1. TRANSCULTURAL NURSING
AND DISASTER NURSING
THANUJA ELEENA MATHEW

3. DEFINITION
• “Transcultural nursing is a comparative study of cultures to
understand similarities across human groups”
-Leininger, 1991
• “Transcultural nursing is a legitimate and formal area of study,
research and practice, focused on culturally based care, values and
practices to help cultures or subcultures maintain or regain their
health and face disabilities or death in culturally congruent and
beneficial caring ways” -Leininger, 1999

4. FOUNDER OF TRANSCULTURAL NURSING
• Madeleine Leininger is considered as the founder of the
theory of transcultural nursing

5. HISTORY
 Through Leininger, transcultural nursing started a theory of diversity
and universality of cultural care
 Transcultural nursing was established from 1955- 1975
 In 1975, Leininger refined the specialty through the use of ‘Sunrise
model’ concept
 It’s international establishment as a field in nursing continued from
1983 to the present

6. GOALS
To give culturally congruent care
To provide culture specific and universal nursing care practices for the
health, wellbeing of the people
To aid them in facing adverse human conditions, illness or death in
culturally meaningful ways.

7. KEY TERMINOLOGIES
↣Culture
• Norms and practices of a particular group that are learned and shared
and guide thinking, decisions and actions.
↣Cultural values
• The individuals desirable or preferred way of acting or knowing
something that is sustained over a period of time and which governs
actions or decisions.

8. ↣Culturally diverse nursing care
• An optimal mode of health delivery; it refers to the variability of
nursing approaches needed to provide culturally appropriate care that
incorporates an individual’s cultural values, beliefs and practices
including sensitivity to the environment from which the individual
comes and to which the individual may ultimately return
↣Ethnocentrism
• The perception that one’s own way is best when viewing the world

9. ↣Ethnic
• A term that relates to races or large groups of people classified
according to common traits or customs
↣Race
• A term related to biology, since members of the same group share
distinguishing physical features such as skin colour, bone structure and
blood group.
↣Ethnography
• The study of culture

10. ↣Culture shock
• A disorder that occurs in response to transition from one cultural
setting to another
↣Religion
• It is a set of belief in a divine or super human power to be obeyed and
worshipped as the creator and ruler of the universe
↣Cultural identity
• The sense of being part of an ethnic group or culture

11. ↣Material culture
• It refers to objects (dress, art, religious articles)
↣Non-material culture
• It refers to beliefs, customs, languages, and social institutions.
↣Diversity
• It refers to the fact or the state of being different. Diversity can occur
between culture and within a culture group

12. ↣Acculturation
• People of a minority group tend to assume the attitudes, values,
beliefs, find practices of the dominant society resulting in a blended
cultural pattern.

13. TRANSCULTURAL NURSING MODEL
• Sunrise model
• [Theory of culture care diversity and universality]
by Leininger

14. PURPOSE AND GOAL
• To discover, document, interpret, explain and predict multiple
factors influencing Care from a cultural holistic perspective.
• The goal of the theory was to provide culturally congruent care
that would contribute to the health and well-being of people

16. SUNRISE MODEL
The model shows factors
• Technological Kinship and social
 Religious and philosophical Cultural values and lifeways
 Political and legal Economic and educational
• They form sunrays that influence individuals, families and groups in
health and illness

17. MAJOR CONCEPTS AND DEFINITIONS
Cultural care
•It is an individual's, group or community's different adaptation or
learning, acquired and being used to improve and face their everyday
way of life, sickness, health and even facing death
World view
•It is how the people perceived the world or universe in making their
personal understanding of what life is all about.

18. Cultural and social structure dimensions
•It refers to the dynamic patterns and features of interrelated
structural and organizational factors of a particular culture
which includes technologic, religious, kinship, cultural values,
political, economic and educational factors and how these
factors are may be interrelated and function to influence
human behavior in different environmental contexts.

19. Environmental context
•It refers to the totality of an event, situation or particular
experiences that give meaning to human expressions,
interpretations, and social interactions in particular physical,
ecological, socio-political and/ or cultural settings.

