Pediatric Population A Concept Analysis Paper
Running head: DISASTER RESPONSE FOR THE PEDIATRIC POPULATION
Disaster Response for the Pediatric Population: A Concept Analysis
In partial fulfillment of the requirements of
Disaster Response for the Pediatric Population: A Concept Analysis
Disaster can strike in any place or at any time. The concept of disaster can have different affects and outcomes for pediatric patients. A disaster could be as localized as a multiple causality event or as global as terrorism or a natural disaster. Disaster can be defined as an event that causes destruction and injury and requires immediate intervention. How does disaster affect children? Are we, as a nation, adequately prepared to respond to pediatric needs in a disaster? …show more content…
For a pediatric patient, coping with this adverse situation can be challenging. The task of helping children deal with a disaster relies on the multidisciplinary expertise of Nursing, Medicine, and Psychology.
Review of Literature
For this paper, the focus is on the Nursing, Medicine and Psychology disciplines and how they can affect the pediatric response to disaster. The three disciplines are unique yet can merge in their role of providing disaster response and improving outcomes for pediatric patients. Nursing must be proactive and collaborate with other disciplines to address this challenging problem in pediatric healthcare.
Nursing Discipline Murray (2006) suggests in recent years terrorism, hurricanes, and school shootings have highlighted the need to understand the pediatric response to disaster and to intervene to improve outcomes. She notes that a child’s age and development will greatly influence their response to disaster. Stress and separation are natural reactions to an unnatural situation though requires intervention with psychosocial support (Murray, 2005). Murray has a multidisciplinary view of helping the pediatric patient deal with disaster. Murray (2005) states that nurses have a critical role in helping to meet the psychosocial needs of the pediatric patient in a disaster. If the nurse is simply available to the parents as emotional support, the parent in turn can care for their children (Murray 2005). Healthcare providers also play an integral role in assisting the pediatric patient in a disaster. Murray (2005) refers to checklists and audit tools to assist the practitioner in assessing and diagnosing traumatic responses for the pediatric patient in and disaster crisis. She notes the importance of collaboration in nursing and medicine to offer the best resources available to the pediatric patient and family in a disaster. The antecedents found in this article are knowledge deficit to care for the pediatric patient in disaster with the criteria of education to reach a consequence of understanding. Unpreparedness for disaster is another antecedent identified in Murray’s (2005) writing which is noted to require the criteria of planning in order to reach the consequence of readiness.
One nursing article suggests that though disaster planning and preparation have increased since recent terroristic events, the pediatric population has been seriously overlooked during disaster preparedness (Fendya, 2006). Nurses must actively participate in the planning and preparation phases in disaster preparedness and assures that plans consider the needs of the pediatric population according to Fendya (2006). Physical, emotional, and developmental differences in children pose complex challenges when caring for them in a disaster. A child’s response to the disaster depends on these differences as well as the caregivers’ well-being and level of support (Fendya, 2006). Some pediatric responses to disaster may include difficulty sleeping or eating, regression to prior developmental state, thoughts of harm to self or others, anxiety reactions, or behavior outbursts (Fendya, 2006). The article suggests that by being prepared, the nurse can address the pediatric patient’s needs by recognizing high-risk symptoms and help educate families so that referral to mental health services can happen quickly (Fendya, 2006). This article uses the antecedents of unpreparedness and knowledge deficit with the criteria of planning and education in order to achieve readiness and understanding in caring for the pediatric population in a disaster. Behney, Breit & Phillips (2006) describe one pediatric mass causality experience at their hospital in Liberty, Missouri. The article describes their preparation as the received the first notification and the realization that the Emergency Department was not prepared for such an event. The hospital was prepared for two or three patients but what they received was 29 children in an already busy 28-bed emergency department (Behney, Breit & Phillips, 2006). Although the hospital had participated in disaster drills, the communication and chaos gave the feeling of being unprepared (Behney, Breit & Phillips, 2006). According to the article, parents, children, and nurses were stressed with the situation but fortunately, the school was able to respond with counselors for support (Behney, Breit & Phillips, 2006). Collaboration with social workers helped to alleviate some of the chaos and stress related to identification of two of the severely injured patients as well as traffic control (Behney, Breit & Phillips, 2006). One OR nurse was assigned to a surgical pediatric patient in the Emergency Department. Through reassurance that she would follow the child through the surgical procedure, the nurse was able to calm the parents and provide a sense of comfort (Behney, Breit & Phillips, 2006). Behney, Breit & Phillips (2006) writes that the collaboration between nursing, physicians, ancillary staff, EMS, and school personnel greatly impacted the care provided for the pediatric patients and their families in this disaster. Behney, Breit & Phillips (2006) use the antecedents of stress, unpreparedness, and knowledge deficit in their article. Nurses, responders, patients, and families reported stress in the disaster which required a prompt intervention of school counselors to help with support allowing for the consequence of stability. The hospital was unprepared for the magnitude of pediatric patients and realized that planning was a necessary criteria for readiness in responding to pediatric disaster. Families and nurses reported a knowledge deficit in addressing the needs of these children and families in a disaster. They realized that education of the family and staff helped in reaching an understanding of injuries and processes. An article in the Journal for Specialists in Pediatric Nursing examines nurses experience following the Haiti earthquake of 2010 (Soland, et al., 2012). Looking through the nurse volunteer perspective, the study illustrates the impact of the earthquake on the pediatric victims and their families (Soland, et al., 2012). Soland, et al. (2012) reports that through the study it was found that almost a third of the patients seen in the earthquake were pediatric aged thus highlighting the importance on being prepared for children in disaster. Due to a lack of resources, creativity was used in caring for the children in the article. Although sometimes this was successful, other times it resulted in inadequate care or death (Soland, et al., 2012). Other challenges included the lack of pediatric experience in the nurses caring for the patients. This also resulted in suboptimal care (Soland, et al., 2012). Soland, et al., (2012) describes the pediatric response of fear, stress, and despair but also love, hope, and resilience. Some antecedents identified in the article were unpreparedness by the nurses to deal with disasters, knowledge deficit in caring for pediatric patients, and lack of resources to care for the patients.
