An integrative literature review on clinical decision-making of novice nurses for disaster management in the Emergency Room

Novice nurses play a workflow part in responsibility among an overwhelming of patient. This emphasizes the need for nurses to have comprehensive decision-making skills, especially in disaster management. However, in practice, clinical decision-making remains a challenging issue for novice nurses working in the Emergency Room (ER). This review was conducted to synthesize the strategy that novice nurses need to do in clinical decision-making in the ER during a disaster. This review used an integrative literature review approach to identify (n=16) relevant scientific articles. Six online databases (ScienceDirect, Proquest, Sage Journals, PubMed, Willey Library, and EBSCO) were utilized to identify articles published between 2013 and 2023. The gathered articles were selected using the PRISMA method by removing duplicate articles and those that did not align with the review's objectives. The PRISMA flowchart was used to illustrate the evidence search process. Out of a total of 2,264 identified articles, sixteen articles are relevant for review. The review revealed that clinical decision-making requires careful consideration in several aspects which focused on determining the priorities of triage, assessment, diagnostic skills, and communication skills in teamwork during a disaster in the ER. This review provides evidence that the accuracy of clinical decision-making is a major influence on patient outcomes during disaster management.
In conclusion, comprehensive training and more education for novice nurses about disaster precision nursing in the future are needed to reduce errors in decision-making.

World Risk Report 2023. Bündnis Entwicklung Hilft, Ruhr University Bochum – Institute for International Law of Peace and Conflict 2023. https://weltrisikobericht.de/en.

Al Harthi M, Al Thobaity A, Al Ahmari W, Almalki M. Challenges for Nurses in Disaster Management: A Scoping Review. Risk Management Healthcare Policy 2020;13:2627–2634.

Wang W, Li H, Huang M. A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations. Front Oncol 2023;13:1178092.

Al Harthi M, Al Thobaity A, Almalki, M, Al Ahmari W. Improving Disaster Readiness and the Response of Nurses in Saudi Arabia. Risk Manag Healthc Policy 2021;14:4537–44.

Goniewicz K, Goniewicz, M, Burkle FM, Khorram-Manesh A. Cohort research analysis of disaster experience, preparedness, and competency-based training among nurses. PLoS One 2021;16: e0244488.

Choi W-S, Hyun SY, Oh H. Perceived Disaster Preparedness and Willingness to Respond among Emergency Nurses in South Korea: A Cross-Sectional Study. Internat J Environ Res Public Health 2022;19:11812.

Ghavami V, Saghi F, Asghari A, Shabanikiya H. Predictors of nurses’ reporting for work at the time of epidemics and natural disasters; solutions for hospital surge capacity. J Nurs Sch 2021;54:470–6.

Yaghmaei S, Raiesdana N, Nobahar M. Novice nurses’ experiences from teamwork in the emergency department: A qualitative content analysis. Internat Emerg Nurs 2022;61:101116.

Fernández-Basanta S, Espremáns-Cidón C, Movilla-Fernández M-J. Novice nurses’ transition to the clinical setting in the COVID‐19 pandemic: A phenomenological hermeneutic study. Collegian 2022;29:654–62.

Geekiyanage D, Fernando T, Keraminiyage K. Assessing the state of the art in community engagement for participatory decision-making in disaster risk-sensitive urban development. Internat J Disaster Risk Reduction 2020;51:101847.

Perpiñá-Galvañ J, Juliá-Sanchis R, Olmos-Castelló É, et al. European Educational Programmes in Health Emergency and Disaster Management: An Integrative Review. Internat J Environ Res Public Health 2021;18:11455.

Kapucu N, Garayev V. Collaborative Decision-Making in Emergency and Disaster Management. Internat J Public Admin 2011;34:366–375.

Xu Q, Li D, Dong Y, et al. The Relationship Between Personality Traits and Clinical Decision-Making, Anxiety and Stress Among Intern Nursing Students During COVID-19: A Cross-Sectional Study. Psychol Res Behavior Manag 2022;16:57–69.

