Emergency nursing service is one of the greatest needs of the developing nation sin the present day scenario, especially for the developing nations the need for disaster management or crisis control is raising every day. The health care workforce is dwindling in the developing countries, and even though the global and national health and welfare maintenance authorities all over the globe are taking efforts to improve the health care scenario of developing nations, the alarming lack of health care workforce is not improving as much as is expected. Hence the need for trained and capable nursing workforce practicing in the emergency situations is improving every day to address the need for relief care in the developing nations that have faced either a crisis or a disaster situation. The effort made by the Australian nursing and midwifery workforce is not just addressing the pressing need of the global health crisis situations, but it is also empowering the visiting and local staff to deliver positive outcomes of health. Although, there are certain challenges that are faced by these nursing professionals that travel to different parts of the globe to provide care to the needy. This essay will attempt to explore the issues, challenges and barriers faced by the emergency nursing workforces that travel to developing counties to provide emergency services in disaster or crisis relief situations.
The globalization within the health care sector and the implementation of the global health and human rights authorities has significantly improved the health and life expectancy status of the developing nations with a much weaker and underdeveloped health care sectors. One of the greatest achievement of these global initiatives taken is the ability for the robust health care workforce form different developed nations that have a much more evolved and advanced health care sector (Zahos 2016). This revolutionary change in the health care sector of the developing nations has therefore allowed the Australian nurses and midwives with various opportunities to work across different disaster management settings or crisis relief sectors in various developing countries outside of Australia. Focusing on a particular geographical region, the most of the emphasis of Australian nurses and their humanitarian contribution of crisis relief has been observed in African, southeast and middle eastern developing nations of Asia. There have been countless reports of the Australian nursing and midwifery workforce contributing their time and efforts in providing disaster relief as emergency nursing service to these developing nations in dire need of proper health care (Fedele 2015). However, it has to be mentioned that the requirement for this assignment had been to choose a particular geographical region for the crisis relief provided by the Australian nurses working as emergency nurses outside of Australia while being associated with the NGO. The chosen NGO organization for this assignment is Medecins Sans Frontieres or MSF which has been contributing to improve the catastrophic health condition of the Central African Republic (Msf.org.au 2018).
The year of 2012 has witnessed the care of Australian nursing workforce in Maban, South Sudan of Africa in order to serve the 40000 refugees residing there. The experience of a nurse who had been a member of the Medecins Sans Frontiers is that she had to resort to developing a makeshift hospital to cater to the crisis health issues faced by the refugees in that region. Along with that the crisis situation relief found in the south of Sudan, the war inflicted South Asian countries have also been witness to the contribution of MSF and other not for profit NGOs where nurses from around the globe including the Australia have devoted themselves in providing relief to these people (Nganga et al. 2014). MSF is a not for profit organization that was established in the year of 1994 and it has been lending a much needed helping hand by the virtue of thousands of Australian health care professionals migrating to different regions with predominant lack of proper health care support. In the recent times the organization has focused more on the CAR region of Africa. In the month of December 2014, the Central African Republic, 430000 people had been internally displaced and hence in the situation of the banditry and security the need for adequate health services have enhanced significantly (Msf.org.au 2018). Similarly, in the Bangui region, MSF has been providing health care services such as emergency surgery for violence and trauma victims, maternal health facilities, psychological care for the sexual or physical abuse victims. Hence, for the CAR and surrounding regions of Africa, MSF had been the primary health care provider for the inhabitants of these regions. As per the data shared above, the demands of emergency care services are diverse and hence an emergency relief nurse, which is the chosen role for the assignment, will require a set of multidimensional skills and expertise to be able to continue to provide care (Martin 2007).