20. Ethnohistory
•It refers to those past facts, events, instances and experiences of
individual, groups, cultures and institutions that are primarily people-
centered (ethno)
Generic (folk or lay) care system
• It refers to culturally learned and transmitted, indigenous (or
traditional), folk (home based) knowledge and skills used to provide
assistive, supportive, enabling or facilitative acts toward or for another
individual, group or institution

21. Professional care system
•It refers to formally taught, learned and transmitted professional care,
health, illness, wellness and related knowledge and practice skills that
prevail in professional institutions usually with multidisciplinary
personnel to serve consumers
Health
• It refers to a state of wellbeing that culturally defined, valued and
practiced and that prevail in professional institutions to perform their
daily role activities in culturally expressed, beneficial

22. Cultural care preservation and maintenance
•Professional actions and decisions that help people of a particular
culture to retain and/or preserve relevant care values so that they can
maintain their well-being, recover from illness, or face handicaps
and/or death
Cultural care accommodation or negotiation
•Professional actions and decisions that help people of a designated
culture to adapt to or to negotiate with others for beneficial or
satisfying health outcomes with professional care providers

23. Cultural care repatterning or restructuring
• Practices that are deleterious to overall health need to be restructured
Cultural congruent nursing care
•It refers to those cognitively based assistive, supportive, facilitative, or
enabling acts or decisions that are tailor made to fit the individual,
group or institutional cultural values, beliefs and lifeways in order to
provide or support meaningful beneficial and satisfying health care or
well-being services.

24. NURSING PROCESS AND LEININGER’S
THEORY
 Assessment & nursing diagnosis:
Gathering knowledge & information about social culture and world view
Preventing culture shock & cultural imposition
Analyze and state it in the form of nursing diagnosis

25. Nursing diagnosis:
Anxiety
Impaired Verbal Communication
Decisional Conflict
Ineffective Health Maintenance
Relocation Stress Syndrome
Ineffective Role Performance
Situational Low Self-esteem
Social Isolation

26.  Planning & implementation
Preservation and maintenance
Culture care accommodation
Culture care restructuring or repatterning
 Evaluation
Behavioral patterns of the culture is equivalent to evaluation

27. TRADITIONAL CONCEPT OF HEALTH
AND DISEASE
• Be aware that the health concepts held by many cultural groups may result in
people choosing not to seek Western medical treatment procedures because they
do not view the illness or disease as coming from within themselves
• Remember that the more traditional person does seek Western medical treatment,
then that person might not be able to provide or describe his/her symptoms in
precise terms that the Western medical practitioner can readily treat.
• Recognize that individuals from other cultures might not follow through with
health promoting or treatment recommendation because they perceive the medical
or the health promoting encounter

28. • Acknowledge that many individual patients and health care
practitioners have specific notions about health and disease causality
and treatment as a negative or perhaps even hostile experience
• Be aware of the need to be flexible in the design of programs, policies
and services to meet the needs and concerns of the culturally diverse
population, groups that are likely to be encountered.

29. TRADITIONAL CONCEPTS OF ILLNESS
CAUSALITY
• Be aware that folk illnesses are generally learned syndromes that
individuals from particular cultural groups claim to have and from
which their culture defines the etiology, behavior, diagnostic
procedures, prevention methods and traditional healing or curing
practices
• Remember that most cases of lay illness have multiple causalities and
may require several different approaches for diagnosis, treatment and
cure including folk and Western medical intervention.

30. • Recognize that folk illnesses which are perceived to arise from a
variety of causes often require the services of a folk healer
• Understanding these differences may help us to be more sensitive to
the special beliefs and practices of multicultural target groups when
planning a program

32. HEALTH PRACTICES IN DIFFERENT
CULTURES
• a) Use of protective objects
 Protective objects can be worn or carried or hung in the home-
charms worn on a string or chain around the neck, wrist, or waist to
protect the wearer from the evil eye or evil spirits.
• b) Use of substances
 It is believed that certain food substances can be ingested to prevent
illness.
 E.g. eating raw garlic or onion to prevent illness or wear them on the
body or hang them in the home

33. • c) Religious practices
• Another traditional approach to illness prevention centers around
religion and includes practices such as from a divine source, burning
candles, rituals of redemption etc.
• d) Traditional remedies
• The use of folk or traditional medicine is seen among people from all
walks of life and cultural ethnic back ground.
• e) Healers
• Within a given community, specific people are known to have the
power to heal.

34. • f) Immigration
• Immigrant groups have their own cultural attitudes ranging beliefs and
practices regarding these areas.
• g) Gender roles
• In many cultures, the male is dominant figure and often they take
decisions related to health practices and treatment. In some other
cultures females are dominant.
• In some cultures, women are discriminated in providing proper
treatment for illness.

35. • . h) Beliefs about mental health
• Mental illnesses are caused by a lack of harmony of emotions or by
evil spirits.
• i) Economic factors
• Factors such as unemployment, underemployment, homelessness,
lack of health insurance poverty prevent people from entering the
health care system.
• j) Time orientation
• It is varying for different cultures groups

36. • k) Personal space and territoriality
• Respect the client's personal space when performing nursing
procedures.
• The nurse should also welcome visiting members of the family and
extended family.
• l) Illness cause and prevention related to food
• Several factors cause illness
• A hot cold imbalance
• Primarily caused by improper diet

