Interprofessional disaster exercises in nursing curricula: a necessary inclusion

Natural disasters (eg, floods, landslides), emergencies (eg, bombings, mass casualty incidents), and public health crises (eg, the COVID-19 pandemic) have occurred frequently in recent years,1 adversely affecting the health and well-being of many individuals. Consequently, it is imperative for health professionals to be thoroughly prepared and equipped to respond promptly and effectively when these situations arise. Our scoping review in this issue of JBI Evidence Synthesis2 explores how disaster exercises involving students from various health care disciplines, including nursing, have been organized globally. Disaster exercises are learning opportunities in a lab environment (eg, simulations) or in simulated settings (eg, drills), with the purpose of replicating a disaster situation for students to practice roles safely under supervision. Scoping review methodology was chosen to gather existing literature on the planning and implementation of these disaster exercises and to help identify the key lessons and research gaps. The review focused on understanding the roles of nursing students in simulated disaster scenarios, as nurses are often frontline personnel in such situations, as well as the lessons derived from these exercises and the outcomes measured. The review mapped 13 papers from 12 studies (1 mixed method, 1 survey, 3 pre-post test studies, and 7 studies reporting the planning of exercises without student-level data) published between 2009 and 2021. The studies were conducted in the United States (9 studies), Canada (2 studies), and Australia (1 study). The limited number of studies suggests that this topic has not received significant coverage in nursing curricula, with notable gaps in disaster management subjects across undergraduate nursing courses.3–5 The disaster exercises varied in terms of the professions and stakeholders involved, including both health professionals (eg, medicine, paramedicine) and non-health professionals (eg, police, firefighters), the contexts of disasters (eg, flood, bus crash, bombing), the methods used to conduct the exercises, and the underlying purposes. Many of the disaster exercises were designed to help students achieve specific learning goals, such as recognizing critical events and implementing initial and appropriate responses,6 evaluating interprofessional collaboration during simulated disasters, honing clinical judgment and patient safety skills, and improving communication. Several studies underscored the importance of clarifying students’ roles in these disaster exercises, either during the planning phase or at orientation, as confusion arose when students were not properly informed about their responsibilities in the exercises.7,8 Overall, there was inconsistency in how the disaster simulations were conducted, with no single model or framework to guide the training, although most reported a post-simulation timeline that included debriefing.9 The findings of the review emphasized that disaster exercises require comprehensive training of volunteer patients, briefing of participants, and ample resources and consumables to replicate real-life situations.2 The findings also stressed the importance of allocating sufficient time, not only for conducting the exercises, but also for planning beforehand, as well as for debriefing after the disaster simulation. The review highlighted that thorough exercise planning is vital to provide a positive learning experience, and all aspects of the preparatory phase must be carried out systematically to achieve the desired outcomes.2 This includes careful attention to details, such as conducting student orientation to familiarize them with the scenario and learning objectives, clearly defining roles for students and others involved, allocating necessary resources (both logistical and financial), ensuring collaborative efforts among multidisciplinary organizers, communication planning, and limiting the number of participants to a manageable level.7,8,10 The process of conducting disaster exercises should encompass defining clear goals and project scope; identifying key stakeholders, methods, and necessary resources for the exercises; conducting debriefing sessions for all participants; and conducting thorough evaluations of all aspects of the disaster exercise to ensure optimal efficiency. Educators could also consider integrating disaster-related content earlier in their courses and provide opportunities for students to consolidate the skills they learn in capstone subjects.3 It was interesting to note that there were no studies from other countries frequently affected by natural disasters, for example, those in the Asian regions. Ultimately, disaster simulation inclusion in nursing, or indeed any health professional curricula, is not only “nice to have” but a necessity to prepare students for these scenarios in their professional roles.

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