¿Sistemas de salud resilientes para países ya resilientes? Los discursos de la pandemia en la era post COVID-19 / Resilient health systems for already resilient countries? Pandemic discourses in the post-COVID-19 era

Resumen El objetivo fue reconstruir y analizar los discursos de la pandemia en la era post-COVID-19. La metodología se basó en una revisión crítica de la literatura científica sobre la pandemia, seleccionándose entre una muestra de los 500 artículos científicos más citados en Google Scholar sobre la pandemia, a 80 artículos de carácter no biomédico, clínico o farmacológico, publicados en revistas indexadas en Scopus o Web of Science. El abordaje teórico se basó en los debates sobre predictibilidad e impredecibilidad, determinación e indeterminación, en las ciencias de la salud y ciencias sociales. Como resultado se identificaron y analizaron seis tesis sobre la pandemia: a) la tesis de la impredecibilidad de las pandemias; b) la tesis negacionista de la pandemia; c) la tesis de la pandemia como falla en los sistemas de predictibilidad; d) la tesis de la prevención de eventos catastróficos con intervenciones puntuales; e) la tesis de la postergación estructural de la atención de predicciones por los países no desarrollados; y f) la tesis ecologista-sanitaria, de previsión de una fase crítica para el planeta y la humanidad. Se concluyó sobre los límites de la resiliencia como centro en la preparación de los sistemas de salud de Latinoamérica en la post-pandemia.

Abstract This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific literature on the pandemic, selecting 80 non-biomedical, clinical, or pharmacological articles published in journals indexed in Scopus or Web of Science from a sample of the 500 most cited scientific articles on the pandemic in Google Scholar. The theoretical approach was based on the debates on predictability, unpredictability, determination, and indeterminacy in the health and social sciences. As a result, six theses on the pandemic were identified and analyzed: a) the thesis of the unpredictability of pandemics; b) the thesis of pandemic denial; c) the thesis of the pandemic as a failure in predictability systems; d) the thesis of the prevention of catastrophic events with timely interventions; e) the thesis of the structural postponement of predictive care by non-developed countries; and f) the environmentalist-health thesis, of foreseeing a critical phase for the planet and humanity. We concluded on the limits of resilience as the center in preparing Latin American health systems in the post-pandemic.

A redução de risco de desastres, a agenda dos Objetivos Sustentáveis e os princípios do SUS, no contexto da pandemia de COVID-19 / Disaster risk reduction, the Sustainable Goals agenda and the principles of the SUS, in the context of the COVID-19 pandemic

Resumo O objetivo foi analisar os nexos entre o Marco de Sendai para a Redução do Risco de Desastres, os Objetivos de Desenvolvimento Sustentável (ODS) e os princípios do Sistema Único de Saúde (SUS), no contexto da emergência de saúde pública da pandemia de COVID-19, e suas potenciais implicações para a saúde da população. O estudo é qualitativo, transversal, exploratório, com dados coletados junto a profissionais de saúde com experiência em práticas assistenciais e de gestão de risco de emergências e desastres, e tratados pelo software Iramuteq para análise lexical. O corpus textual foi apresentado através da classificação hierárquica descendente, que originou sete classes aglutinadas em três categorias denominadas: resposta a desastres no contexto do SUS; prevenção de futuros riscos de desastres; e ações de preparação e recuperação a partir do Marco de Sendai e dos ODS. Ressaltou-se aspectos sobre os efeitos diretos e indiretos da pandemia de COVID-19 e os desafios relacionados à redução do risco de desastres preconizados no Marco de Sendai, apontando a necessidade de fortalecer a cultura de segurança e sustentabilidade no âmbito do SUS, o que se coaduna com os ODS, bem como aos determinantes sociais da saúde.