37. PURPOSE OF KNOWING THE PATIENT’S CULTURE
AND RELIGION FOR HEALTH CARE PERSONNEL
↣Cultural background affects a person’s health in all dimensions, so
the nurse should consider the client’s cultural background when
planning care.
↣Although basic human needs are the same for all people, the way a
person seeks to meet those needs is influenced by culture.
↣To foster understanding, respect and appreciation for the
individuality and diversity of patient’s beliefs, values, spirituality and
culture regarding illness its meaning, cause, treatment and outcome

38. ↣To strengthen in their commitment to relationship centered medicine
that emphasizes care of the suffering person rather than attention
simply more to the pathophysiology of disease.
↣To facilitate in recognizing the role of the hospital chaplain and the
patient's clergy as partners in the health care team in providing care
for the patient
↣To encourage in developing and maintaining a program of physical,
emotional and spiritual self-care introduce therapies from the East
such as Ayurveda and panchakarma

39. CULTURE AND HEALTH BELIEFS IN
INDIA
Many elders believe in the traditional Indian system of medicine
called Ayurvedic medicine as the means of preventing and curing
illness.
Modesty is highly valued among Indians, and patients usually feel
more comfortable with same sex care providers
Sensitivity and care should be taken in situations that may cause the
patient embarrassment, such as wearing gown, which the patient
may consider too short

40. Hindu women wear a thread around their necks and it should not be removed
during the exam
Mental illness is considered as a social stigma. Some believe that mental illness is
due to possession of the evil eye.
Because of the close-knit family structure, health care decisions are frequently
discussed within the immediate family before seeking outside help
Women are more passive in the Indian culture and men play a major role in health
care decisions

41. • Fasting frequently is a common practice among elderly women. It is
done because of the religious belief that it improves the welfare of the
family. Health care providers should respect these practices if the
patient’s medical condition can tolerate it.
Beef is forbidden for Hindus and pork for Muslims
Some patients hesitate to wear clothing that others have worn before
them, even though it has been washed and sterilized

42. Sikh men do not cut their hair and wear a bracelet and kirpan. If the
hair must be cut, it is important to explain the need to the patient and
family.
Some elders prefer to have the surgery only on some auspicious days.
If procedures such as enema or bladder catheterization must be done,
elders would prefer that someone of the same sex do it

43. Most Indians do not readily agree to a postmortem examination or
organ donation
Some behaviors that elders may prefer include ritual chanting by a
priest, tying a thread around a sick person’s wrist, writing a protective
verse to be worn in a metal cylinder on a chain around the neck or
wrist.
Sick persons also promise gifts to the God if they recover

44. NURSING CARE
 RELIGIOUS BELIEFS THAT AFFECT NURSING CARE
Belief about birth and death
Belief about diet and food practices
Belief regarding medical care

45. ROLE OF NURSE
o Determine the client's cultural heritage and language skills.
o Determine if any of his health beliefs relate to the cause of the illness
or to the problem.
o Collect information that any home remedies the person is taking to
treat the symptoms.
o Nurses should evaluate their attitudes toward ethnic nursing care.

46. o Self-evaluation helps the nurse to become more comfortable when
providing care to clients from diverse backgrounds
o Understand the influence of culture, race &ethnicity on the
development of social emotional relationship, child rearing practices &
attitude toward health.
o Collect information about the socioeconomic status of the family and
its influence on their health promotion and wellness
o Identify the religious practices of the family and their influence on
health promotion belief in families.

47. o Understanding of the general characteristics of the major ethnic groups, but
always individualize care.
o The nursing diagnosis for clients should include potential problems in their
interaction with the health care system and problems involving the effects of
culture.
o The planning and implementation of nursing interventions should be adapted as
much as possible to the client's cultural background.
o Evaluation should include the nurse's self-evaluation of attitudes and emotions
toward providing nursing care to clients from diverse sociocultural backgrounds.
o Self-evaluation by the nurse is crucial as he or she increases skills for interaction.

48. DISASTER NURSING
• INTRODUCTION
• A disaster is serious disruption of the functioning of a society,
causing widespread human, material or environmental losses which
exceed the ability of affected society to cope using only its own
resources. Disaster occurs suddenly and unexpectedly, disrupting
normal life and infrastructure of social services including health care
system. For this reason, a country’s health system and public health
infrastructure must be organized and kept ready to act in any
emergency situation as well as under normal condition.

50. DEFINITION OF DISASTER
Disaster is defined as “any occurrence that causes damage,
ecological disruption, loss of human life or deterioration of health
services on a scale sufficient to warrant an extraordinary response from
outside the affected community or area”.

