key: cord-0866693-n35voxsi authors: Zhang, Di; Zhang, Liyan; Gong, Aihua title: Development of Disaster Nursing in China: From the Spirit of Nightingale to COVID-19 date: 2020-12-28 journal: Disaster medicine and public health preparedness DOI: 10.1017/dmp.2020.468 sha: d8fb46d9e86a23dbd85fa3414dbbe4e1d15562e2 doc_id: 866693 cord_uid: n35voxsi As an emerging discipline, disaster nursing is very important in disaster emergency management, but there are few mature practice models and theoretical discussions. In particular, the contribution of nursing staff in disaster emergency has not yet received widespread attention and recognition. After more than 10 y of rapid development, China’s disaster nursing has gradually formed a Chinese model and Chinese experience. During the global fight against coronavirus disease 2019 (COVID-19), this article takes the nursing work in disaster emergency rescue as the perspective and briefly describes the development process of disaster nursing in China to introduce the practice and theoretical development of disaster nursing in China to nursing workers around the world. Analyzing the role of Chinese nurses in national disaster emergency response provides a reference for global disaster nursing talent capacity building. By sharing the Nightingale spirit of Chinese nurses in disaster emergency, we will show people all over the world the professional value of disaster nursing practitioners and pay tribute to the nursing staff engaged in disaster emergency work. The Chinese Nursing Society returned to the International Nursing Association (ICN) in 2013, 13 and created a database of disaster experts. The 3rd World Disaster Nursing Conference was held in Beijing in 2014, 12 consisting of 1389 representatives from 13 countries conducting talks on topics such as disaster rescue, disaster building capacity, disaster management, and disaster psychology. The Disaster Training Program of the Chinese Nursing Society was certified by the International Nurses Association (ICN) in 2015, and published its first training textbook "Nursing Disasters" and was designated by ICN to be the only training book required. 14 In 2017, the successful holding of the 9th National Natural Disaster Nursing Symposium and the 3rd ICN Disaster Nursing Training Course of the Chinese Nursing Society 15 indicates that China's disaster nursing careers have taken a new step forward. As of 2020, a total of 27 of the country's 34 provinces have established special disaster nursing committees to carry out practices with broad coverage, new content, and continual improvement, indicating the commitment China has to the development of disaster nursing. China's disaster rescue medical science has accumulated solid practical experience; however, if compared with other more developed countries, China's disaster nursing education started late, educational content has not been unified, and disaster education and training has not been encompassed into the basic nursing education curriculum. 16 Only a few higher nursing schools offer disaster training. Most general nursing colleges only present disaster nursing in theory form, as chapters in community nursing or emergency medical courses without any practical experience. 17 Universities that offer disaster nursing courses include Sichuan University, Jiangsu University, Dalian Medical University, Jinzhou Medical University, Nanchang University, Shanxi Medical University, etc. In 2012, the School of Nursing of Jilin University began enrollment of graduate students in the direction of critical care and disaster nursing research. In 2013, the Hong Kong Polytechnic University and Sichuan University jointly established the School of Post-Disaster Reconstruction and Management, and formally began the systematic cultivation of postgraduates in disaster nursing. However, there are still fewer Chinese medical colleges that carry out postgraduate training in disaster nursing. As of April 2019, the WHO has certified 25 international emergency medical teams in 15 countries, of which China has 5 and is 1 of the largest in the world. 18 The same year, China's National Emergency Medical Team built 49 teams, 7 which has laid a solid foundation for the development of China's disaster rescue nursing. However, China's disaster nursing is still in its infancy and exploratory stage; it has yet to establish disaster nursing departments 5 and has yet to form a complete discipline system. 2 The Lancet pointed out that Chinese nursing teams are facing a critical dilemma with a lack of well-trained nurses. 19 More skilled nurses are required at a disaster site. 20 As China's largest health professional group, nurses are not only the executors of medical orders, but also play an indispensable role in the preparation and coordination of emergency materials and human resources. In 2011, nursing became a first-tier discipline in China, 21 equal with clinicians. Medical personnel are of equal importance in an emergency rescue, because medical rescue in the disaster area is not to diagnose and treat. Disaster nursing focuses on the scene, which is more arduous, time critical, and complicated than general nursing work, involving prehospital emergency care, emergency surgical care, intensive care, infection care, and psychological care among other vital nursing duties. Disaster nursing requires interdisciplinary skills, strong social coordination, and higher requirements of professional nurses. Since the establishment of China's International Rescue Team in 2001, Chinese nurses have been working on the front line of emergency rescue, whether at earthquake sites, such as Wenchuan, Yushu, and Lushan in China, or providing international assistance at the tsunami in Indonesia, the Futian earthquake in Japan, the nuclear rescue site in Japan, and the Ebola outbreak in Africa. 