The Development Process of Disaster Nursing in China

After the “September 11” incident in 2001, the topic of “rescue medicine” began to attract global attention. ^{Reference Bundy9} Disaster nursing came into being along with rescue medicine. From 2004 to 2006, Chinese nurses represented by Dean Zhang Li Yan of the Chinese Armed Police General Hospital participated in the rescue of the Indian ocean tsunami, and the Pakistan and Indonesia earthquakes, ^{Reference Wei, Ge and Xu10} summing up the disaster rescue nursing experience, and completed the theory of disaster nursing preliminary discussion with practice.

After the Wenchuan earthquake in 2008, the Disaster Nursing Professional Committee of the Chinese Nursing Society was established in 2009, ^{Reference Zhang, Song and Zhang11} and received the Disaster Nursing Training Program from the World Health Organization (WHO). Since then, China has been devoted to the study of disaster management, and the discipline of disaster nursing in China has grown rapidly. In 2011, the Chinese Nursing Society joined the World Disaster Organization ¹² to build a platform for the development of disaster nursing within China.

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 ^{Reference Seng15} 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. ^{Reference Huang, Zhang and Feng16}

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. ^{Reference Seng, Wu and Xu17} 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, ^{Reference Xu7} 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 ^{Reference Li5} and has yet to form a complete discipline system. ^{Reference Zhang, Zhu and Sheng2}

The Role of Nurses in Disaster Relief Nursing in China

The Lancet pointed out that Chinese nursing teams are facing a critical dilemma with a lack of well-trained nurses. ^{Reference Yang and Hao19} More skilled nurses are required at a disaster site. ^{Reference Wenji, Turale and Stone20} 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. ^{Reference Xu7,Reference Liu, Yang and Liu22,Reference Yang, Xiao and Cheng23} 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. ^{Reference Hutton, Veenema and Gebbie25} 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, ^{Reference Wang, Cheng and Hu26} 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. ^{Reference Mao, Loke and Hu28,Reference Deng, Xiong and Liu29} 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. ^{Reference Li, Huang and Wei30} 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. ^{Reference Jiang, He and Zhou31,Reference Li, Li and Chen32} 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.

The Nightingale Spirit of Nurses in China’s Disaster Emergency Management

Summaries and Outlook

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.