Two criteria and consequences included understanding that planning and education was needed to be ready to care for the pediatric population in a disaster in order to have readiness and understanding. Another criteria and consequence identified in the article was that creativity was needed to address the antecedent of lack of resources but did have the consequence of inadequate care.
These four articles comprise the nursing role in providing care to the pediatric population in a disaster. Nurses are leaders in disaster preparedness and care for the pediatric patient and should collaborate with other disciplines to reach positive consequences in disaster response. Nursing can have a great impact on the consequences of disaster for pediatric patients and their families. Unfortunately, the consequences of disaster are not always positive. This is why the nursing discipline antecedents, criteria and consequences are comprised of both positives and negatives. Some of the antecedents of the nursing discipline as defined by the articles are: fear, stress, unpreparedness, lack of resources, and knowledge deficit. These are based on the criteria of anxiety, prompt intervention, planning, creativity, and education. The consequences of these events would be mental instability, stability, readiness, inadequate care, and understanding respectively. Although we strive for positive consequences, it is also important to be aware of the negative aspects so that we can improve outcomes.
Medicine Discipline According to Hagan (2005), there is a deficit when parental response to a disaster overrides the parent’s ability to address the child’s need during that time. Hagan (2005) includes diagnosis criteria for Acute Stress Disorder and Posttraumatic Stress Disorder in his article to assist the practitioner in identifying these reactions in children and adults. He suggests that Pediatricians have the responsibility to assist parents during and after disaster situations to understand and address children’s unique psychological needs in response (Hagan 2005). In this article, Hagan (2005) compares the Medical and Psychology disciplines’ response to the pediatric victims for both the September 11, 2001 attacks and the Oklahoma bombing. He suggests that although the Medical and Psychology discipline responses were improved for this population, there was still and increased number of visits for anxiety and stress reactions following the events. According to Hagan (2005), this suggests that the Medical and Psychology interventions and resources were not adequate to address the needs of the pediatric population in disaster situations. Hagan (2005) recommends use of tools such as checklists to identify at-risk pediatric patients and to intervene quickly with referrals to mental health services. The antecedents, criteria and consequences found in this article are similar to those found in nursing. Unpreparedness of the practitioner to care for pediatric disaster patients requires planning to reach a consequence of readiness. The physician knowledge deficit in identifying pediatric needs has a criteria of education related to tools available to come to the consequence of understanding. Lack of resources also required use of little available knowledge and tools with a result of inadequate identification and care of these patients. Another antecedent discussed in the article was stress of the pediatric disaster patient which requires intervention of referral to mental health services to acquire stability. Otherwise, fear felt by the pediatric patient results in increased anxiety causing mental instability.
Kim (2013) discusses in her article on Disaster Planning in the Pediatric Emergency Department that disaster and mass causality is not about whether it will happen, but when. Because disasters have become common place in our world, planning and preparation are the first steps to addressing the pediatric patient needs (Kim, 2013). The pediatric age group makes up 24% of the population, yet we tend to forget about this group when looking at disaster management (Kim, 2013). Children are at higher risk for physical and psychological injury in a disaster than adults and thus require an increased focus on their needs (Kim, 2013). Older children tend to have an inappropriate response to disaster and threat and their fear responses are challenging for caregivers (Kim, 2013). Kim (2013) suggests pediatric disaster planning include the child being kept with the family, ready access to medical care, safe environment, to be kept clean, warm, and fed, as well as the ability to return to school and normal routines as soon as possible. Returning to normal activities such as attending school is important in protecting the child from increased psychological trauma (Kim, 2013). Kim suggests that the pediatric response to disaster can be mitigated through the emergency physician role in planning and practicing for disaster situations. Identified antecedents in this article include unpreparedness and knowledge deficit of physicians when dealing with pediatric disasters. Kim (2013) states the respective criteria of these antecedents are planning and education to reach readiness and understanding.
A publication on terrorism impact on children reports that after the September 11th attacks, 25% of children affected had acute anxiety which was then followed by Posttraumatic Stress Disorder (PTSD) diagnoses ("Chemical-biological terrorism and," 2006). The article lists a myriad of biological and terroristic threats to consider for the pediatric patient as well as responses to such disasters. Pediatric physicians must educate themselves in disaster preparedness in order to, in turn, effectively educate and care for pediatric patients and their families ("Chemical-biological terrorism and," 2006). Antecedents, criteria, and consequences identified in this article are based on stress, unpreparedness, and knowledge deficit. The pediatric patient in a disaster suffers from stress related to the criteria of anxiety. The consequence of this criterion is mental instability as expressed by PTSD. The unpreparedness and knowledge deficit of the physicians caring for the pediatric disaster patient requires planning and education to reach readiness and understanding.
The Medicine discipline articles all cited similar antecedents, criteria, and consequences that revolved around the realization that there is a lack of preparedness and knowledge to care for the pediatric patient. This results in the need for education and preparation for disaster situations involving children. Without the correct preparation and education the provider cannot reach readiness and understanding. Although the Medicine discipline takes accountability in the articles for disaster preparedness, planning, and care, collaboration with other disciplines is noted to be crucial to care for this unique population.