Abstract The aim of this study was to analyze the connections between the Sendai Framework for Disaster Risk Reduction, the Sustainable Development Goals (SDGs), and the principles of Brazil's Unified Health System (SUS) in the context of the public health emergency caused by the COVID-19 pandemic and its potential implications for population health. This qualitative, cross-sectional, exploratory study collected data from health professionals with experience in emergency and disaster risk management and treatment practices, which were then processed using the Iramuteq software for lexical analysis. The textual corpus was presented through a descending hierarchical classification that resulted in seven classes grouped into three categories: disaster response in the context of SUS; prevention of future disaster risks; and preparedness and recovery actions based on the Sendai Framework and the SDGs. The study highlighted aspects related to the direct and indirect effects of the COVID-19 pandemic and the challenges related to disaster risk reduction as advocated by the Sendai Framework, emphasizing the need to strengthen the culture of safety and sustainability within the SUS, which aligns with the ODS and social determinants of health.

Preparación y enfrentamiento a la pandemia de la COVID-19

Los desastres sanitarios han afectado la humanidad desde sus albores. En otras epidemias, las bajas causadas se contabilizan por cientos de miles. La preparación para el enfrentamiento a la epidemia de la COVID-19 en el hospital Militar de Matanzas, "Dr. Mario Muñoz Monroy", comenzó tempranamente. Con el objetivo de analizar esa experiencia, se reflexiona sobre los resultados del enfrentamiento en el año 2020, a partir de los principales aspectos, las coordinaciones con otros organismos, las decisiones tomadas, cambios estructurales y modificaciones de procesos institucionales. Consolidar la superación científica ha sido un pilar permanente, junto con la disciplina, la responsabilidad personal y social de los miembros del colectivo.

Health disasters have affected humanity since its dawn. In other epidemics, the casualties caused number in the hundreds of thousands. The preparation for confronting the COVID-19 epidemic at the Military Hospital of Matanzas, "Dr. Mario Muñoz Monroy", began early. In order to analyze this experience, we reflect on the results of the confrontation in 2020, based on the main aspects, the coordination with other organizations, the decisions made, structural changes and modifications of institutional processes. Consolidating scientific improvement has been a permanent pillar, along with discipline, personal and social responsibility of the members of the collective.

O papel do psicólogo frente a situações de desastres / The psychologist's role in disaster situations / El papel del psicólogo en situaciones de desastre

INTRODUÇÃO: Os desastres são considerados eventos vitimadores que provocam danos psíquicos e sofrimento às pessoas atingidas e esses casos exigem que os psicólogos estejam cada vez mais preparados para atuar nessas circunstâncias. OBJETIVO: investigar a atuação do psicólogo frente a situações de desastres. A pesquisa se configurou como qualitativa com delineamento de pesquisa de campo. METODOLOGIA: Foram participantes cinco psicólogas com especializações na área de desastres e emergências. O instrumento utilizado para atingir os objetivos da pesquisa foi um roteiro de entrevista semiestruturado composto por sete perguntas semiabertas. As entrevistas foram gravadas em áudio, transcritas na íntegra e analisadas por meio da análise de conteúdo. RESULTADOS: De acordo com os temas abordados pelas participantes, a atuação do psicólogo em desastres é dividida em: pré-desastre, durante o desastre e pós-desastre, o que dependerá do tipo de evento e condições apresentadas; as vítimas devem receber apoio integral, buscando minimizar os danos gerados pela tragédia. Ressalta-se que não é necessária uma atuação apenas depois que o desastre já ocorreu, mas há, além disso, toda uma preparação no prédesastre em locais que possuem maior propensão ao acontecimento destes eventos. CONCLUSÃO: O trabalho do profissional da Psicologia no campo dos desastres é de extrema importância para as vítimas, os parentes das vítimas, a comunidade como um todo e até para os profissionais envolvidos, podendo reduzir o estresse agudo, que é gerado a partir da experiência traumática, priorizando que o sujeito recupere sua capacidade cognitiva de agir e sentir a situação.

INTRODUCTION: Disasters are considered victimizing events that cause psychic damage and suffering to the people affected and these cases require psychologists to be increasingly prepared to act in these circumstances. OBJECTIVE: to investigate the role of the psychologist in the face of disaster situations. The research was configured as qualitative with a field research design. METHODOLOGY: Five psychologists with specializations in the area of disasters and emergencies participated. The instrument used to achieve the research objectives was a semi-structured interview guide composed of seven semi-open questions. The interviews were audio recorded, fully transcribed and analyzed using content analysis. RESULTS: According to the topics addressed by the participants, the psychologist's role in disasters is divided into: pre-disaster, during the disaster and post-disaster, which will depend on the type of event and conditions presented; victims must receive full support, seeking to minimize the damage generated by the tragedy. It is noteworthy that it is not necessary to act only after the disaster has already occurred, but there is, in addition, a whole pre-disaster preparation in places that are more prone to the occurrence of these events. CONCLUSION: The work of the Psychology professional in the field of disasters is extremely important for the victims, the victims' relatives, the community as a whole and even for the professionals involved, and can reduce the acute stress, which is generated from the experience trauma, prioritizing the subject to recover his cognitive ability to act and feel the situation.