Roles and function of emergency relief nurses:
An emergency relief nurse that is providing disaster or crisis relief to the people has a horde of different overlapping role and responsibilities while functioning. First and foremost, the disaster relief practice scenario call for a distinctive communication and responsive ability to any crisis scenario. The nursing professionals have to communicate the needs of the patients in the crisis or a disaster among the health staff and with the related stakeholders on a robust and immediate basis. Hence, effective communication and responsiveness is undoubtedly one of the greatest professional roles or responsibilities of an emergency crisis relief nurse (Hamlin 2010). Critical thinking and decision making is another very important aspect of the crisis relief nursing as the nurse is required to provide care in a life and death situation following a disaster or war or while in a huge crisis. Hence, without acute ability to make critical decisions instantaneously, the nursing professionals will not be able to provide acute crisis relief care. Counseling and trauma management is another very important roles or functions that an emergency crisis relief nurse is expected to perform and as MSF has introduced a psychological trauma relief care for the sexual abuse victims, it is a very important skill-set that the emergency relief nurse working for MSF must acquire. Exploring further, in a post war or disaster situation, the victims often are not just injured or ill, they are often acutely traumatized (Wakabi 2011). In such situations the emergency relief nurses are required to provide trauma care or counseling to be able to reach out to the traumatized victims with compassion and empathy to help with their recovery as well (Edmonson et al. 2016). Lastly, professional resilience is another functional role or requirement of an emergency relief nurse while dealing with injuries, bloodbath and death associated with war or disaster. Without the ability to overcome the occupational trauma of encountering such situations, it is impossible for a crisis relief nurse to continue practice. Lastly, the competency skills as directed by the ICN emergency crisis relief nursing standards is also needed to be highlighted as well. These competencies include facilitating deployment of nurses globally, consistency in the care given, facilitating communication, building confidence, facilitating a professional approach, promoting shared aims, unified approach, and working as a member of interdisciplinary team effectively. These competency skills help the emergency relief nurses blend in effectively with the care team they represent in the emergency crisis situation and perform with optimal safety and efficacy (Wpro.who.int 2018).
Challenges and benefits:
Considering the example of Sudan of South Africa, the most important challenge or barriers faced by the nursing workforce providing crisis relief had been the extreme scarcity of the different resources. Elaborating more on the not for profit organization chosen, while providing relief in Maban, MSF had to provide care in a makeshift hospital setting without any health care infrastructure or even basic accommodation necessities, which is indicative of the extremely scarce health infrastructure of the nation, which has inevitably given rise to various challenges for not just the emergency relief nurses, but all the health care professionals providing care (Bradbury-Jones and Clark 2017). As per the literature evidence the health care resources and infrastructure is focused on the Ndjamena and surrounding cities of the nation. And hence the remote and crisis inflicted areas of Sudan such as Maban has faced a huge scarcity of health care workforce. Along with that, in support the Veenema et al. (2016) have stated that there are less than 3 health care professionals per 100000 people and only 2 existing nursing or midwifery personnel per 100000 people functioning in the most of remote the areas of Africa. Hence, it has to be mentioned that the lack of resources and any basic health infrastructure is a grave issue that has been prevalent in the care scenario of Africa. According to the Endress (2012), the climatic hazards like heavy rain and lack of medical resources and technologies have also been very important aspect associated with relief work scenario in these underdeveloped areas. As mentioned by authors, the impact of a civil war going for more than two decades is a situation where lack of resources and any infrastructure is an inevitable challenge. On the other hand the NGO workers have faced issues such as lack of safety and even endemic diseases such as Malaria and diarrhea as well. While caring for the patients, the lack of proper infection control and personal safety measures which can be adhered to a health care facility setting involving basic health care infrastructure eventually led to health issues for the nurses working with MSF as well, complicating the already alarming situation further (Foster et al. 2011).
On an another note, it has to be mentioned that lack k urban infrastructure along with health care infrastructure is one of the greatest concerns for the nurses working as emergency relief in the developing nations as well. The lack of proper transportation and accommodation has been on the greatest issues that has forced many of the humanitarian workforces to flee from these situations. As for example, the civil war crisis situation mentioned above in Sudan had called for emergency relief forces from around the world taking the assistance of MSF, GOAL, and AusAid. However, as per the experience of the Australian nurses that have been a member of these relief forces have stated that they often had to reside in makeshift huts and the climatic extremities such as heavy rain and stark winters have been very difficult to endure in such accommodations, and it even enhanced the risk of the nurses acquiring endemic diseases such as Malaria and Diarrhea which affected their contribution and personal health as well (Defranciscis 2017).