51. DISASTER ALPHABETICALLY MEANS:
• D Destructions
• I Incidents
• S Sufferings
• A Administrative failures
• S Sentiments
• T Tragedies
• E Eruption of communicable diseases
• R Research program and its implementation

52. TYPES OF DISASTER
• Natural Disasters
• 1. Earthquake: Violent shaking of earth’s surface caused by individual
plates moving against each other is known as earthquake. These
plates make up the outermost shell of the earth’s crust and move
relative to each other and to the earth’s movement. The intensity of
an earthquake is measured by the Richter scale, where an earthquake
of a magnitude of 2.5 represents a mild tremor and little damage
while an earthquake of magnitude 7.0 or greater represents a major
tremor, where changes to earth’s surface occur and vast damage is
expected.

53. • 2. Floods: Among all-natural disasters, floods are regarded as most
damaging in terms of human lives and property. The flood is an
annual feature in respect of major rivers and tributaries during the
monsoon season. Populations living on alluvial plains prone to
flooding are worst affected. Mortality is high in case of sudden
flooding. Beside fracture injuries and bruises, cases of accidental
hypothermia also occur during cold weather. Deaths due to poisonous
snakes and insects are also common.

54. • 3. Drought: Factors responsible for drought are low rainfall, reduction
in vegetation, soil erosion and surface evaporation. Droughts cause
protein-energy malnutrition, vitamin A deficiency, measles, acute
respiratory infection, diarrhoea with dehydration, etc Drought-
affected populations who migrate and settle down on the outskirts of
cities and towns face the problem of poor hygiene and sanitation.
Overcrowding further exposes them to communicable diseases like
diarrhoea, TB, parasitic infestations and malaria.

55. • 4. Volcanic eruptions: A volcano has a vent in the earth’s surface and
the cone formed by it. This vent extends to the layers of molten
material called magma. The cone is called volcanic edifice and is
formed by the material thrown from the event.

56. • 5. Tropical cyclones: They are also known as typhoons and
hurricanes. Tsunamis are the most powerful and destructive marine
hazards. The impact of tsunamis and cyclones on human health
cannot be under estimate. In additional to the public health and
medical consequences of these natural calamities, the social, cultural
and psychological impact of tsunamis and cyclones have an enormous
and long-lasting impact across the world, and a direct impact on
human development in general. Drowning that takes place during the
impact phase of the disaster causes the overwhelming majority of
deaths from tsunamis and cyclones. People are at risk of death simply
by being close to low- lying areas and the coastline. Injury is the major
cause of morbidity for tropical cyclones.

58. MAN MADE DISASTER

59. Man –Made Disasters
• 1. Nuclear warfare: When a nuclear bomb is exploded in the air it
causes blast heat and radiation.
• a. Blast: It is the sudden huge increase in air pressure, which bursts
out all at once from the bomb just as waves from a stone dropped in a
still water. The blast waves knock down buildings, shatter window
panes and hurl around debris of all sorts. People are hurt by falling
buildings or struck by flying glass and rubble. Victims suffer burns,
cuts, bruises, sprains and fractures’.

60. • b. Heat: a flash of intense heat lasting only a few seconds is capable
of scorching the exposed skin of persons up to several miles away
from the exploding bomb.
• c. Radiation: Atomic explosion produces an instantaneous discharge
of radiation similar to X- rays; these rays are capable of producing a
serious degree or radiation sickness in exposed people up to mile
from the bomb centre. The vast majority of nuclear bomb causalities
suffer from blast injuries or burns.

61. • 2. Biological warfare: One possible method of enemy attacks to
introduce diseases that affect humans, domestic animals or food
crops, either germs or toxins(poisons) produced by germs may be
spread by bombs or aerial sprays or by saboteurs who add the
dangerous organisms directly to food or water supplies.
• 3. Chemical warfare: In case of massive attacks on civilian population,
the most likely chemical agents are nerve gas and mustard gas. Nerve
gases are a group of highly poisonous chemicals that are colourless
and odourless. They are likely to be introduced in the form of a liquid
spray from planes, bombs or shells. The liquid can quickly penetrate
clothing and get absorbed through the skin. Speed is essential in
dealing with the nerve gas, since even in low concentration, they can
produce serious illness or death within a few minutes.

62. • Mustard gas: It is a group of oily liquids ranging in colour from yellow
to brown and smelling like garlic, shoe polish or rotten fish. It is used
in the form of liquid spray from aircraft, booms or shells, drops on the
skin quickly produce blisters that are very slow to heal, and the liquid
slowly evaporates, producing a gas that is very harmful to the eyes,
causing redness, soreness and ulceration. If the vapour is inhaled, it
affects the lungs, leading to coughing, difficulty in breathing and fever.

63. • 4. Convention warfare: Conventional arms have been used for a long
time and include explosives and fire bombs. They produce the
following effects:
• a. Wounds and fractures caused by flying splinters of the explosives.
• b. Rupture of ear drums, lungs and small intestines
• c. Falling buildings may cause multiple injuries and fractures.
• d. Fire caused by the destroyed buildings may cause severe bums.