INTRODUCCIÓN: Los desastres son considerados hechos victimizantes que provocan daño psíquico y sufrimiento a las personas afectadas, y estos casos exigen que los psicólogos estén cada vez más preparados para actuar en estas circunstancias. OBJETIVO: investigar el papel del psicólogo frente a situaciones de desastre. La investigación se configuró como cualitativa con diseño de investigación de campo. METODOLOGÍA: Participaron cinco psicólogos con especializaciones en el área de desastres y emergencias. El instrumento utilizado para lograr los objetivos de la investigación fue un guión de entrevista semiestructurado compuesto por siete preguntas semiabiertas. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas mediante análisis de contenido. RESULTADOS: De acuerdo a los temas abordados por los participantes, el rol del psicólogo en desastres se divide en: predesastre, durante el desastre y postdesastre, lo que dependerá del tipo de evento y condiciones que se presenten; las víctimas deben recibir todo el apoyo, buscando minimizar los daños causados por la tragedia. Cabe señalar que no es necesario actuar solo después de que ya haya ocurrido el desastre, sino que existe, además, toda una preparación previa al desastre en los lugares más propensos a la ocurrencia de estos eventos. CONCLUSIÓN: La labor del profesional de la Psicología en el campo de los desastres es sumamente importante para las víctimas, los familiares de las víctimas, la comunidad en su conjunto e incluso para los profesionales involucrados, pudiendo disminuir el estrés agudo, que se genera a partir de la experiencia traumática, priorizando que el sujeto recupere su capacidad cognitiva para actuar y sentir la situación.

Indicators of Nurse Leadership in Disaster Management: A Qualitative study

@#Introduction: Nurses play critical roles in disaster management and are required to demonstrate leadership by dealing with disaster events effectively. This study aimed to identify the nurse leadership indicators at each phase of disaster management. Methods: A qualitative descriptive study was conducted in two phases between November 2017 -January 2018 at two regional hospitals and one central hospital in Yogyakarta. The first phase involved semi-structured in-depth interviews with seven emergency nurses, and the second was a focus group discussions with five nurses’ managers or lecturers. Participants were selected using a purposive sampling technique. Data Analyze used a modified version framework method. Results: We found 49 indicators of nurse leadership in disaster management. We grouped indicators into two major groups: common indicators (27 indicators) and specific indicators (22 indicators). Four themes were obtained according to the disaster management phases: nurse leadership in the mitigation phase, the preparedness phase, the response phase, and the recovery/rehabilitation phase. Each theme contains three main sub-themes (3Cs): character, competence, and the central role of the leader. Conclusion: Using the International Council of Nurses (ICN) framework’s disaster phase as a conceptual basis, 49 nurse leadership indicators were identified as potential information for future items candidates of the instrument for measuring nurse leadership in disaster management.

Cross-Sectional Study Protocol on Community Disaster Resilience in Selangor Flood-Prone Communities During Covid-19 Pandemic

@#Introduction: Future floods are expected to increase in frequency and intensity. Communities must arm themselves with information and skills to overcome these disasters and limit their impact. Moreover, the Coronavirus-19 infection doubled as the transmission was thought to occur when evacuation facilities were overrun and crowded. Despite government and agency assistance, the aftermath of a flood disaster leaves victims susceptible to the impacts. Resilience is essential when battling flooding or a pandemic. Thus, this study aims to determine the community disaster resilience score and its associated factors in Selangor flood-prone communities during the COVID-19 Pandemic. Methods: A cross-sectional quantitative survey will be conducted with a sample size of 574 residents living in flood-prone areas. A validated self-administered questionnaire will be distributed in liaison with community leaders using paper and online. The questionnaire includes respondents’ demographic, flood disaster preparedness, general disaster preparedness belief, and community disaster resilience. The associations and predictors between the independent and dependent variables will be examined using bivariate analysis and multiple linear regression with a < 0.05 significance level. Discussion: Insights from this research will help communities better prepare for and recover from disasters. A more robust resilience approach requires focusing on predictors and recruiting those factors to assist health authorities in promoting flood disaster preparedness and resilience practices in the community. Researchers may comprehend the health behaviour of a community to build disaster preparedness and resilience as well as a health intervention.

