1. Educator’s Forum
Defining ‘‘Disasters’’ with Implications for Nursing
Scholarship and Practice
Elizabeth G. NeSmith, RN, MSN
Nurses have long been a part of disaster care, yet
the nurses’ unique approaches to disaster victims
have not been reported in the nursing literature.
This situation raises the questions, ‘‘How does
disaster nursing differ than general nursing?’’ and
‘‘What defines the specialty care of disaster
nursing?’’ An analysis of the term ‘‘disaster’’ and
the concepts that have been used to build
a theoretic base for disaster nursing are
presented.
D
isasters tend to be described in terms of
cause (e.g., natural forces or human-made)
and effect (e.g., events that overwhelm and
suspend the productive function of a community or
society). Historically, nurses always have been a part
of the response to care for victims of various types of
disasters, and nursing scholars search for answers to
the question, ‘‘What separates disaster care from the
everyday emergencies that nurses face?’’ Is disaster
nursing a form of specialized care that is composed of
unique knowledge and skills? The purpose of this
article is to explore the concept of disaster using
a framework provided by Walker and Avant1
and to
identify concepts that are used to define disaster
nursing.
Defining Disasters
Origins of Term
The secular use of the term ‘‘disaster’’ has French,
Italian, Latin, and Greek origins referenced as early
as the year 1297.2
The French root desastre (1564)
and the Italian root disastro both mean ‘‘ill-starred,’’
from dis-, ‘‘away, without’’ plus astro, ‘‘star, planet.’’
The Latin and Greek roots of the word originate
from L. astrum and G. astron. The sense is astrolog-
ical, of a calamity blamed on an unfavorable position
of a planet.2
A modern interpretation of this root is that the oc-
currence of a disaster is outside human control. The
word ‘‘disaster’’ has many synonyms that collectively
add conceptual significance to the definition in com-
municating misery, death, destruction, helplessness,
sudden reversal of what is expected, and unhappy res-
olutions to distressing events.2
These synonyms are
summarized in Table 1.
Themes in the Literature
The literature is rich with illustrations of disaster
themes (Table 2). Newspapers, magazines, and other
publications catalog past and present accounts of di-
sasters such as fires, floods, hurricanes, tornados,
earthquakes, droughts, disease and famine.3-5
Fic-
tional accounts of disaster survival, such as the film
version of ‘‘Gone With the Wind,’’ vividly depict the
personal dramas experienced as a result of these cata-
strophic events.6-8
Professional Definitions of Disaster
International disaster health organizations, such as
the Centre for Research on the Epidemiology of Disas-
ters9-11
and the World Association for Disaster Emer-
gency Medicine,11
have provided definitions that
include attributes and outcomes of events that help
to distinguish an event as a disaster (see Table 3). Di-
sasters also can be described in terms of antecedents
and consequences and are summarized in Table 4.
Disaster Nursing as a Specialty
Defining Nursing
Professional nursing is recognized by its practice
and scholarship. The American Nurses Association12
A modern interpretation of this root is that
the occurrence of a disaster is outside
human control.
Elizabeth G. NeSmith is a Doctoral Nursing Student, Medical
College of Georgia, Augusta.
Reprint requests: Elizabeth G. NeSmith, Medical College of
Georgia, School of Nursing, EB-218, 1120 15th St, Augusta,
GA 30912; E-mail: bnesmith@students.mcg.edu
Disaster Manage Response 2006;4:59-63.
1540-2487/$32.00
Copyright Ó 2006 by the Emergency Nurses Association.
doi:10.1016/j.dmr.2006.01.004
DMR
April-June 2006 Disaster Management & Response/NeSmith 59

2. defines nursing as ‘‘the diagnosis and treatment of hu-
man responses to actual or potential health problems.’’
The Canadian Nurses Association13
states that nursing
‘‘exists in response to a need of society’’ and ‘‘directs
its energies toward the promotion, maintenance and
restoration of health; the prevention of illness, the al-
leviation of suffering and the insurance of a peaceful
death when life can no longer be sustained.’’ Such def-
initions tend to be general because nurses practice in
a variety of settings (e.g., institutional, community,
and field care) and under a variety of conditions. No
mention is made of the specific knowledge and skills
that are required to successfully practice in a given
setting or situation.