65. DISASTER AGENTS/ EPIDEMIOLOGY OF DISASTER
• AGENTS
• Primary Agents
• This includes falling of buildings, earthquakes, floods, tsunami, bomb
blasts, hurricanes, automobile accidents, epidemic outbreak of
diseases, draughts
• Secondary Agents
• This includes bacteria and viruses that produce contamination of
infection after the primary agent has caused injury or destruction.

67. HOST FACTORS
• Host factors are those characteristics of human that influence the
severity of the disasters effect.
• This includes age, immunization status, pre- existing health status,
degree of mobility and economical stability of individuals.
• Most severely affected by disaster are elderly persons who may have
trouble leaving the area quickly, young children whose immunity
systems are not fully developed and persons with respiratory or
cardiac problems.

68. ENVIRONMENTAL FACTORS
• Physical factors include the time when the disaster occurs; weather
conditions the availability of food and water and the functioning of
utilities such as electricity and telephone services
• Chemical factors influencing disaster outcome include leakage of
stored chemical in to the air, soil, ground water or food supplies

69. • Biological factors are those that increase as a result of contaminated
water, improper waste disposal, insect or rodent proliferation,
improper food storage or lack of refrigeration due to interrupted
electrical services
• Social factors are those contribute to the individual’s social support
systems. Loss of family members, change in roles and the questioning
of religious beliefs are social factors to be examined after a disaster

70. PSYCHOLOGICAL FACTORS
• Psychological factors contribute to the effect of the disaster on individual. The
nature and severity of the disaster affect the psychological disaster experienced
by the victims
• Adults
 Extreme sense of urgency
 Panic and fear
 Disbelief
 Disorientation and numbing
 Fantasies that disaster never occurred

71.  Reluctance to abandon properly
 Difficulty in making decisions
 Nightmares
 Need to help others
 Anger and blaming
 Delayed reactions

72.  Insomnia
 Headaches
 Apathy and depression
 Sense of powerlessness
 Guilt
 Moody and irritable
 Jealousy and resentment

73.  Domestic violence
 Children
 Regressive behaviours (bed wetting, thumb sneaking)
 Crying and clinging to parents
 School related problems
 Inability to concentrate
 Refuse to go back school

75. PHASES OF A DISASTER
PRE-DISASTER PHASE
•The phase before the disaster strikes
ALERT PHASE
•This is the period when a disaster is developing when it has not yet
hit the community
IMPACT PHASE
•Impact may be sudden or slow onset. Sudden onset disaster is
unpredictable. So there is less time available to face it. But in case of
gradual onset type, the time is available, so we can save more lives,
with less damage to the community

76. POST- IMPACT PHASE
•This is the phase following the actual impact of the disaster. The steps
take during this phase are very important. Infectious diseases appear
more during this phase. So, more active participation is needed.
RECONSTRUCTION PHASE
•This is a slow and long-term phase. It aims at getting the community
back into the groove. Steps are also needed to be taken to prevent
further attacks or episodes.

77. LEVELS OF DISASTER
• Goolsby and Kulkarni (2006) further classify disasters according to the
magnitude of the disaster in relation to the ability of the agency or
community to respond.
• Level I: If the organization, agency, or community is able to contain
the event and respond effectively
• utilizing its own resources.
• Level II: If the disaster requires assistance from external sources, but
these can be obtained from nearby
• agencies.

78. IMPACT OF DISASTER
Direct: it is different according to the geographical area as well as type
of disaster.
• E.g.: direct impact of flood will be different from the direct impact of
earthquake
• Indirect: all natural disasters have more or less the same indirect
impact i.e. loss of life, loss of shelter, disruption of water and food and
communication, epidemics and psychological illness

79. HEALTH EFFECTS OF DISASTERS
Disasters may cause premature deaths, illnesses, and injuries in the
affected community, generally exceeding the capacity of the local health
care system.
Disasters may destroy the local health care infrastructure, which will
therefore be unable to respond to the emergency. Disruption of routine
health care services and prevention initiatives may lead to long-term
consequences in health outcomes in terms of increased morbidity and
mortality.

80.  Disasters may create environmental imbalances, increasing the risk of
communicable diseases and environmental hazards.
 Disasters may affect the psychological, emotional, and social well-
being of the population in the affected community. Depending on the
specific nature of the disaster, responses may range from fear, anxiety,
and depression to widespread panic and terror.
 Disasters may cause shortages of food and cause severe nutritional
deficiencies.
 Disasters may cause large population movements (refugees) creating a
burden on other health care systems and communities. Displaced
populations and their host communities are at increased risk for
communicable diseases and the health consequences of crowded living
conditions.