Application of Sendai Framework for Disaster Risk Reduction in Food Security During Flood Disaster in Malaysia: A Narrative Review

@#Disaster risk reduction (DRR) plays essential roles in ensuring food security to avoid adverse social, economic and financial implications to the disaster victims. This article aims to review existing DRR strategies in food security during flood disasters and recommend strategies that can be adapted into policies in Malaysia according to the Sendai Framework. Sendai Framework provides comprehensive, globally recognized priority themes in DRR while highlighting governmental and stakeholders’ responsibility. A literature review was carried out by searching available published literatures from online databases and selected information used in this review is taken from articles, journals, reports, national reports, news, and thesis regarding the topic from November 2021 to January 2022. This review revealed that DRR strategies of food security during flood disasters in Malaysia lack one out of 14 work areas in four priorities in the Sendai Framework, which is the national-level risk and vulnerability assessment system and tools. This article proposed 19 recommendations to improve eight work areas across all four priority areas to enhance national food security during flood disasters.

Self Efficacy and Nurses’ Disaster Competency in Disaster Preparedness Management

@#Introduction: Natural disasters are catastrophic events with geological, and hydrological origins such as earthquakes, floods, hurricanes, landslides that can cause fatalities, property damage and social environmental disruption. The threat of geological disasters like tsunami and earthquakes as well as the threat of hydrometeorology, such as floods, landslides, hurricanes, and fires normally occur in Indonesia. Nurses have a role to play in educating the public and engaging in the crisis. This research aims to determine the relationship between nurses’ self-efficacy and disaster preparedness management competency. Method: This research is a quantitative study with a cross-sectional approach. The population consisted of nurses who served in the Emergency Room at three disaster referral hospitals in Padang. According to the inclusion criteria, nurses who participated in this study were selected by the purposive sampling method as 1st level disaster nurses, as many as 60 nurses. The data collection was carried out from August to October 2020. Results: This research shows that there was a significant relationship between nurses’ self-efficacy and disaster preparedness management with a p-value of 0.0001 and a strong relationship with a value of r = 0.673. There was a relationship between disaster management competencies and disaster preparedness management with a p-value of 0.0001, the strength of the relationship was moderate with a value of r = 0.473. Conclusion: The nurse is one of the resources responsible for disaster preparedness management in the community. Educating the nurses about disaster preparedness management increases the nurses’ readiness. Nurses can take action in managing the disaster response.

Development of “Moroca” as a Learning Media for Reproductive Health Services in Disaster Situations

@#Introduction: Due to its geographical, geological, and demographic conditions, Indonesia is facing the risks of natural disasters such as floods, landslides, earthquakes, and volcanic eruptions. Midwives as health workers have a strategic role as providers of reproductive health services, including in disaster situations. This study aims to develop learning media for reproductive health services in a disaster situation based on the monopoly game. Methods: The research employed research and development (R&D) design. The development of learning media for reproductive health services in disaster situations is based on the monopoly game, which consists of the following steps: seeing the potential and problems, data collection, product design, validation by experts, product trials, and product revisions. Results: The learning media is named “Moroca” (Monopoli Kesehatan Reproduksi pada Situasi Bencana / Monopoly of Reproductive Health Services in Disaster Situations). Validation was carried out by two experts and the media was declared feasible and valid for use. The product trial was conducted on 22 students of Midwifery Program. The statistical test used the Wilcoxon test. The results of the analysis showed that there was a significant increase in the level of knowledge about reproductive health services in disaster situations among students after using “Moroca”. Conclusion: Learning media is needed to increase the knowledge and skill of the students. Moroca is can be used as one of the alternative media in education for midwifery students.