Psychology Discipline Children and their response to a disaster can be unique and based on their stage of social and cognitive development (Speier & Nordboe, 2000). This publication from Substance Abuse and Mental Health Services Administration addresses a multidisciplinary approach to caring for children in disaster situations. This approach includes nurses, physicians, case management, mental health workers, and other public health and social service providers. Speiere and Nordboe (2005) suggest that the most obvious statement about children in disaster situations is frequently overlooked or forgotten: Children are not small adults. They have very different needs and responses to disaster than an adult. The publication looks at the Theories of Child Development and relates them to the pediatric response to disaster. Speiere and Nordboe (2005) also suggest that the media has a degree of impact on the pediatric response to disasters. Though media, a child can experience their responses to disaster over and over from different perspectives. According to Speier and Nordboe (2005), a child’s typical reaction to disaster can include fear, anxiety, and sleep disturbance among other developmental specific problems. This is due to children interpreting their experiences based on their level of development (Speier & Nordboe, 2000). Understanding this is the key to being able to help the pediatric population. Some steps for the healthcare or mental health worker in helping the healing process for the pediatric patient is to start with developing a rapport, identifying the problem, understanding the feelings, listening, and communicating clearly (Speier & Nordboe, 2000). Speier and Nordboe (2005) believe that knowing the resources available in a community and helping the parents to access those resources are a critical element in assisting the pediatric patient through disaster. Although lack of resources depending on the area, may require additional consideration. Antecedents identified in this article include knowledge deficit, fear, stress, lack of resources and unpreparedness. Speier and Nordboe (2005) suggest that there is a knowledge deficit among healthcare workers on how to care for the pediatric patient in a disaster. This can be resolved with the criteria of education and a consequence of understanding. The article also discusses the fear and stress of the pediatric population in disaster. Stress of the pediatric patient requires mental health intervention to achieve the consequence of stability while fear can have increased anxiety resulting in mental instability. Lack of resources requires creativity and pulling of available information but may result in inadequate care for these children. The overall unpreparedness of healthcare workers is noted in the article to require planning with the consequence of readiness to care for the pediatric disaster patient.
Disaster response for children requires preparation and consideration of the physical and emotional needs unique to the pediatric population ("Pediatric and obstetric," 2010). This publication outlines the developmental considerations in the pediatric response to disaster and how the family unit must be considered as a whole when caring for the pediatric patient. Children may have preconceived notion about disaster and what they will experience ("Pediatric and obstetric," 2010). Their fear related to disaster can lead to anxiety and ultimately stress disorders. A chart is provided in this publication of developmental levels and responses to disaster. Parents may not understand their child’s reaction in disaster situations and must be educated without undermining their place in the family unit ("Pediatric and obstetric," 2010). Collaborating with mental health and primary healthcare workers is important to address the psychosocial needs of the pediatric patient in a disaster ("Pediatric and obstetric," 2010). The article discusses a knowledge deficit of healthcare in the unique needs of the pediatric patient experiencing disaster. This requires the criteria of education of the healthcare team to reach the consequence of understanding. Another antecedent noted in the article is the pediatric fear related to disaster which leads to a criterion of anxiety with the result of mental instability. Knowledge deficit of the parent related to the child’s response to disaster is also described by “Pediatric and obstetric” (2010). For this antecedent, the criterion is education of the parent to reach an understanding of the child’s response and how to help them.
Research from one article studied children’s mental health after the September 11, 2001 attacks in New York City (Hovan et al., 2009). The research looked at a disaster’s effect on children whose parents’ occupations are considered stressful (Hovan et al., 2009). This research studied the children and families of firefighters, policemen, and first responders. It was found that the children of parents with stressful occupations had higher mental health problems such as anxiety, stress, and Posttraumatic Stress Disorder (PTSD) (Hovan et al., 2009). The article notes antecedents of increased fear and stress as experienced by the pediatric population in disaster with parents who have stressful occupations. Fear relates to the criteria of anxiety which has the consequence of mental instability such as PTSD, depression, and risk behaviors in these children. Stress in the studied children requires criteria of intervention of mental health workers to reach stability.
The psychology discipline has a crucial role in care of the pediatric population in disaster planning and response. Through these three articles, it is noted that collaboration with mental health providers is necessary in the pediatric disaster response to help with readiness, understanding, and coping. Without the psychology discipline involvement, mental instability, knowledge deficit, and unpreparedness can occur. Antecedents identified in the psychology discipline include: stress, fear, unpreparedness, knowledge deficit, and lack of resources. These antecedents were noted to have the criteria of: intervention, anxiety, planning, education, and creativity to have the consequences of: stability, mental instability, readiness, inadequate resources, and understanding.
Summary of Literature Review
The collaborative efforts of the nursing, medicine, and, psychology disciplines are all necessary in the response of the pediatric population in disaster. Each discipline emphasizes the need for preparation, education, and intervention to meet the needs of this unique group. Nursing and psychology not only focus on the education and preparation of caring for this population in disaster, but also the pediatric response to the disaster. While the medicine articles do mention the pediatric psychological response in disaster, the focus is more on preparation and education of the providers. While their approach may slightly differ, all of the disciplines do agree that a collaborative approach to disaster response for pediatric patients is critical in meeting the needs for this population.
Common antecedents, criteria, and consequences from the disciplines of nursing, medicine, and psychology were chosen. The common antecedents for these three disciplines are stress, fear, unpreparedness, lack of resources, and knowledge deficit. Common criteria identified in the disciplines are intervention anxiety, planning, creativity, and education. These consequences include: stability, mental instability, readiness, inadequate care, and understanding. See Table 1 below, for a list of the selected antecedents, criteria and consequences.
Antecedents, Criteria and Consequences Table
Table 1
Selected Antecedents, Criteria and Consequences of the Concept of Disaster Response
Antecedents Criteria Consequences
Stress Prompt intervention Stability
Fear Anxiety PTSD
Unpreparedness Planning Readiness
Lack of resources Creativity Inadequate care
Knowledge Deficit Education Clarity
Rationale for Selection Children require specialized response and have very unique needs in disaster. The collaborative effort of healthcare disciplines is needed to prepare and respond to this population’s distinctive needs. The antecedents, criteria, and consequences, though all similar in the disciplines analyzed, have varying perspectives based on their expertise and relationship to the pediatric patient.