The cultural gap and language barrier is another very important challenge or issue faced by the nursing workforce working in crisis or disaster relief in the African nations. It has to be mentioned that the Australian nurses that travel to these underdeveloped counties belong to a completely different national cultures that do not coincide with the national culture or expectations of the African nations. Along with that, these remote war inflicted regions of Africa mainly have conventional and socially backward populations that have either very limited or nil English language proficiency, hence communicating with the patients and providing them care interventions or patient education while in crisis or disaster situations is a grave challenge for the nurses. As illustrated by Mohamedkheir et al. (2016), even though the existing health care staff if any belonging to these remote regions like the Sudan or the DMC of Africa have very limited English language proficiency which affects the communication between the professional relief teams providing care as well.
The westernized culture of Australia also has been reported to have an effect on the care approaches taken by the Australian care workforce as well, which also delimits the ability of these Australian nurses providing relief care to the disaster or war destroyed regions. The cultural gap between the different nursing workforces coming together in the international setting is also a very important aspect associated that gives rise to the issues and challenges in Interprofessionalanl communication and contribution while providing relief care as well. Lastly, the occupational trauma of encountering the death and injuries of the disaster situation is a grave issue faced by the crisis relief nurses which affects their mental health and often leads to post traumatic stress disorder. However, there are certain moral benefits of providing care and relief to the victims of war or a crisis is not just a gain associated with job satisfaction but also extends to moral satisfaction (Edmonson et al. 2016).
Along with that, it has to be mentioned crisis relief is also elaborately considered as humanitarian aid as well, and with the globalization of the nursing workforce, there are certain ethical and moral issues that the nurses might face while providing care in an overseas setting. According to Toiviainen (2007), globalization in the context of health and social care indicates that the nursing workforce will have to travel to numerous developed or developing countries all across the globe in order to be able to provide care services. One of the greatest ethical constraints that the the nurses will have to face is the humanitarian clash of their home country and the countries they have travelled to for providing care. It has to be mentioned that Australia is a nation with progressive and equity based humanitarian rights for all socio-economic groups. However, while working in nations like Africa, where human rights of the lower socio-economic strata is not equally respected, the nurses often face ethical dilemma of what care format to follow and where they can demand the health care or humanitarian rights of the patient (Jeddian et al. 2017). Along with that, for backward countries the aspect of power and exploitation are two very important ethical issues in the globalized health care sector where the emergency relief nurses often face dilemma and conflict. Last, the religious and cultural gap is undoubtedly a significant ethical issue, while the Africans are ethnically and culturally diverse, they often are secretive and guarded from interacting with nurses that are from the western developed nations with westernized care approaches, even the colour of the skin, and language spoken is considerable barrier between effective therapeutic interactions. In the emergency crisis relief setting with no proper infrastructure, adhering to cultural safety protocol is often very difficult, hence, the unresponsiveness and withdrawal of the patients to the nurses are not only ethical issues but also a cause for moral distress (Toiviainen 2007). The moral challenge for nurses also includes the concept of truth telling, deciding how much information to share with the patients and what to not disclose becomes a moral stress on the nurses while addressing critically ill patients and in end of life care. Lastly, often the expectation of the nurses regarding their job roles clashes with the expectations of the organizational body they represent and hence it also leads to a moral distress among the emergency relief nurses (de Mello 2015).
On a concluding note, the role of an emergency crisis relief nursing workforce is irreplaceable in the present day scenario. The active moral contribution of the Australian nursing workforce to the disaster led care scenarios of the developing nations with lacking health care structure is an admirable aspiration for generations to come. However, there are various challenges and issues faced by these workforces that are attempting to provide care to the victims. Hence, there is need for better infrastructure and protective measures provided to these brave and selfless members of the society along with recognitions and rewards so that their effort can be acknowledged adequately.
Arbon, P., Ranse, J., Cusack, L., Considine, J., Shaban, R.Z., Woodman, R.J., Bahnisch, L., Kako, M., Hammad, K. and Mitchell, B., 2013. Australasian emergency nurses’ willingness to attend work in a disaster: a survey. Australasian emergency nursing journal, 16(2), pp.52-57.