Management of helicopter medical transport in 36 patients with critical cardiac disease / 中华危重病急救医学

Objective:To summarize the management experience of helicopter medical transport in patients with critical heart disease, so as to provide reference for transport of patients with critical heart disease under the background of major natural disasters.Methods:The clinical and transport data of 36 critically ill cardiac patients in Fuwai Central China Cardiovascular Hospital from 16:30 on July 21 to 19:30 on July 22, 2021 due to historically rare heavy rainstorms were collected. All 36 critically ill cardiac patients were transported by helicopter. The safe transportation was implemented under the measures of quickly forming a transport leadership and coordination group, clarifying responsibilities and division of labor, doing a good job in the pretreatment of the patient's condition, pipeline assessment and mechanical circulation support (MCS) equipment, simulating and practicing the transfer process, improving the safety of the transfer implementation process, and effectively handing over with the target hospital. The gender, age, disease type, MCS, transport and outcome of patients were collected.Results:Thirty-six patients with cardiac critical illness were from adult extracardiac intensive care unit (ICU), adult cardiac care unit (CCU), children's CCU, comprehensive ICU and department of neurology. There were 24 males and 12 females; age (50.93±20.86) years old. There were 12 patients using respirator, 7 patients needing MCS, 2 of whom needed both extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), and 7 patients with post-cardiac surgery. The total distance of transportation of 36 patients was 1 638.4 km, the transit time was 10.5 hours, one way flight time of helicopter was about 8 minutes, and the average transport time per patient was about 17.5 minutes. The vital signs of 36 patients during transport were basically stable, without complications, and all of them reached the target hospital safely.Conclusion:Under the seamless connection of the rapid establishment of the transfer leadership coordination group, assessment of the patient's condition and pretreatment, the simulation of the transfer process, and the effective handover with the receiving hospital, the use of helicopter for medical transport for critically ill heart patients is feasible and safe, which can buy valuable time for saving patients' lives and further treatment.

Correlations between disaster cognition and professional identity of nurses during post-disaster reconstruction: a cross-sectional study / 中国实用护理杂志

Objective:To investigate the status of clinical nurses′ professional identity and disaster cognition during the post-disaster reconstruction, and to analyze the correlation between the two.Methods:With the convenient sampling method, the 346 nursing staff of the First Affiliated Hospital of Zhengzhou University participated in the disaster reconstruction for the survey, using the general questionnaire, the nurse professional identity scale, the disaster cognition questionnaire for investigation. Pearson correlation was used to analyze the correlation between disaster cognition and professional identity.Results:The disaster cognition during the post-disaster needed to be improved, the choice rate of knowing disaster nursing well was 6.36%-70.23%. Gender had significant statistical significance on the scores of thinking the importance of disaster care training and willingness to join in disaster care continuing education ( t=-2.54 and -2.32, both P<0.05). Position had significant statistical significance on the score of willing to join in the enthusiasm of emergency rescue( F=6.62, P<0.05). Whether have ever participated in disaster training had significant statistical significance on the scores of focusing on the frequency of disasters and understanding the degree of disaster care ( t=5.57, 7.88, both P<0.05). Nurse professional identity level was high during the post-disaster reconstruction, the total score was (121.73 ± 19.75). Whether have ever participated in disaster training had significant statistical significance on the score of professional identity ( t=4.57, P<0.05). And the total score and each dimension score of disaster recognition were positively correlated with the total score and each dimension score of professional identity in nurses ( r values were 0.44-0.53, all P<0.05). Conclusions:The disaster cognition level is still lacking, the professional identity level is high. The disaster cognition affects professional identity levels to a certain extent, so nursing managers should improve the disaster recognition of nursing staff by making targeted strategy, which can not only improve the professional identity levels, but also reserve power for emergency disaster and post-disaster reconstruction reserves.