Antecedents
The antecedents to disaster throughout this paper are stress, fear, unpreparedness, lack of resources, and knowledge deficit. All of them can be terrifying to everyone involved in a disaster. Stress can be experienced by the pediatric patient, family, or healthcare workers in a disaster. Loss life, health, property, and control can increase the stress of individuals in a disaster. Lack of knowledge and resources can induce stress in the healthcare worker as it limits their ability to care for children in a disaster. It can also cause the family to be unprepared to care for the child in a disaster. Fear can be defined as an emotion in response to a real or perceived threat. That threat to a child could be the loss of home and family, injury and illness, or the fear of the unknown. What will tomorrow bring? Unpreparedness is tragic in that the people that the pediatric patient relies on for help are themselves unsure on what to do in a disaster. Lack of resources in disaster is the inability to provide medical and mental care, food, shelter, or psychosocial support for the pediatric patient. Finally, knowledge deficit can be seen in the nurse, provider, or mental worker who has never cared for a pediatric patient in a disaster. It can also include the parent who is unaware of the child’s response to disaster and is ill prepared to care for that child. All of the antecedents are interrelated and can lead to negative consequences if not addressed.
Criteria
The factors that influence consequences are the criteria. Intervention, anxiety, planning, creativity, and education are the common consequences in the disciplines of nursing, medicine, and psychology. The criteria are the turning point for the pediatric disaster patient. Intervention is a necessity to cause either a positive or negative outcome. Although the criteria could be listed with different antecedents to produce alternate consequences, they were chosen in the groups listed on Table 1 as they were identified in the discipline articles. Intervention is a criterion for stress as without it, the consequence would be oppositional. Anxiety as the criteria for fear is due to a positive correlation between the two in the articles reviewed. Planning as a criterion for unpreparedness in all of the disciplines was noted to be a key to successfully responding to the pediatric patient in a disaster. Several of the articles noted that creativity was used to affect the lack of resources available. Finally, education was noted to be a consistent criteria for knowledge deficits through all of the disciplines researched.
Consequences
The disaster has occurred, now what happens to the pediatric patient? The consequences for disaster throughout the disciplines are noted to be both positive and negative, though depend on whether the criteria have been met. Stability can only occur if intervention has happened. What happens if anxiety is the criteria for fear? If there is a negative criterion of anxiety, the pediatric response to disaster is mental instability such as PTSD. Readiness is a positive consequence of planning for pediatric disaster response while inadequate care is a negative consequence for having to use creativity with lack of resources. Finally, understanding can only come from education on needs related to the disaster response for the pediatric patient. While the goal is to have a positive consequence, it is necessary to be aware and understand that negative consequences do occur in disaster response depending on the criteria.
Theoretical Definition
Theoretical definition is described as “internally consistent group of relational statements that presents a systematic view about a phenomenon and that is useful for description, explanation, prediction and prescription or control” (Walker & Avant, 2011). Disaster response for children includes intervention, planning, and education to achieve the resulting positive consequences of stability, readiness, and understanding while anxiety and creativity result in a negative response of mental instability and inadequate care. Through both the positive and negative criteria, we can better understand the needs and response to disaster in the pediatric patient.
Operational Definition
Strategies for Theory Construction in Nursing states that “operational definitions reflect the theoretical definition, but must have the measurement specifications included” (Walker & Avant, 2011). Disaster planning and education are critical to responding to pediatric populations in disasters. Lack of resources for the pediatric patient in a disaster requires creativity by healthcare workers which may have a negative impact of inadequate care. Disaster can also produce fear that is experienced by pediatric patients. Anxiety can then occur resulting in mental instability. Through medical and psychosocial intervention, healthcare can bring stability to pediatric patients and families dealing with stress in a disaster.
Conclusion
A review of literature from the three disciplines of nursing, medicine, and psychology with focus on disaster response for the pediatric population produced a list of antecedents, criteria, and consequences. Collaboration of the three disciplines was found to be necessary to apply a comprehensive approach to disaster response. Through different perspectives, each of the articles describes a multidisciplinary approach to pediatric disaster response.
The articles referenced in this concept analysis dated back to the earliest year of 2000 and latest year of 2013. This lead to the question: What have we actually done to improve disaster response for the pediatric population over the last thirteen years? There are a myriad of articles outlining what is wrong in disaster response for this population though the challenges reported now is the same as reported thirteen years ago. With recent media emphasis on school shootings, natural disasters, and other terroristic attacks involving children, why has healthcare not found better solutions for caring for the pediatric population? As the manager of a large Emergency Department with a Pediatric Center, I have a better understanding of disaster response for the pediatric patient and can advocate for increased planning and education. Through a multidisciplinary collaborative approach, disaster preparedness can be applied to my practice in order to provide readiness, understanding, and adequate care. “The next time you have a disaster drill and are thinking, ‘‘Why are we doing this again?’’ remember that you do not plan disasters, you can only plan your response to them” (Behney, Breit & Phillips, 2006). Nursing has a responsibility to advocate for our patients through collaboration to improve outcomes including disaster response for pediatric patients.
References
Behney, A., Breit, M., & Phillips, C.
(2006). Pediatric mass casualty: Are you ready?. JOURNAL OF EMERGENCY NURSING, 32, 241-245. doi: 10.1016/j.jen.2006.03.005
Fendya, D. (2006). When disaster strikes--care considerations for pediatric patients. Journal of Trauma Nursing, 13(4), 161-165.