83. DISASTER MANAGEMENT
• DEFINITION
• Disaster management can be defined as the organization and
management of resources and responsibilities for dealing with all
humanitarian aspects of emergencies, in particular preparedness,
response and recovery in order to lessen the impact of disasters.
• Disaster management is the body of policy and administrative
decisions and operational activities which pertain to the various stages
of a disaster at all levels.

84. PRINCIPLE S OF DISASTER MANAGEMENT
• According to Gach and Eng (1969) there are eight fundamental
principles that should be followed by all who have a responsibility for
helping the victims of a disaster. They are
• 1. Prevent the occurrence of disaster whenever possible.
• 2. Minimizing the number of causalities if the disaster cannot be
prevented
• 3. Prevent further causalities from occurring after the initial impact of
the disaster of the disaster.
• 4. Rescue the victims

85. • 5. Provide first aid to the injured
• 6. Evacuate the injured to medical
facilities.
• 7. Provide definitive medical care.
• 8. Promote re- construction of live.

86. GOAL OF DISASTER MANAGEMENT
 Safety- (avoiding death and injuries to human lives during a disaster)
 Sustainability- (livelihood, socioeconomic, cultural, environmental and
psychological aspects)
• PHASES IN THE MANAGEMENT OF DISASTERS
• Disasters can be viewed as a series of phases on a time continuum.
Identifying and understanding these phases helps to describe disaster-
related needs and to conceptualize appropriate disaster management
activities.

88. Rapid –Onset Disasters
• The relief phase is the period immediately following the occurrence of
a sudden disaster (or the late discovery of a neglected/deteriorated
slow-onset situation) when exceptional measures have to be taken to
search and find the survivors as well as meet their basic needs for
shelter, water, food and medical care.
• Rehabilitation is the operations and decisions taken after a disaster
with a view to restoring a stricken community to its former living
conditions, while encouraging and facilitating the necessary
adjustments to the changes caused by the disaster.

89. • Reconstruction is the actions taken to re-establish a community after
period of rehabilitation subsequent to a disaster. Actions would
include construction of permanent housing, full restoration of all
services, and complete resumption of the pre-disaster state.

90. • Mitigation is the collective tern used to encompass all actions taken
prior to the occurrence of a disaster (pre-disaster measures) including
preparedness and long-term risk reduction measures.
• Preparedness consists of activities designed to minimize loss of life
and damage, organize the temporary removal of people and property
from a threatened location, and facilities timely and effective rescue,
relief and rehabilitation.

91. Slow-onset disasters
• The sequence of a disaster continuum for slow-onset disasters is
similar in framework but has important distinctions. The following
terms and definitions reflect those additions or modifications.
• Early warning is the process of monitoring situations in communities
or areas known to be vulnerable to slow-onset hazards.

92. • The emergency phase is the period during which extraordinary
measures have to be taken .special emergency procedures and
authorities may be applied to support human needs, sustain
livelihoods, and protect property to avoid the onset of disaster. This
phase can encompass pre-disaster, disaster alert, disaster relief and
recovery periods. An emergency phase may be quite extensive, as in a
slow- onset disaster such as a famine. It can also be relatively short-
lived, as after an earthquake
• Rehabilitation is the actions taken after a slow-onset disaster where
attention must be give to the issues of resettlement or returnee
programs, particularity for people who have been displaced for
reasons arising out of conflict or economic collapse

94. DISASTER CYCLE
• Disaster cycles are fundamental aspects of disaster management
 Disaster preparedness
 Disaster response
 Disaster mitigation
 Rehabilitation

96. Disaster preparedness
• Disaster preparedness is an ongoing multispectral activity. This
consists of strengthening the capacity of a country to manage
efficiently all type of emergencies, so that the resources should be
able to provide assistance to the victims and bring back the life to
normal. The preparedness should start from the community people
because many times the external agency may not arrive for days to
the affected area, especially if transportation and communication are
affected. Preparedness should be in the form of money, manpower
and materials:

97.  Evaluation from past experiences about risk
 Location of disaster prone areas
 Organization of communication, information and warning system
 Ensuring coordination and response mechanisms.
 Development of public education program
 Coordination with media

98.  National and international relations
 Keeping stock of foods, drug and other essential commodities
• For e.g.: Indian Meteorological Department
(IMD) plays a key role in forearming the disaster of cyclone-storms by
detection tracing.
• The international agencies, which provide humanitarian assistance to
the disaster strike areas are united Nation agencies:

99.  International Committee of Red cross
 World health organization(WHO)
 United nations international children’s emergency fund(UNICEF)
 World food Programme(WFP)
 Food and Agriculture organization (FAO), e.g. intergovernmental
agencies.