7, 22, 23 In 2020, a total of 28,600 nurses are fighting the coronavirus disease 2019 (COVID-19) pandemic, becoming the front-line fighters against the epidemic in China. Among the 42,600 members supporting the Hubei medical teams, there are 28,600 nurses, accounting for nearly 70%; a total of 25,300 of which were female nurses, accounting for nearly 90% of the total number of nurses in Hubei. Nurses born in the 1980s and 1990s accounted for 90% of the total number of nurses; of these, nurses born in the 1990s accounted for 40%. From a professional perspective, they mainly included nurses in specialties, such as critical illness, respiratory, infection, and continuous renal replacement therapy. During disasters, Chinese nurses play a huge role, whether it is to rescue victims at the scene or to help them recover from their physical injuries or psychological trauma after the disaster. The ICN released version 1.0 of the Disaster Care Competency Framework in December 2009. 24 Because of its reasonable structure and comprehensive design, it has become the most widely used theoretical framework guide in the practice and application of disaster nursing in the world. 25 West China School of Nursing, Sichuan University, developed a clinical nursing disaster assessment capability tool for Chinese clinical nurses based on the 1.0 version of the ICN framework, 26 proposing that Chinese nurses should play an organizational management role, demonstrate professional skills, provide postdisaster psychological crisis intervention, carry out disaster nursing research tasks, and implement the role of infectious disease prevention and control. ICN released version 2.0 of the Disaster Care Competency Framework in December 2019. 27 The framework involves general registered nurse practitioners (level I nurses) and registered nurses who wish to become disaster responders (level II). The framework includes 8 areas, namely, preparation and planning, communication, incident management, security, evaluation, intervention, recovery, and law and ethics. However, as of yet, there are no reports on the application of version 2.0 of the framework in China. Existing research on disaster nursing capabilities in China mostly adopts the Delphi method to carry out research and design, and the research content is limited, such as the study of the ability of nurses during disaster recovery and disaster nursing readiness of male nurses. 28, 29 Most of the existing evaluation tools are mainly based on the ICN framework version 1.0 and lack the foundation of previous research, the setting of dimensions and items, and lacks a reliable theoretical basis. 30 In addition, due to the differences in the functions and level of authority of Chinese nurses than those of other countries, it is difficult for China's disaster nursing to strictly follow the model of those countries. Related research also shows that Chinese nurses can currently assume the responsibilities of disaster response and management, but still need disaster training. 31, 32 Obviously, the abilities and standards of nurses for disaster relief in China have not yet been unified, which is also the focus of our research. The "World Nursing Status Report 2020" released by the WHO makes it clear that disaster nursing is the focus of attention. WHO has designated 2020 as the "International Year of Nurses and Midwives." May 12 is International Nurses' Day. This year's theme for our country is "Salute to the teams of nurses and fight the epidemic together." The National Health and Health Commission issued the "Notice on Doing a Good Job in the May 12th Nurses' Day in 2020," emphasizing that organizations at all levels in the country must care for the nurses, take care of the physical and mental health of nurses, implement nurses' treatment guarantee policies, and effectively reduce the burden on nurses, safeguard nurses work place safety, and increase the general public's awareness of nursing work, etc. 33 In 2020, China's master of nursing enrolls 73 academic colleges and 107 professional colleges. There are 28 doctoral enrollment colleges, and the level of nursing education in China has been significantly improved. 34 At present, the nursing teams in China are growing continuously, accounting for nearly 1/4 of the total number of nurses in the world, and the professional literacy and service abilities continue to improve. Florence Nightingale is the founder of modern nursing and the founder of modern nursing education; she is also the pioneer of the International Red Cross Movement. 35 The earliest attempt to study disaster nursing was Nightingale. 36 During the Crimean War of 1854 to 1856, Nightingale fully organized field hospitals to carry out on-site emergency medical work, reducing the casualty mortality rate from 42% to 2%. 37 She put her personal safety out of consideration and served the wounded soldiers with a spirit of humanity, fraternity, and dedication, becoming the role model for nursing workers worldwide. Since then, people have changed their perception of nurses. In 2019, when COVID-19 broke out in China, 19,800 medical staff first assisted in Wuhan, of which 14,000 were nurses. This team changed people's perception of Chinese nurses. 38 Nightingale dedicated her life to nursing, and the Nightingales spirit has become synonymous with the nursing spirit. 39 2020 is the 200th anniversary of Nightingale's birth and is also the "International Year of Nurses and Midwives." Chinese nurses bravely faced COVID-19, inherited and practiced the Nightingale spirit, and made the world take notice and understand the important role and strength of a nursing team. Disaster relief must face challenges, such as fatigue, personal suffering, and the test of life and death at all times. 