Hagan, J. F. (2005). Psychosocial implications of disaster or terrorism on children: a guide for the pediatrician. Pediatrics, 116, 787-795. doi: 10.1542/peds.2005-1498
Hoven, C., Duarte, C., Wu, P., Doan, T., Singh, N., Mandell, D., & ... Cohen, P. (2009). Parental Exposure to mass violence and child mental health: the First Responder and WTC Evacuee Study. Clinical Child & Family Psychology Review, 12(2), 95-112. doi: 10.1007/s10567-009-0047-2
Kim, K. M. (2013). Disaster planning in the pediatric emergency department. Pediatric Emergency Medicine Reports, 18(5), 53-63. Retrieved from www.ahcmedia.com
Murray, C. S. (2006). Addressing the Psychosocial Needs of Children Following Disasters. Journal for Specialists in Pediatric Nursing, 11(2), 133-137. doi:10.1111/j.1744-6155.2006.00055.x
New York State Department of Health, (2010). Pediatric and obstetric emergency preparedness toolkit. Retrieved from website:
http://www.health.ny.gov/facilities/hospital/emergency_preparedness/guideline_for_hospitals/psychosocial.htm
Sloand, E., Ho, G., Klimmek, R., Pho, A., & Kub, J. (2012). Nursing children after a disaster: A qualitative study of nurse volunteers and children after the Haiti earthquake. Journal for Specialists in Pediatric Nursing, 17(3), 242-253. doi:10.1111/j.1744-6155.2012.00338.x
Speier, A. H., & Nordboe, D. U.S Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2000). (ADM86-1070R). Retrieved from DHHS Publication website: http://store.samhsa.gov/product/Psychosocial-Issues-for-Children-and-Adolescents-in-Disasters/ADM86-1070R
Walker, L., & Avant, K. (2011). Strategies for theory construction in nursing. New Jersey: Pearson.
(2006). Chemical-biological terrorism and its impact on children. PEDIATRICS, 118(3), 1267-1278. doi: 10.1542/peds.2006-1700
Disaster Response for the Pediatric Population: A Concept Analysis
In partial fulfillment of the requirements of
Disaster Response for the Pediatric Population: A Concept Analysis
Disaster can strike in any place or at any time. The concept of disaster can have different affects and outcomes for pediatric patients. A disaster could be as localized as a multiple causality event or as global as terrorism or a natural disaster. Disaster can be defined as an event that causes destruction and injury and requires immediate intervention. How does disaster affect children? Are we, as a nation, adequately prepared to respond to pediatric needs in a disaster? …show more content…
For a pediatric patient, coping with this adverse situation can be challenging. The task of helping children deal with a disaster relies on the multidisciplinary expertise of Nursing, Medicine, and Psychology.
Review of Literature
For this paper, the focus is on the Nursing, Medicine and Psychology disciplines and how they can affect the pediatric response to disaster. The three disciplines are unique yet can merge in their role of providing disaster response and improving outcomes for pediatric patients. Nursing must be proactive and collaborate with other disciplines to address this challenging problem in pediatric healthcare.
Nursing Discipline Murray (2006) suggests in recent years terrorism, hurricanes, and school shootings have highlighted the need to understand the pediatric response to disaster and to intervene to improve outcomes. She notes that a child’s age and development will greatly influence their response to disaster. Stress and separation are natural reactions to an unnatural situation though requires intervention with psychosocial support (Murray, 2005). Murray has a multidisciplinary view of helping the pediatric patient deal with disaster. Murray (2005) states that nurses have a critical role in helping to meet the psychosocial needs of the pediatric patient in a disaster. If the nurse is simply available to the parents as emotional support, the parent in turn can care for their children (Murray 2005). Healthcare providers also play an integral role in assisting the pediatric patient in a disaster. Murray (2005) refers to checklists and audit tools to assist the practitioner in assessing and diagnosing traumatic responses for the pediatric patient in and disaster crisis. She notes the importance of collaboration in nursing and medicine to offer the best resources available to the pediatric patient and family in a disaster. The antecedents found in this article are knowledge deficit to care for the pediatric patient in disaster with the criteria of education to reach a consequence of understanding. Unpreparedness for disaster is another antecedent identified in Murray’s (2005) writing which is noted to require the criteria of planning in order to reach the consequence of readiness.
One nursing article suggests that though disaster planning and preparation have increased since recent terroristic events, the pediatric population has been seriously overlooked during disaster preparedness (Fendya, 2006). Nurses must actively participate in the planning and preparation phases in disaster preparedness and assures that plans consider the needs of the pediatric population according to Fendya (2006). Physical, emotional, and developmental differences in children pose complex challenges when caring for them in a disaster. A child’s response to the disaster depends on these differences as well as the caregivers’ well-being and level of support (Fendya, 2006). Some pediatric responses to disaster may include difficulty sleeping or eating, regression to prior developmental state, thoughts of harm to self or others, anxiety reactions, or behavior outbursts (Fendya, 2006). The article suggests that by being prepared, the nurse can address the pediatric patient’s needs by recognizing high-risk symptoms and help educate families so that referral to mental health services can happen quickly (Fendya, 2006). This article uses the antecedents of unpreparedness and knowledge deficit with the criteria of planning and education in order to achieve readiness and understanding in caring for the pediatric population in a disaster. Behney, Breit & Phillips (2006) describe one pediatric mass causality experience at their hospital in Liberty, Missouri. The article describes their preparation as the received the first notification and the realization that the Emergency Department was not prepared for such an event. The hospital was prepared for two or three patients but what they received was 29 children in an already busy 28-bed emergency department (Behney, Breit & Phillips, 2006). Although the hospital had participated in disaster drills, the communication and chaos gave the feeling of being unprepared (Behney, Breit & Phillips, 2006). According to the article, parents, children, and nurses were stressed with the situation but fortunately, the school was able to respond with counselors for support (Behney, Breit & Phillips, 2006). Collaboration with social workers helped to alleviate some of the chaos and stress related to identification of two of the severely injured patients as well as traffic control (Behney, Breit & Phillips, 2006). One OR nurse was assigned to a surgical pediatric patient in the Emergency Department. Through reassurance that she would follow the child through the surgical procedure, the nurse was able to calm the parents and provide a sense of comfort (Behney, Breit & Phillips, 2006). Behney, Breit & Phillips (2006) writes that the collaboration between nursing, physicians, ancillary staff, EMS, and school personnel greatly impacted the care provided for the pediatric patients and their families in this disaster. Behney, Breit & Phillips (2006) use the antecedents of stress, unpreparedness, and knowledge deficit in their article. Nurses, responders, patients, and families reported stress in the disaster which required a prompt intervention of school counselors to help with support allowing for the consequence of stability. The hospital was unprepared for the magnitude of pediatric patients and realized that planning was a necessary criteria for readiness in responding to pediatric disaster. Families and nurses reported a knowledge deficit in addressing the needs of these children and families in a disaster. They realized that education of the family and staff helped in reaching an understanding of injuries and processes. An article in the Journal for Specialists in Pediatric Nursing examines nurses experience following the Haiti earthquake of 2010 (Soland, et al., 2012). Looking through the nurse volunteer perspective, the study illustrates the impact of the earthquake on the pediatric victims and their families (Soland, et al., 2012). Soland, et al. (2012) reports that through the study it was found that almost a third of the patients seen in the earthquake were pediatric aged thus highlighting the importance on being prepared for children in disaster. Due to a lack of resources, creativity was used in caring for the children in the article. Although sometimes this was successful, other times it resulted in inadequate care or death (Soland, et al., 2012). Other challenges included the lack of pediatric experience in the nurses caring for the patients. This also resulted in suboptimal care (Soland, et al., 2012). Soland, et al., (2012) describes the pediatric response of fear, stress, and despair but also love, hope, and resilience. Some antecedents identified in the article were unpreparedness by the nurses to deal with disasters, knowledge deficit in caring for pediatric patients, and lack of resources to care for the patients.