Analysis on the status quo and influencing factors of disaster preparedness of nursing organization among newly recruited nurses in tertiary grade A hospitals of Zhengzhou city / 中国实用护理杂志

Objective:To investigate the status quo of disaster preparedness of nursing organization among newly recruited nurses in tertiary grade A hospitals of Zhengzhou city and analyze the influencing factors in order to provide theoretical basis for further improving the standardized training program for newly recruited nurses.Methods:This study was a cross-sectional survey. From December 2021 to March 2022, 964 newly recruited nurses from 4 tertiary grade A hospitals of Zhengzhou city were selected as the survey objects by convenient sampling method. The general information questionnaire and Hospital Nursing Department Disaster Preparedness Scale were used to conduct the questionnaire survey. Disordered multiple classification Logistic regression was used to analyze the influencing factors of disaster preparedness of hospital nursing organization.Results:The disaster preparedness score of nursing organization of newly recruited nurses was (37.62 ± 7.57) points. The results of disordered multiple classification Logistic regression showed that the factors influencing the disaster preparedness level of nursing organization of newly recruited nurses were whether they had participated in disaster rescue work and the degree of attention paid by nursing organizations to disaster rescue training (both P<0.05). Conclusions:The disaster preparedness of the nursing organization of newly recruited nurses in tertiary grade A hospitals of Zhengzhou city was at a medium level. Nursing managers should pay attention to the disaster preparedness of newly recruited nurses, develop their core abilities for disaster rescue according to their influencing factors, and incorporate disaster preparedness related contents on the basis of standardized training programs.

Ethics Considerations on Public Management of Disaster Rescue under the Context of Epidemic Prevention and Control / 中国医学伦理学

Natural disasters and epidemics are intertwined, posing a great threat to national health and property security, and hindering economic development. Faced with the complex rescue environment, the contradiction between individual interests and collective interests may escalate, causing ethical dilemmas different from those encountered in conventional medicine. In the context of COVID-19 epidemic prevention and control, how to maximize the coordination of the conflict between individual interests and collective interests, minimize the losses caused by disasters, and maintain social stability is a new topic of ethical research. Based on the ethical principles of public management, this paper explored the ethical conflicts of public management faced by emergency disaster rescue, in the view of providing ethical theoretical support for dealing with the practical difficulties of emergency public health crisis, and promoting the development and progress of disaster medical rescue work.

Desastre socioambiental de Mariana: implicações nas condições de saúde da população atingida e no processo de trabalho dos serviços de saúde / Mariana socio-environmental disaster: implications for the health conditions of the affected population and the work process of health services

O desastre socioambiental, ocorrido em Mariana, em consequência do rompimento da barragem de Fundão da mineradora Samarco, devastou as comunidades de Bento Rodrigues e de Paracatu de Baixo provocando perdas e danos que podem se desdobrar ao longo do tempo, produzindo efeitos profundos na saúde, no meio ambiente, bem como no contexto de vida e trabalho. Com isso, busca-se analisar o processo saúde-doença e o processo de trabalho nos serviços de saúde destinados à população atingida pelo desastre socioambiental em Mariana. Trata-se de um estudo de caso conduzido pela abordagem qualitativa, descritiva e exploratória, cujo cenário é Mariana, onde se encontram as comunidades diretamente atingidas pelo rompimento da barragem de rejeito de mineração. As fontes de evidências utilizadas foram documentos de domínio público e entrevistas com profissionais de saúde e gestores. Foram escolhidas intencionalmente a Unidade de Saúde de Bento Rodrigues e o dispositivo Conviver, por atenderem exclusivamente as famílias vítimas do desastre. Participaram da pesquisa onze profissionais de saúde e três gestores. Os dados foram analisados por meio da estratégia de proposições teóricas à luz da teoria de Determinação Social do Processo Saúde-Doença. Os resultados revelaram as implicações do desastre nas condições sociais, econômicas, culturais e sobretudo na saúde da população atingida, com consequências relacionadas aos agravos respiratórios e os ocasionados por veiculação hídrica ou contato com a lama toxica de rejeito, e os casos depressivos e demais transtornos psicossociais que intensificaram o sofrimento crônico da população. Já as implicações do desastre no processo de trabalho nos serviços de atendimento exclusivo aos atingidos, evidenciam uma (re)organização do sistema de saúde, o qual enfrentou dificuldades estruturais tanto na fase emergencial quanto de recuperação pós-desastre. Destaca-se que embora os instrumentos do processo de trabalho utilizados pelos profissionais de saúde e gestores, são capazes de acolher, estimular práticas mais integradas e que transcendem a intervenção apenas nos corpos biológicos, ainda assim não são capazes de suprir as necessidades mediadas de saúde dos atingidos, não promovendo respostas às necessidades políticas, sociais e econômicas no que tange à reparação, à indenização e os direitos da população atingida.