Al Harthi M, Al Thobaity A, Al Ahmari W, Almalki M. Challenges for Nurses in Disaster Management: A Scoping Review. Risk Manag Healthc Policy 2020;13:2627–34.

Abdulmohdi N, Mcvicar A. Investigating the clinical decision‐making of nursing students using high‐fidelity simulation, observation and think aloud: A mixed methods research study. J Adv Nurs 2023;79:811–824.

Ncube A, Chimenya GN. Hospital disaster emergency preparedness: a study of Onandjokwe Lutheran Hospital, Northern Namibia. Afr Saf Promot 2016;14:1–17

Qie Z, Rong L. A scenario modelling method for regional cascading disaster risk to support emergency decision making. Internat J Disaster Risk Reduction 2022;77:103102.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.

Holmström IK, Kaminsky E, Lindberg, Y, et al. Registered Nurses’ experiences of using a clinical decision support system for triage of emergency calls: A qualitative interview study. J Adv Nurs 2020;76:3104–12.

Murphy JP, Rådestad M, Kurland L, et al. Emergency department registered nurses’ disaster medicine competencies. An exploratory study utilizing a modified Delphi technique. Internat Emerg Nurs 2019;43:84–91.

Feng Y, Cui S. A review of emergency response in disasters: Present and future perspectives. Natural Hazards 2021;105:1109–38.

Heydari M, Lai K, K, Fan Y, Li X. A Review of Emergency and Disaster Management in the Process of Healthcare Operation Management for Improving Hospital Surgical Intake Capacity. Mathematics 2022;10;2784.

Labrague LJ, Hammad K, Gloe DS, et al. Disaster Preparedness among nurse: A systematic review of literature. Internat Nurs Rev 2018;65:41-53.

Tilahun L, Desu B, Zeleke M, et al. Emergency and Disaster Handling Preparedness Among Front Line Health Service Providing Nurses and Associated Factors at Emergency Department, at Amhara Regional State Referral Hospitals, Ethiopia. Open Access Emergency Medicine 2022;13:221–32.

Canatan H. An Investigation On The Concept Of Triage In The Event Of Disasters And Emergences: Definition, Ethical Decision-Making. J Internat Health Sci Manag 2020;6:74–82.

Paganini M, Borrelli F, Cattani J, et al. Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity. Scandinavian J Trauma Resusc Emerg Med 2016;24:101.

Amberson T, Wells C, Gossman S. Increasing Disaster Preparedness in Emergency Nurses: A Quality Improvement Initiative. J Emerg Nurs 2020;46:654-665.e21.

Azizpour I, Mehri S, Soola AH. Disaster preparedness knowledge and its relationship with triage decision-making among hospital and pre-hospital emergency nurses Ardabil, Iran. BMC Health Serv Res 2022;22:934.

Yang J, Kim KH. Effect of the Strategic Thinking, Problem Solving Skills, and Grit on the Disaster Triage Ability of Emergency Room Nurses. Internat J Environ Res Public Health 2020;19:987.

Al Harthi M, Al Thobaity A, Al Ahmari W, Almalki M. Challenges for Nurses in Disaster Management: A Scoping Review. Risk Management and Healthcare Policy 2020;13:2627–34.

Khorram-Manesh A, Nordling J, Carlström E, et al. A translational triage research development tool: Standardizing prehospital triage decision-making systems in mass casualty incidents. Scandinavian J Trauma Resusc Emerg Med 2021;29:119.

Jiang G.-J, Chen H.-X, Sun H.-H, et al. An improved multi-criteria emergency decision-making method in environmental disasters. Soft Computing 2021;25:10351–79.

Ghanbari V, Ardalan A, Zareiyan A, et al. Fair prioritization of casualties in disaster triage: A qualitative study. BMC Emerg Med 2021;21:119.