Two criteria and consequences included understanding that planning and education was needed to be ready to care for the pediatric population in a disaster in order to have readiness and understanding. Another criteria and consequence identified in the article was that creativity was needed to address the antecedent of lack of resources but did have the consequence of inadequate care.
These four articles comprise the nursing role in providing care to the pediatric population in a disaster. Nurses are leaders in disaster preparedness and care for the pediatric patient and should collaborate with other disciplines to reach positive consequences in disaster response. Nursing can have a great impact on the consequences of disaster for pediatric patients and their families. Unfortunately, the consequences of disaster are not always positive. This is why the nursing discipline antecedents, criteria and consequences are comprised of both positives and negatives. Some of the antecedents of the nursing discipline as defined by the articles are: fear, stress, unpreparedness, lack of resources, and knowledge deficit. These are based on the criteria of anxiety, prompt intervention, planning, creativity, and education. The consequences of these events would be mental instability, stability, readiness, inadequate care, and understanding respectively. Although we strive for positive consequences, it is also important to be aware of the negative aspects so that we can improve outcomes.
Medicine Discipline According to Hagan (2005), there is a deficit when parental response to a disaster overrides the parent’s ability to address the child’s need during that time. Hagan (2005) includes diagnosis criteria for Acute Stress Disorder and Posttraumatic Stress Disorder in his article to assist the practitioner in identifying these reactions in children and adults. He suggests that Pediatricians have the responsibility to assist parents during and after disaster situations to understand and address children’s unique psychological needs in response (Hagan 2005). In this article, Hagan (2005) compares the Medical and Psychology disciplines’ response to the pediatric victims for both the September 11, 2001 attacks and the Oklahoma bombing. He suggests that although the Medical and Psychology discipline responses were improved for this population, there was still and increased number of visits for anxiety and stress reactions following the events. According to Hagan (2005), this suggests that the Medical and Psychology interventions and resources were not adequate to address the needs of the pediatric population in disaster situations. Hagan (2005) recommends use of tools such as checklists to identify at-risk pediatric patients and to intervene quickly with referrals to mental health services. The antecedents, criteria and consequences found in this article are similar to those found in nursing. Unpreparedness of the practitioner to care for pediatric disaster patients requires planning to reach a consequence of readiness. The physician knowledge deficit in identifying pediatric needs has a criteria of education related to tools available to come to the consequence of understanding. Lack of resources also required use of little available knowledge and tools with a result of inadequate identification and care of these patients. Another antecedent discussed in the article was stress of the pediatric disaster patient which requires intervention of referral to mental health services to acquire stability. Otherwise, fear felt by the pediatric patient results in increased anxiety causing mental instability.
Kim (2013) discusses in her article on Disaster Planning in the Pediatric Emergency Department that disaster and mass causality is not about whether it will happen, but when. Because disasters have become common place in our world, planning and preparation are the first steps to addressing the pediatric patient needs (Kim, 2013). The pediatric age group makes up 24% of the population, yet we tend to forget about this group when looking at disaster management (Kim, 2013). Children are at higher risk for physical and psychological injury in a disaster than adults and thus require an increased focus on their needs (Kim, 2013). Older children tend to have an inappropriate response to disaster and threat and their fear responses are challenging for caregivers (Kim, 2013). Kim (2013) suggests pediatric disaster planning include the child being kept with the family, ready access to medical care, safe environment, to be kept clean, warm, and fed, as well as the ability to return to school and normal routines as soon as possible. Returning to normal activities such as attending school is important in protecting the child from increased psychological trauma (Kim, 2013). Kim suggests that the pediatric response to disaster can be mitigated through the emergency physician role in planning and practicing for disaster situations. Identified antecedents in this article include unpreparedness and knowledge deficit of physicians when dealing with pediatric disasters. Kim (2013) states the respective criteria of these antecedents are planning and education to reach readiness and understanding.
A publication on terrorism impact on children reports that after the September 11th attacks, 25% of children affected had acute anxiety which was then followed by Posttraumatic Stress Disorder (PTSD) diagnoses ("Chemical-biological terrorism and," 2006). The article lists a myriad of biological and terroristic threats to consider for the pediatric patient as well as responses to such disasters. Pediatric physicians must educate themselves in disaster preparedness in order to, in turn, effectively educate and care for pediatric patients and their families ("Chemical-biological terrorism and," 2006). Antecedents, criteria, and consequences identified in this article are based on stress, unpreparedness, and knowledge deficit. The pediatric patient in a disaster suffers from stress related to the criteria of anxiety. The consequence of this criterion is mental instability as expressed by PTSD. The unpreparedness and knowledge deficit of the physicians caring for the pediatric disaster patient requires planning and education to reach readiness and understanding.