Defining Disaster Nursing
Recently, the definition of disaster nursing has be-
come the topic of much discussion because practicing
under disaster conditions is what makes disaster nursing
unique. Disaster nursing requires new concepts of what
constitutes good care. For instance, in a disaster, nurses
know to shift from the usual assessment and treatment
goals of care, that is, providing care to the sickest
patients first, including those with a comparatively low
Table 1. Disaster synonyms2
Synonym Origin Date Meaning
Mischance Old French 1297 Bad luck, calamity
Tragedy Old French 1375 Unhappy ending
Wrack Middle Dutch 1390 Misery, punishment,
damage, destruction
Qualm Old English 1530 Death, plague,
destruction
Catastrophe Greek 1540 Reversal of what
is expected
Emergency French 1631 Unforeseen
occurrence
Debacle French 1848 Violence, to ‘‘un-bar’’
Table 2. Disaster themes/examples in the
literature
Disaster themes Examples in the literature
Act of God; event
outside human
control
Noah’s ark and the
biblical flood, fires,
hurricanes, earthquakes,
and other natural
disasters4,5,18
Large loss of human,
environmental, and/or
financial resources
Stock Market Crash of
1929,19
Exxon Valdez
Oil Spill,20
tsunami tragedy
Potential prevention
and ignorance of
warning signs
Titanic,21
Hindenburg,22
Space Shuttle disasters23
Personal drama ‘‘Gone With The Wind,’’6,7
Titanic,21
‘‘Drought,’’8
‘‘The
Year of Disaster &
Disgrace’’24
Nursing response Story of Clara Barton and
the origin of the American
Red Cross,25
nurses in
WWII,26
inscription on
Vietnam Nurses Memorial,27
reports of nurses caring
for victims of the World
Trade Center disasters28
Table 3. Defining attributes/empirical referents
Defining attributes Empirical referents
Negative impact event
of natural, financial,
technologic, or human-
made origin, for
example, armed
conflict3-5,11,18,20,25,29
Notification of emergency
services personnel (to
include nursing
component) of an
occurrence that is
deemed likely to
overwhelm the
resources necessary to
effectively manage the
event
Event that disrupts the
health of and occurs
to a collective unit of
a society or community11
Activation of the
institutional, community,
or regional Emergency
Operations Plan
Event overwhelms
available resources and
requires outside
assistance for
management and
mitigation9,10
Initiation and use of the
Incident Command
System within a
community or institution
to access and coordinate
additional resources
Represents tremendous
relative human losses9
Conduction of on-scene
triage and treatment to
mitigate casualty losses
Represents a breakdown
in the relationship
between man and his
environment10
Subsequent investigation
reveals turning point
event that caused
disaster
Table 4. Antecedents of disaster/consequences
of disaster
Antecedents of
disaster
Consequences of
disaster
Normal community or
societal functioning
prior to the event
Relatively widespread
human casualties with
an overwhelming need
for physical and/or
psychological health care
assistance9,10
Negative proportional
preparation in
comparison to size of
subsequent event29
Losses exceed the resources
and ability of society/
community to manage or
cope and result in serious
disruption in the functioning
of the population affected11
Citizens ignore or
become or
desensitized to
preventive warning
signs, if they are
present21-23,29
Requirement of
unprecedented cooperation
and communication among
victims, others in the
community, and those who
arrive to assist associated
with a need for prioritization
and rationing of available
health care resources
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3. probability of survival, to ‘‘doing the greatest good for
the greatest number.’’14
This means that victims with
a low probability of survival may receive comfort mea-
sures only, making more resources available for victims
who potentially could benefit most. Disaster nurses
who are specialists in this type of care will know
when to make this paradigm shift from emergency to di-
saster nursing practice. Nursing scholarship is chal-
lenged to define additional concepts that represent the
unique roles of nurses who prevent, plan for, respond
to, and help others recover from disasters. From multi-
ple concepts, scholars can build theories that guide
nursing practice.
Use of nursing theory. Historically, nursing theo-
ries generally address 4 central concepts: person, envi-
ronment, health, and nursing.15
Disaster nursing
practice also encompasses these domains. Disaster
nurses care for the ‘‘person’’ by diagnosing and treat-
ing the physical and psychological response to disas-
ter of individuals, families, and communities.
Environment may refer to the usual physical surround-
ings, personal circumstances, or even the human
body. Environment also refers to the setting in which
nursing care is delivered15
and is expanded in disaster
nursing practice from the usual institutional and public
health settings to include field and impact zone
settings, as well as Incident Command System (ICS)
posts. Health, known as ‘‘a person’s state of well-
being,’’15
is profoundly changed as result of disaster.
Nurses promote, maintain, and restore health through
careful disaster planning, activation of the Emergency
Operations Plan, and by prioritizing and rationing of
available health care resources following the event.