Winarti W, Gracya N. Exploring Nurses’ Perceptions of Disaster Preparedness Competencies. Nurse Media J Nurs 2023;13:236–45.

Alharbi NS, Youssef DHA, Felemban DEM, et al. Saudi Emergency Nurses Preparedness For Biological Disaster Management At The Governmental Hospitals. J Positive School Psychol 2022;6:1218–35.

Labrague LJ, Hammad K, Gloe DS, et al. Disaster Preparedness among nurse: A systematic review of literature. Internat Nurs Rev 2018;65:41-53.

Ayenew T, Tassew SF, Workneh BS. Level of emergency and disaster preparedness of public hospitals in Northwest Ethiopia: A cross-sectional study. Afr J Emerg Med 2022;12:246–51.

Aliakbari F, Pirani T, Heidari M, Kheiri S. Effect of operational exercises on nurses' competence in dealing with disaster. J Educ Health Promot 2022;11:54.

Ayenew T, Tassew SF, Workneh BS. Level of emergency and disaster preparedness of public hospitals in Northwest Ethiopia: A cross-sectional study. Afr J Emerg Med 2022;12:246–51.

Considine J, Botti M, Thomas S. Do Knowledge and Experience Have Specific Roles in Triage Decision‐making? Acad Emerg Med 2007;14:722–726.

Jiang GJ, Chen HX, Sun HH, et al. An improved multi-criteria emergency decision-making method in environmental disasters. Soft Computing 2021;25:10351–79.

Al Harthi M, Al Thobaity A, Al Ahmari W, Almalki M. Challenges for Nurses in Disaster Management: A Scoping Review. Risk Manag Healthcare Policy 2020;13:2627–34

Seyedin H, Abbasi Dolatabadi Z, Rajabifard F. Emergency Nurses’ Requirements for Disaster Preparedness. Trauma Monthly 2015;20.

Ortiz-Barrios M, Gul M, López-Meza, P, Yucesan M, Navarro-Jiménez E. Evaluation of hospital disaster preparedness by a multi-criteria decision making approach: The case of Turkish hospitals. Internat J Disaster Risk Reduction 2020;49:101748.

Brewer CA, Hutton A, Hammad KS, Geale SK. A feasibility study on disaster preparedness in regional and rural emergency departments in New South Wales: Nurses self- assessment of knowledge, skills and preparation for disaster management. Australasian Emerg Care 2020;23:29–36.

Chegini Z, Arab‐Zozani M, Kakemam E, et al. Disaster preparedness and core competencies among emergency nurses: A cross‐sectional study. Nursing Open 20229:1294–302.

Brinjee D, Al Thobaity A, Almalki M, Alahmari W. Identify the Disaster Nursing Training and Education Needs for Nurses in Taif City, Saudi Arabia. Risk Management and Healthcare Policy 2021;14:2301–10.

Hasan MdK, Younos TB, Farid ZI. Nurses’ knowledge, skills and preparedness for disaster management of a Megapolis: Implications for nursing disaster education. Nurse Education Today 2021;107:105122.

Rizqillah AF, Suna J. Indonesian emergency nurses’ preparedness to respond to disaster: A descriptive survey. Australasian Emerg Care 2018;21:64–68.

Alzahrani F, Yiannis K. Emergency nurse disaster preparedness during mass gatherings: A cross-sectional survey of emergency nurses’ perceptions in hospitals in Mecca, Saudi Arabia. BMJ Open 2017;7:e013563.

Choi WS, Hyun, SY, Oh H. Perceived Disaster Preparedness and Willingness to Respond among Emergency Nurses in South Korea: A Cross-Sectional Study. Internat J Environ Res Public Health 2022;19:11812.

Fithriyyah YN, Alda AK, Haryani H. Trends and ethical issues in nursing during disasters: A systematic review. Nursing Ethics 2023:096973302311556.