The Medicine discipline articles all cited similar antecedents, criteria, and consequences that revolved around the realization that there is a lack of preparedness and knowledge to care for the pediatric patient. This results in the need for education and preparation for disaster situations involving children. Without the correct preparation and education the provider cannot reach readiness and understanding. Although the Medicine discipline takes accountability in the articles for disaster preparedness, planning, and care, collaboration with other disciplines is noted to be crucial to care for this unique population.
Psychology Discipline Children and their response to a disaster can be unique and based on their stage of social and cognitive development (Speier & Nordboe, 2000). This publication from Substance Abuse and Mental Health Services Administration addresses a multidisciplinary approach to caring for children in disaster situations. This approach includes nurses, physicians, case management, mental health workers, and other public health and social service providers. Speiere and Nordboe (2005) suggest that the most obvious statement about children in disaster situations is frequently overlooked or forgotten: Children are not small adults. They have very different needs and responses to disaster than an adult. The publication looks at the Theories of Child Development and relates them to the pediatric response to disaster. Speiere and Nordboe (2005) also suggest that the media has a degree of impact on the pediatric response to disasters. Though media, a child can experience their responses to disaster over and over from different perspectives. According to Speier and Nordboe (2005), a child’s typical reaction to disaster can include fear, anxiety, and sleep disturbance among other developmental specific problems. This is due to children interpreting their experiences based on their level of development (Speier & Nordboe, 2000). Understanding this is the key to being able to help the pediatric population. Some steps for the healthcare or mental health worker in helping the healing process for the pediatric patient is to start with developing a rapport, identifying the problem, understanding the feelings, listening, and communicating clearly (Speier & Nordboe, 2000). Speier and Nordboe (2005) believe that knowing the resources available in a community and helping the parents to access those resources are a critical element in assisting the pediatric patient through disaster. Although lack of resources depending on the area, may require additional consideration. Antecedents identified in this article include knowledge deficit, fear, stress, lack of resources and unpreparedness. Speier and Nordboe (2005) suggest that there is a knowledge deficit among healthcare workers on how to care for the pediatric patient in a disaster. This can be resolved with the criteria of education and a consequence of understanding. The article also discusses the fear and stress of the pediatric population in disaster. Stress of the pediatric patient requires mental health intervention to achieve the consequence of stability while fear can have increased anxiety resulting in mental instability. Lack of resources requires creativity and pulling of available information but may result in inadequate care for these children. The overall unpreparedness of healthcare workers is noted in the article to require planning with the consequence of readiness to care for the pediatric disaster patient.
Disaster response for children requires preparation and consideration of the physical and emotional needs unique to the pediatric population ("Pediatric and obstetric," 2010). This publication outlines the developmental considerations in the pediatric response to disaster and how the family unit must be considered as a whole when caring for the pediatric patient. Children may have preconceived notion about disaster and what they will experience ("Pediatric and obstetric," 2010). Their fear related to disaster can lead to anxiety and ultimately stress disorders. A chart is provided in this publication of developmental levels and responses to disaster. Parents may not understand their child’s reaction in disaster situations and must be educated without undermining their place in the family unit ("Pediatric and obstetric," 2010). Collaborating with mental health and primary healthcare workers is important to address the psychosocial needs of the pediatric patient in a disaster ("Pediatric and obstetric," 2010). The article discusses a knowledge deficit of healthcare in the unique needs of the pediatric patient experiencing disaster. This requires the criteria of education of the healthcare team to reach the consequence of understanding. Another antecedent noted in the article is the pediatric fear related to disaster which leads to a criterion of anxiety with the result of mental instability. Knowledge deficit of the parent related to the child’s response to disaster is also described by “Pediatric and obstetric” (2010). For this antecedent, the criterion is education of the parent to reach an understanding of the child’s response and how to help them.
Research from one article studied children’s mental health after the September 11, 2001 attacks in New York City (Hovan et al., 2009). The research looked at a disaster’s effect on children whose parents’ occupations are considered stressful (Hovan et al., 2009). This research studied the children and families of firefighters, policemen, and first responders. It was found that the children of parents with stressful occupations had higher mental health problems such as anxiety, stress, and Posttraumatic Stress Disorder (PTSD) (Hovan et al., 2009). The article notes antecedents of increased fear and stress as experienced by the pediatric population in disaster with parents who have stressful occupations. Fear relates to the criteria of anxiety which has the consequence of mental instability such as PTSD, depression, and risk behaviors in these children. Stress in the studied children requires criteria of intervention of mental health workers to reach stability.
The psychology discipline has a crucial role in care of the pediatric population in disaster planning and response. Through these three articles, it is noted that collaboration with mental health providers is necessary in the pediatric disaster response to help with readiness, understanding, and coping. Without the psychology discipline involvement, mental instability, knowledge deficit, and unpreparedness can occur. Antecedents identified in the psychology discipline include: stress, fear, unpreparedness, knowledge deficit, and lack of resources. These antecedents were noted to have the criteria of: intervention, anxiety, planning, education, and creativity to have the consequences of: stability, mental instability, readiness, inadequate resources, and understanding.
Summary of Literature Review
The collaborative efforts of the nursing, medicine, and, psychology disciplines are all necessary in the response of the pediatric population in disaster. Each discipline emphasizes the need for preparation, education, and intervention to meet the needs of this unique group. Nursing and psychology not only focus on the education and preparation of caring for this population in disaster, but also the pediatric response to the disaster. While the medicine articles do mention the pediatric psychological response in disaster, the focus is more on preparation and education of the providers. While their approach may slightly differ, all of the disciplines do agree that a collaborative approach to disaster response for pediatric patients is critical in meeting the needs for this population.