100.  European country humanitarian office
 Organization of American states, e.g. non-governmental
organizations
 Cooperative American Relief every where
 International committee of red cross

101. Disaster Mitigation
• Disaster mitigation involves lessening the effects of emergencies.
These include depending upon the disaster, protection of vulnerable
population and structure, for e.g., improving structural qualities of
schools, houses and other buildings so that medical casualties can be
minimized, similarity ensuring the safety of health facilities and public
health services including water supply and sewage system to reduce
the cost of rehabilitation and reconstruction. This mitigation
compliments the disaster preparedness and disaster response
activities.

102. Disaster impact and Response
• The greatest need is the emergency care to be given in the first few
hours, since the casualties occur in mass; the management is carried
out in following steps:
 Search, Rescue and first Aid
• It is the uninjured survivors who come to immediate help. These
survivors are organized. They come to rescue and provide first aid.
 Field care

103.  Food to be provided at the place of disaster. People are sheltered in
tents, schools and community halls. Health resource persons and
other volunteers, police, home guard are deployed to the place. An
enquiry centre to be established to respond to patients, friends,
relatives and family members. Dead victims to be identified and
adequate mortuary space provided.
 Triage managing mass Causalities
• Since the health manpower resources are in shortage compared to
causalities, the injured survivor is classified depending upon the
severity of injuries and chance of the triage approach system consist
of colour coding of victims in priorities carried out at the site.

104. • Disaster triage
• Triage is a French word meaning sorting or categorizing
• During disaster, the goal is to maximize the number of survivors by
sorting the treatable from the untreatable victims
• American Red Cross (1982) gives colour coding probably the best and
most easily understood system is the first- priority, second priority,
third priority dying or dead system.

106. • First priority
• Red- most urgent
• These clients have reasonable chance of survival only if they receive
immediate treatment. Emergency treatment is initiated immediately
and continued during the transportation. This include victims with
respiratory insufficiency, cardiac arrest, haemorrhage, severe
abdominal injury

107. • Second priority- Yellow
• These victims can wait for transportation after they receive initial
emergency treatment.
• Victims include immobilized closed fracture, soft tissue injury
without haemorrhage, burns less than 40 % of the body.

108. • Third priority- Green
• Victims in this category are ambulatory have minor tissue injuries and
may be delayed. They can be treated by non- professionals and held
for observations if necessary
• Black- dying/ dead
• At the disaster site or primary triage point simple support measures
can alleviate the psychological trauma experienced by survivors.
• Keeping families together, especially children with parents
 Assigning a companion to frightened or injured victims or placing
victims in group when they can help each other

109.  Giving survivor’s tasks to keep them busy and reduce trauma to their
self esteem
 Provide adequate shelter food and rest
 Establishing and maintaining a communication network to reduce
rumours
 Encouraging individuals to share their feelings and support each other
 Isolating victims who demonstrate hysterical or panic behaviour

111. • Response
• Response is carried out under the following phases.
 Relief Phase
• Relief Phase starts when help or assistance is obtained from outside. Measures
are taken to prevent the occurrence of epidemics. Arrangements are made to
provide food clothes shelter and drug. External relief measures require the
following health information:
 Information on disability and injuries
 Baseline data on the site of impact
 Detailed information a health facility existing
 Survey of water and sanitation system.

112. • Measure in the relief phase
 Acquisition (food, drugs and other supplies)
 Transportation
 Storage
 Distribution
• Survival with medical supervision. This is called ‘triage approach’.
Before that the people trapped under debris, following earthquake
and collapse of the buildings are tracked and rescued by cutting
through fallen buildings with spades, gas cutters, bulldozer, etc people
marooned in flood are rescued with boats.

113. • Rehabilitation phase
• Rehabilitation phase should be started from the time of onset of
disaster to see that the normal conditions of life are restored as early
as possible services are follows:
• a. Sanitary measures:
 Accommodation of refugees in camps and settlement
 Safe water supply
 Safe excreta disposal
 Vector control measures
 Provision of dwelling

114. • b. Medical measure
 Conduct of medical camps
 Provision of drugs and other medical supplies
 Vaccination campaign
 Provision of adequate nutrition

116. NURSES ROLE
• Disaster preparedness Nurse Role
• a. Facilitating preparation within the community and place of
employment within employing organization the nurse can help initiate
updating disaster plan, provide educational programs and material
regarding disasters specific to areas.
• b. To provide updated record of vulnerable population within
community; the nurse should be involved in educating these
population about what impact the disaster have/cause on them.
Review availability of specific resources in the event of an emergency.

117. • Nurse leads a preparedness effort: Nurse can help recruit others
within the organization that will help when a response is required. It is
wise to involve person in these efforts who demonstrate flexibility,
decisiveness, stamina, endurance and emotional stability.
• d. Nurse play multirole in community; Nurse might be involved in
many role, as a community advocate; the nurse should always seek to
keep a safe environment. She/he must assess and report
environmental hazards, e.g. nurse should be aware of and report
unsafe equipment.