40 From the day Nightingale founded nursing, nursing has always been closely linked with the humanitarian spirit of caring for life and saving lives. In the fight against the COVID-19 epidemic, the workload of Chinese nurses is extreme, from professional nursing to life care, ventilator management, observation of vital signs, prospective prevention of complications, airway management, artificial membrane lung care, prone position ventilation, bedside hemofiltration, specimen collection, nutrition support, disinfection and isolation, humanistic care, psychological care, stress injury care etc., all of which must be completed by nurses. The nursing teams played a vital role in the response to the COVID-19 epidemic. COVID-19 is a severe infectious disease, and family members cannot accompany the patients. Chinese nurses replaced the role of family members, giving patients needed comfort and company. These nurses go beyond the scope of psychological counseling, providing more soothing, humanistic literacy that is patient-centered. The Nightingale Award is the highest honorary award that the ICRC bestows for outstanding contributions to nursing. Since our country first participated in the Nightingale Medal in 1983, there have been 80 Nightingale Medal winners to the present day. 41 They inherited the Nightingale spirit of Chinese nurses in the domestic and foreign medical rescues against SARS, Ebola, earthquake medical rescue, flood relief, peace-keeping medical care, and other domestic and foreign medical aids. China's Nightingale Volunteer Nursing Service Corps were approved and named by China's Red Cross Federation and were established in Beijing in July 2007. 42 This is a volunteer service organization composed of Nightingale Medal winners, nursing professionals, nursing school students, and caring people from all walks of life. It is the only volunteer organization in China with nursing specializations. At present, nursing volunteer services have spread to 31 provinces, municipalities, autonomous regions, and municipalities in China, and 538 teams have been established, encompassing more than 300,000 nursing volunteers. Whether it is international or domestic rescue, Chinese nurses have stepped up and faced the disasters head on. Disaster nursing is an important part of disaster emergency management. The nursing teams are very important in disaster emergency construction, which deserves the close attention of the global society. Disaster nursing in China has developed rapidly, injecting strength into the development of emergency disaster management in China and the development of global disaster nursing. Through the display of disaster nursing work in China, we call on the world to pay attention to the development of disaster nursing disciplines and understand the status and role of nurses in disaster relief. We look forward to working with disaster relief colleagues all over the world to expand the scope and development of disaster care so that nursing staff can play a greater role in emergency disaster response and rescue. care experts who participated in the study were obtained after reading the informed consent and ensuring that they were voluntary. Major natural disasters in China, 1985-2014: occurrence and damages Disaster nursing development in China and other countries: a bibliometric study Road traffic accident severity analysis: a census-based study in China Disaster medicine in China: present and future Disaster Nursing Science. Beijing: People's medical publishing house National Health Commission of the People's Republic of China Thinking about the development of disaster nursing work in the new era People's Network. National Health and Health Commission: 68% of nurses supporting the frontline medical staff A course in disaster mitigation Knowledge maps of disaster medicine in China based on co-word analysis Research progress on disaster relief nursing at home and abroad Disaster Nursing Professional Committee of Chinese Nursing Society. The 3rd world disaster nursing conference was held in Beijing Editorial Department of Chinese Nursing Magazine. Ceremony of Chinese nursing society returning to International Nurses Association held in Beijing Notice on holding the first international nursing association (ICN) disaster nursing course training course The 9th national natural disaster nursing symposium and the 3rd International Nurses Association disaster nursing course training course of the Chinese Nursing Association was successfully held in Tianjin Development and enlightenment of disaster nursing education in China Comparison of the development of disaster nursing education in China and abroad Macao emergency medical team becomes China's fifth international emergency medical team Dilemmas for nurses in China Chinese nurses' relief experiences following two earthquakes: implications for disaster education and policy development The Ministry of Education of the People's Republic of China. Notice on issuing the catalogue of academic degrees and talent training disciplines Medical rescue of China National Earthquake Disaster Emergency Search and Rescue Team in Lushan earthquake International Council of Nurses. ICN framework of disaster nursing competencies Review of the International Council of Nurses (ICN) framework of disaster nursing competencies Psychometric testing of the nurse' disaster nursing competency evaluation tool International Council of Nurses. ICN framework of disaster nursing competencies Developing a tool for measuring the disaster resilience of healthcare rescuers: a modified Delphi study Investigation and analysis of male nurses' disaster preparedness Analysis of disaster nursing capacity assessment tools Knowledge, attitudes and competence in nursing practice of typhoon disaster relief work among Chinese nurses: a questionnaire survey Disaster nursing experiences of Chinese nurses responding to the Sichuan Ya'an earthquake the May 12th nurses day in 2020. 2020 More than 100-list of enrollment institutions for master of nursing in 2020 Two famous female nurses during the Crimean War Professional nursing values: a concept analysis Public health and nursing: a natural partnership Chinese nurses deserve to be respected by the world The life and impact of Florence Nightingale Nightingale and Irish nursing List of winners of previous Nightingale Medals in China China Nightingale Volunteer Nursing Service Corps Acknowledgements. We thank the leaders, staffs, and disaster nursing experts from Chinese Nursing Association Disaster Nursing Professional Committee for taking part in the project and for valuable support.