Common antecedents, criteria, and consequences from the disciplines of nursing, medicine, and psychology were chosen. The common antecedents for these three disciplines are stress, fear, unpreparedness, lack of resources, and knowledge deficit. Common criteria identified in the disciplines are intervention anxiety, planning, creativity, and education. These consequences include: stability, mental instability, readiness, inadequate care, and understanding. See Table 1 below, for a list of the selected antecedents, criteria and consequences.
Antecedents, Criteria and Consequences Table
Table 1
Selected Antecedents, Criteria and Consequences of the Concept of Disaster Response
Antecedents Criteria Consequences
Stress Prompt intervention Stability
Fear Anxiety PTSD
Unpreparedness Planning Readiness
Lack of resources Creativity Inadequate care
Knowledge Deficit Education Clarity
Rationale for Selection Children require specialized response and have very unique needs in disaster. The collaborative effort of healthcare disciplines is needed to prepare and respond to this population’s distinctive needs. The antecedents, criteria, and consequences, though all similar in the disciplines analyzed, have varying perspectives based on their expertise and relationship to the pediatric patient.
Antecedents
The antecedents to disaster throughout this paper are stress, fear, unpreparedness, lack of resources, and knowledge deficit. All of them can be terrifying to everyone involved in a disaster. Stress can be experienced by the pediatric patient, family, or healthcare workers in a disaster. Loss life, health, property, and control can increase the stress of individuals in a disaster. Lack of knowledge and resources can induce stress in the healthcare worker as it limits their ability to care for children in a disaster. It can also cause the family to be unprepared to care for the child in a disaster. Fear can be defined as an emotion in response to a real or perceived threat. That threat to a child could be the loss of home and family, injury and illness, or the fear of the unknown. What will tomorrow bring? Unpreparedness is tragic in that the people that the pediatric patient relies on for help are themselves unsure on what to do in a disaster. Lack of resources in disaster is the inability to provide medical and mental care, food, shelter, or psychosocial support for the pediatric patient. Finally, knowledge deficit can be seen in the nurse, provider, or mental worker who has never cared for a pediatric patient in a disaster. It can also include the parent who is unaware of the child’s response to disaster and is ill prepared to care for that child. All of the antecedents are interrelated and can lead to negative consequences if not addressed.
Criteria
The factors that influence consequences are the criteria. Intervention, anxiety, planning, creativity, and education are the common consequences in the disciplines of nursing, medicine, and psychology. The criteria are the turning point for the pediatric disaster patient. Intervention is a necessity to cause either a positive or negative outcome. Although the criteria could be listed with different antecedents to produce alternate consequences, they were chosen in the groups listed on Table 1 as they were identified in the discipline articles. Intervention is a criterion for stress as without it, the consequence would be oppositional. Anxiety as the criteria for fear is due to a positive correlation between the two in the articles reviewed. Planning as a criterion for unpreparedness in all of the disciplines was noted to be a key to successfully responding to the pediatric patient in a disaster. Several of the articles noted that creativity was used to affect the lack of resources available. Finally, education was noted to be a consistent criteria for knowledge deficits through all of the disciplines researched.
Consequences
The disaster has occurred, now what happens to the pediatric patient? The consequences for disaster throughout the disciplines are noted to be both positive and negative, though depend on whether the criteria have been met. Stability can only occur if intervention has happened. What happens if anxiety is the criteria for fear? If there is a negative criterion of anxiety, the pediatric response to disaster is mental instability such as PTSD. Readiness is a positive consequence of planning for pediatric disaster response while inadequate care is a negative consequence for having to use creativity with lack of resources. Finally, understanding can only come from education on needs related to the disaster response for the pediatric patient. While the goal is to have a positive consequence, it is necessary to be aware and understand that negative consequences do occur in disaster response depending on the criteria.
Theoretical Definition
Theoretical definition is described as “internally consistent group of relational statements that presents a systematic view about a phenomenon and that is useful for description, explanation, prediction and prescription or control” (Walker & Avant, 2011). Disaster response for children includes intervention, planning, and education to achieve the resulting positive consequences of stability, readiness, and understanding while anxiety and creativity result in a negative response of mental instability and inadequate care. Through both the positive and negative criteria, we can better understand the needs and response to disaster in the pediatric patient.
Operational Definition
Strategies for Theory Construction in Nursing states that “operational definitions reflect the theoretical definition, but must have the measurement specifications included” (Walker & Avant, 2011). Disaster planning and education are critical to responding to pediatric populations in disasters. Lack of resources for the pediatric patient in a disaster requires creativity by healthcare workers which may have a negative impact of inadequate care. Disaster can also produce fear that is experienced by pediatric patients. Anxiety can then occur resulting in mental instability. Through medical and psychosocial intervention, healthcare can bring stability to pediatric patients and families dealing with stress in a disaster.
Conclusion
A review of literature from the three disciplines of nursing, medicine, and psychology with focus on disaster response for the pediatric population produced a list of antecedents, criteria, and consequences. Collaboration of the three disciplines was found to be necessary to apply a comprehensive approach to disaster response. Through different perspectives, each of the articles describes a multidisciplinary approach to pediatric disaster response.
The articles referenced in this concept analysis dated back to the earliest year of 2000 and latest year of 2013. This lead to the question: What have we actually done to improve disaster response for the pediatric population over the last thirteen years? There are a myriad of articles outlining what is wrong in disaster response for this population though the challenges reported now is the same as reported thirteen years ago. With recent media emphasis on school shootings, natural disasters, and other terroristic attacks involving children, why has healthcare not found better solutions for caring for the pediatric population? As the manager of a large Emergency Department with a Pediatric Center, I have a better understanding of disaster response for the pediatric patient and can advocate for increased planning and education. Through a multidisciplinary collaborative approach, disaster preparedness can be applied to my practice in order to provide readiness, understanding, and adequate care. “The next time you have a disaster drill and are thinking, ‘‘Why are we doing this again?’’ remember that you do not plan disasters, you can only plan your response to them” (Behney, Breit & Phillips, 2006). Nursing has a responsibility to advocate for our patients through collaboration to improve outcomes including disaster response for pediatric patients.
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