The socio-environmental disaster that occurred in Mariana, because of the collapse of the Samarco mining company's Fundão dam, devastated the communities of Bento Rodrigues and Paracatu de Baixo, causing losses and damages that can unfold over time, producing profound effects on health, in the environment, as well as in the context of life and work. With this, we seek to analyze the health-disease process and the work process in health services intended for the population affected by the socio-environmental disaster in Mariana. This is a case study conducted using a qualitative, descriptive and exploratory approach, whose setting is Mariana, where the communities directly affected by the collapse of the mining tailings dam are located. The sources of evidence used were public domain documents and interviews with health professionals and managers. The Bento Rodrigues Health Unit and the Conviver device were intentionally chosen, as they exclusively serve families who were victims of the disaster. Eleven health professionals and three managers participated in the research. The data were analyzed using the strategy of theoretical propositions in light of the theory of Social Determination of the HealthDisease Process. The results revealed the implications of the disaster on social, economic, cultural conditions and above all on the health of the affected population, with consequences related to respiratory problems and those caused by water transport or contact with toxic waste sludge, and depressive cases and other disorders, psychosocial problems that intensified the chronic suffering of the population. The implications of the disaster on the work process in services providing exclusive care to those affected highlight a (re) organization of the health system, which faced structural difficulties in both the emergency and postdisaster recovery phases. It is noteworthy that although the work process instruments used by health professionals and managers are capable of welcoming and stimulating more integrated practices, that transcend intervention only in biological bodies, they are still not capable of meeting mediated health needs of those affected, failing to promote responses to political, social and economic needs in terms of reparation, compensation and the rights of the affected population.

Vulnerability of Venezuelan immigrants living in Boa Vista, Roraima / Vulnerabilidad de inmigrantes venezolanos residentes en Boa vista, Roraima / Vulnerabilidade de imigrantes venezuelanos residentes em Boa vista, Roraima

ABSTRACT Objective: To identify the social and health vulnerabilities of Venezuelan immigrants living in Boa Vista, Roraima. Method: Mixed methods research, with concomitant transformative strategy. In the quantitative phase, analysis of management documents for the state of Roraima and the capital Boa Vista were carried out. In the qualitative, open interviews with 16 Venezuelan immigrants, 14 nursing professionals and 8 public managers and a focus group with 12 nursing professionals. The webQDA software was used to organize the data and the content and discourse analyzes were based on Bardin and on dialectic-hermeneutics, according to Minayo. Results: The main vulnerabilities identified were the absence of public policies for immigrants, the fragility of links with health services and language differences. Conclusion: The vulnerabilities of Venezuelan immigrants are linked to their ways of living and working. Health institutions and organizations are not fully qualified to serve them. Specific policies are needed for this social group and to qualify institutions and health professionals to implement these policies.

RESUMEN Objetivo: Identificar las vulnerabilidades sociales y sanitarias de inmigrantes venezolanos residentes en Boa Vista, Roraima. Método: Es una investigación de métodos mixtos, con estrategia transformativa concomitante. En la fase cuantitativa se llevó a cabo el análisis de documentos de gestión del estado de Roraima y de su capital, Boa Vista. En la fase cualitativa, se realizaron entrevistas abiertas con 16 inmigrantes venezolanos, 14 enfermeros y 8 gestores públicos y un grupo focal con 12 profesionales de enfermería. Se utilizó el software webQDA para organizar los datos y el análisis de contenido y discurso estuvo basado en Bardin y en la hermenéutica-dialéctica, según Minayo. Resultados: Las principales vulnerabilidades fueron la falta de políticas públicas hacia los inmigrantes, la fragilidad de los vínculos con los servicios sanitarios y las diferencias lingüísticas. Conclusión: Las vulnerabilidades de los inmigrantes venezolanos están relacionadas con su forma de vida y trabajo. Las instituciones y organizaciones sanitarias no tienen suficiente capacidad para atenderlos. Se necesitan políticas específicas para este grupo social y preparación de las instituciones y profesionales de la salud para implementar dichas políticas.