Bradbury-Jones, C. and Clark, M., 2017. Globalisation and global health: issues for nursing. Nursing Standard (2014+), 31(39), p.54.
Charlton, S., O’Reilly, G., Jones, T. and Fitzgerald, M., 2011. Emergency care in developing nations: The role of emergency nurses in Galle, Sri Lanka. Australasian Emergency Nursing Journal, 14(2), pp.69-74.
Cunningham, J., 2000. Nursing near a war zone. Australian Nursing and Midwifery Journal, 7(7), p.19.
de Mello, S.V., 2015. Working towards better health in humanitarian crises.
Defranciscis, J., 2017. Educating Nurses in Resource-Poor Areas. Australian Nursing and Midwifery Journal, 25(1), p.35.
Edmonson, C., Sumagaysay, D., Cueman, M. and Chappell, S., 2016. Crisis Management: The Nurse Leader's Role. Nurse Leader, 14(3), pp.174-176.
Endress, F., 2012. A touch of humanity. Nursing Standard, 26(19).
Fedele, R., 2015. Mission possible: Australian nurses and midwives strengthening developing countries. Australian Nursing and Midwifery Journal, 23(1), p.16.
Foster, R., Morris, S., Ryder, N., Wray, L. and McNulty, A., 2011. Screening of HIV-infected patients for non-AIDS-related morbidity: an evidence-based model of practice. Sexual health, 8(1), pp.30-42.
Hamlin, L., 2010. Australian perioperative nurses' humanitarian activities in Banda Aceh. AORN journal, 91(5), pp.594-598.
Hewison, C., 2003. Working in a war zone: The impact on humanitarian health workers. Australian family physician, 32(9), p.679.
Jeddian, A., Marshall, T., Hemming, K., Lindenmeyer, A., Rashidian, A., Sayadi, L., Jafari, N. and Malekzadeh, R., 2017. Implementation Of Critical Care Outreach Service In A Developing Country. In C55. CRITICAL CARE: CRITICAL CARE IN LOW AND MIDDLE INCOME COUNTRIES (pp. A5850-A5850). American Thoracic Society.
Martin, J., 2007. Working abroad as an aid volunteer. Primary Health Care (through 2013), 17(6), p.20.
Mohamedkheir, R.A., Amara, Z.M., Balla, S.A. and Mohamed, H.A.A., 2016. Occupational stress among nurses working in intensive care units in Public Hospitals of Khartoum State, Sudan 2016. American Journal of Health Research, 4(6), pp.166-171.
Msf.org.au. 2018. MSF Focus on Central African Republic. [online] Available at: https://www.msf.org.au/central-african-republic [Accessed 4 Sep. 2018].
Ng’ang’a, N., Woods Byrne, M. and Anh Ngo, T., 2014. In their own words: The experience of professional nurses in a Northern Vietnamese women’s hospital. Contemporary nurse, 47(1-2), pp.168-179.
Titus, L.B., 2011. Haiti disaster relief: one third-world humanitarian medical mission group's experience. Journal of Emergency Nursing, 37(2), pp.186-189.
Toiviainen, L., 2007. ‘The Globalisation of Nursing: Ethical, Legal and Political Issues’ University of Surrey 10-11 July 2006: A summary of the deliberations of the concurrent working groups. Nursing ethics, 14(2), pp.258-263.
Veenema, T.G., Griffin, A., Gable, A.R., MacIntyre, L., Simons, R.N., Couig, M.P., Walsh Jr, J.J., Lavin, R.P., Dobalian, A. and Larson, E., 2016. Nurses as leaders in disaster preparedness and response—A call to action. Journal of Nursing Scholarship, 48(2), pp.187-200.
Wakabi, W., 2011. South Sudan faces grim health and humanitarian situation. The Lancet, 377(9784), pp.2167-2168.
Wpro.who.int 2018. ICN Framework of Disaster Nursing Competencies. [online] Available at: https://www.wpro.who.int/hrh/documents/icn_framework.pdf [Accessed 4 Sep. 2018].
Zahos, H., 2016. Humanitarian crisis a roller coaster ride for an Australian nurse. Australian Nursing and Midwifery Journal, 23(8), p.16.