118. • e. Nurse should have an understanding of what community resources
will be available after a disaster strikes and how community will work
together. A community wide disaster plan will guide the nurse in
understanding what should occur before, during and of to the
response and his or her role within the plan.
• f. Disaster nurse must be involved in community organization: nurse
who sects greater involvement or a more in-depth understanding of
disaster management can become involved any number of community
organizations and the peat of official response team such as the
American red cross, ambulance corps, etc.

119. Disaster Response—Nurse Role
• a. Nurse must involve in community assessment, case finding and
referring, prevention, health education and surveillance.
• b. Once rescue workers begin to arrive at the scene, immediate plans
for triage should begin, Triage is the process of separating causalities
and allocating treatment based on the victim’s potential for survival.
Higher priority is always given to victim’s potential who have life
threatening injuries but who have a high probability of survival once
stabilized.

120. • c. Second priority is given to victims who have injuries with systemic
complications that are not yet life threatening but who wait up to 45-
60 minutes of treatment. Last priority is given to those victims who
have local injuries without immediate complications and who can wait
several hours for medical attention.
• D. Nurse working as members of an assessment team have the
responsibility of gives accurate feed back to relief mangers to facilities
rapid rescue and recovery.

121. • Many times, nurses are required to make home visit to gather needed
information. Type of information include in initial assessment report
include geographical extend of disasters impact population at risk or
affected, presence of continuing hazards injuries and death
availability of shelter, current level of sanitation and status of
healthcare infrastructure.
• e. Nurse involve in ongoing surveillance uses the following methods
to gather information- interview, observation, physical examination,
health and illness screening surveys, record, etc.

122. Disaster Recovery—Nurse Role
• a. Successful recovery preparation: Flexibility is an important
component of successful recovery preparation. Community clean up
efforts can incur a host of physical and psychological problems. For
e.g. physical stress of moving heavy object can cause back injury,
severe fatigue and even death from heart attacks.
• B. Be vigilant in health teaching: The continuing threat of
communicable diseases will continue as long as the water supply
remains threat and reliving conditions remain crowded. Nurse must
remain vigilant in teaching proper hygiene and making sure
immunization records are up to date.

123. • c. Psychological support: acute and chronic illness can be exacerbated
by prolonged effects of disaster. The psychological stress of cleanup
and moving can bring about feelings of server’s hopelessness,
depression and grip.
• d. Referrals to hospital as needed: stress can lead to suicide and
domestic abuse. Although most people recovery from disasters,
mental disasters may persist in those vulnerable populations. Referrals
to mental health professional should continue as long as the need
exists.

124. • e. Remain alert for environmental health: Nurse must also remain
alert for environment health hazards during recovery phase of a
disaster. Home visit may lead the nurse to uncover situations such as
lack of water supply or lack of electricity.
• f. Nurse must be attentive to dangers of live or dead animals and
rodents, which are harmful to person’s health. E.g. finding snakes in
and around homes, once water from flood start to reduce

125. CONCLUSION
• Emergencies and disasters do not only affect health and well-being of
people; frequently, large number of people are displaced, killed or
injured, or subjected to greater risk of epidemics. Considerable
economic harm is also common. Disasters cause great harm to the
existing infrastructure and threaten the future of sustainable
development

126. BIBLIOGRAPHY
Ray Suresh. Nurses’ Role in Disaster Management. 1 ed. New Delhi:
CBS publishers; 2010
J. S Mathur. A Comprehensive Text Book of community Medicine. 1 ed.
New Delhi. CBS Publishers; 2008. 542-547
Navdeep & Rawak. Textbook of Advanced Nursing Practice.1 ed. New
Delhi: Jaypee Brothers; 2015. 1037-1056
Shebeer & Yaseen. A Concise Text Book of Advanced Nursing Practice.
Bangalore: Emmess Publishers. 730-742

127. Park K. Preventive and social Medicine.19 ed. New delhi: M/ S
Banarsidas Bhanot; 2007. 650-657
A. H SuryaKantha. Community Medicine. 3 ed. New Delhi: Jaypee
Brothers; 881-885
Rajvir Bhalwa. Textbook of Community Medicine. New Delhi: United
India Periodical; 710-712
SuderLal et.al. Textbook of Community Medicine. 2 ed. New Delhi. CBS
Publishers; 723-729

128. •JOURNAL REFERENCE
Rachana Gupta. Disaster Management. International Journal of
Nursing Education. April- June. 2015. Vol. 7. No.2. 100-105
Dr. Maruthi Sarma Mannava. Disaster Management. Health Action.
Dec 2009. 4-7
•NET REFERENCE
http://currentnursing.com/nursing_management/disaster_nursing.ht
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https://pariharraj.wordpress.com/2011/01/20/disaster-nursing