Creating new concepts. A concept is defined as
a characteristic that is used to define a phenomenon,
and the concept of disaster nursing has not been as
well defined. Efforts have been made to define disas-
ter nursing on the basis of minimum competencies.16
In an attempt to demonstrate how these concepts16
can be put into operation, the disaster paradigm as de-
scribed in the Advanced Disaster Life Support
Course17
has been used here to provide a framework
for specific examples of disaster nursing practice.
These examples include, but are not limited to the
following:
DdDetection
Nurses are aware of and involved in the planning
and implementation of local (community or institu-
tional), regional, or national emergency response
plans and participate in subsequent disaster drills
and disaster continuing education. Disaster nursing
practice also includes the planning, early recognition,
and coordination of assistance for the needs of
vulnerable victims following events that are likely to
overwhelm available resources. Examples include par-
ticipation in disaster planning committees, initiation of
the disaster plan when necessary, and educating new
nurses regarding how to implement disaster plans.
IdIncident Command
Nurses command, work within, and foster team-
work within the carefully designed and complex ICS.
Practice examples include receiving scene assess-
ments from field workers and directing the coordina-
tion of available personnel and equipment resources
to appropriate sites to mitigate the effects of the
disaster.
SdSafety and Security
Nurses are alert to all potential hazards at the pri-
mary scene of the incident and/or within secondary
care perimeters, such as a triage area or hospital. An
example of practice in this area would include the
maintenance of a high index of suspicion for hazards
such as chemical, biologic, or nuclear contamination
of a scene or victims received from a scene.
AdAssess
Nurses assess for the presence of hazards at the pri-
mary or secondary disaster sites (sites that receive di-
saster victims). Nurses provide for the safety of
health care providers through the distribution and cor-
rect utilization of personal protective equipment.
Nursing practice would include training and education
on the correct process for choosing, donning, and
working within specific personal protective equip-
ment for different exposure situations.
SdSupport
Nurses act as a support link in the successful mitiga-
tion and management of the incident. Acting as a sup-
port link may include provision and/or maintenance
of essential nursing or other personnel, supplies, facil-
ities, and resources and/or providing direct nursing
care to victims according to their specific injuries or
complaints. This role may include participation in or
command of the ICS, as well as functioning as the
charge nurse on duty at the scene or the receiving
institution during a disaster incident. It also could
include coordination of resources at the scene as part
of the response team.
Disaster nursing requires new concepts of
what constitutes good care.
The Advanced Disaster Life Support Course has
beenusedheretoprovideaframeworkforspecific
examples of disaster nursing practice.
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April-June 2006 Disaster Management & Response/NeSmith 61

4. TdTriage and Treatment
Nurses work within the parameters of the Nurse
Practice Act to move, assess, sort, and treat the various
conditions of victims and serve as a communication link
to describe conditions of individual and groups of
patients between the field and receiving institutions,
as well as within the boundaries of the receiving hospi-
tals themselves. This would include the work of the tri-
age nurse in the receiving emergency department or in
the field.
EdEvacuation
Nurses may participate in the planning and imple-
mentation of a disaster evacuation and accommoda-
tion plan for victims and their families either at the
scene or following receipt of the individuals at desig-
nated institutions. Coordination of this function would
be carried out most appropriately by the charge nurse
on duty and by senior, more experienced staff nurses
who receive patients and families requiring care.
RdRecovery
Nurses provide physical and psychological care to
affected individuals, which includes providing care to
rescue and treatment personnel. Nurses provide this
care while being sure to address the long-term care im-
plications and costs. Nurses work within the established
structure to minimize the impact of the event on the
community, state, nation, and environment. Advanced
practice nurses, including psychiatric clinical nurse spe-
cialists and nurse practitioners, as well as nurses work-
ing in a case management or rehabilitation role, are
examples of nurses involved in this type of care.
Future Implications
Nurse leaders, scholars, and practitioners will be
challenged to further develop the conceptual, theo-
retic, and practical foundations for disaster nursing.
To advance the specialty of disaster nursing, scholars
will need to involve theory synthesis, theory testing
through research, and transition of research results
into practice. Providing care to vulnerable persons
all over the world demands responsible and careful
nursing scholarship and practice.
Summary
The concept of disaster has developed over time,
and the origin of terms demonstrates a changing belief
regarding the causes of disasters. Nurses historically
have been a part of disaster care, and with the ad-
vancement of scientific basis for practice, there is in-
terest in developing an emerging specialty of disaster
nursing. Further conceptual refinement and construc-
tion of a framework to guide future disaster research
and practice is needed.
Acknowledgment: I extend special thanks to
Dr Shelia Bunting, Professor, Department of Health
Environment and Systems, Schools of Nursing and
Graduate Studies at the Medical College of Georgia,
for assistance with the conceptualization and critical
review of this manuscript.
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