Nurses serve as leaders in disaster preparedness and response at multiple levels: within their own homes and neighborhoods, at disaster scenes, and the workplace, which can vary from a health care facility, in the community, or at the state, national, or international level. This chapter provides an overview on theories of leadership with a historical context for nursing leadership; setting the context for nursing leadership in disaster preparedness and response. Although few research studies exist, there are numerous examples of nurses who provide leadership for disaster preparedness and response. To define the current state of the science, the research studies cited in this chapter are supplemented with case studies from particular disasters. The major finding of this review is that nursing leadership in disaster preparedness and response is a field of study that needs to be developed.
During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters.
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