disasters can take on a life of
coordinate the services. In complicated cases, the their own, therefore being prepared is the single
nurse will continue to serve as the liaison between most effective way to improve outcomes. Nurses
the client and agency. Nurses could help initiate a should be encouraged to promote disaster pre-
system for tracking disaster victims in conjunction paredness as part of their daily responsibilities in
with the British Red Cross. their roles of clinicians, managers, educators, ad-
vocates, and researchers.
The Jennings Disaster Nursing Management
Phase III post-disaster Model helps nurses plan for and manage disasters at
their community health work setting. The model is
Assessment also useful in introducing disaster-nursing content
In this situation, the flood could have affected to nursing students. The model can be applied to a
many people and caused complex health problems. case study as illustrated in the article. This
The nurse will review triage and case management teaching strategy serves as an effective and inter-
records and follow up with those clients to ensure active way for students to begin thinking about
that health care needs were addressed. disaster management. Nursing educators must be-
In addition, re-assessment of the existing disas- gin to prepare our future nurses in disaster man-
ter plan is needed. The following questions need to agement so that they can function effectively in
be asked: How effective was the plan? What were disaster situations.
the strengths? What were the weaknesses? The nursing process is embedded in the model
and allows for the tracking of client/population
Education outcomes. The model through the assessment and
Tertiary preventive interventions are incorporated planning phases allows nurses to revise and con-
in this segment. Demonstrating breathing tech- stantly update their disaster plan. Thus, prepara-
niques to an anxious disaster victim with asthma tion can be achieved at the highest of levels. The
would be an example of a tertiary preventative model encourages nurses to provide holistic, cul-
intervention. Another example would be referring turally competent care to all populations. It is es-
disaster victims to support groups due to the long sential that the model is used in future studies and
term psychological trauma associated with this findings be disseminated. This could lead to further
type of disaster. refinement of the model. In addition, this type of
research would contribute significantly to the area
Planning of disaster nursing research, which is relatively
Revision of the existing plan should occur. In this unexplored and deserving of further attention.
case, there should be some updates to the existing
plan because it was so new from the onset.
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