RESUMO Objetivo: Identificar as vulnerabilidades sociais e de saúde de imigrantes venezuelanos residentes em Boa Vista, Roraima. Método: Pesquisa de métodos mistos, com estratégia transformativa concomitante. Na fase quantitativa, foram realizadas análises de documentos de gestão do estado de Roraima e da capital Boa Vista. Na qualitativa, entrevistas abertas com 16 imigrantes venezuelanos, 14 profissionais de enfermagem e 8 gestores públicos e um grupo focal com 12 profissionais de enfermagem. Utilizou-se o software webQDA para organização dos dados, e as análises de conteúdo e de discurso foram baseadas em Bardin e na hermenêutica-dialética, segundo Minayo. Resultados: As principais vulnerabilidades identificadas foram a ausência de políticas públicas para imigrantes, a fragilidade dos vínculos com os serviços de saúde e as diferenças de idioma. Conclusão: As vulnerabilidades dos imigrantes venezuelanos encontram-se vinculadas aos seus modos de viver e de trabalhar. As instituições e organizações de saúde não se encontram plenamente qualificadas para atendê-los. São necessárias políticas específicas para esse grupo social e qualificar instituições e profissionais de saúde para execução dessas políticas.

Forensic Nursing competencies in disasters situations: scoping review / Competências de enfermagem forense em situações de desastres: revisão do escopo / Competencias de la enfermería forense en situaciones de catástrofes: scoping review

ABSTRACT Objective: To map sources of technical-scientific information on Forensic Nursing competencies in disasters situations. Method: Scoping review developed in accordance with the JBI methodology, carried out in three stages by two reviewers independently on selected databases and gray literature, using keywords and descriptors. After reading them in full, we proceeded with data extraction and content analysis of 28 publications. Results: Identified 24 publications in English, 20 of which were produced in the United States of America. 24 competencies of forensic nurses in disasters situations were mapped, including: training; resource management; link with the justice service; direct care; psycho-emotional care; collection and preservation of traces; registration and documentation with photography; body management; maintenance of the chain of custody; and epidemiological surveillance. Conclusion: The forensic nurse acts in all phases of disasters with the affected people, families and communities, under an interdisciplinary perspective. The development of competencies aimed at the practice of Forensic Nursing in disasters should be incorporated into the training strategies of these professionals, in order to obtain better response standards.

RESUMO Objetivo: Mapear fontes de informações técnico-científicas relativas às competências da Enfermagem Forense em situações de desastres. Método: Revisão de escopo desenvolvida de acordo com a metodologia JBI, realizada em três etapas por dois revisores, de forma independente, em bases de dados e literatura cinzenta selecionadas, utilizando palavras-chave e descritores. Depois de lê-los na íntegra, foi feita extração de dados e análise de conteúdo de 28 publicações. Resultados: Identificamos 24 publicações em inglês, das quais 20 foram produzidas nos Estados Unidos da América. Foram mapeadas 24 competências do enfermeiro forense em situações de desastres, entre elas: treinamento; gerenciamento de recursos; vínculo com o serviço de justiça; atendimento direto; atendimento psicoemocional; coleta e preservação de vestígios; registro e documentação com fotografia; gerenciamento de corpos; manutenção da cadeia de custódia; e vigilância epidemiológica. Conclusão: O enfermeiro forense atua em todas as fases dos desastres com as pessoas, famílias e comunidades afetadas, em uma perspectiva interdisciplinar. O desenvolvimento de competências voltadas para a prática da Enfermagem Forense em desastres deve ser incorporado às estratégias de treinamento desses profissionais, a fim de se obter melhores padrões de resposta.

RESUMEN Objetivo: Mapear las fuentes de información técnico-científica sobre competencias de Enfermería Forense en situaciones de catástrofes. Método: Scoping review desarrollada de acuerdo con la metodología del JBI, realizada en tres etapas por dos revisores de forma independiente sobre bases de datos y literatura gris seleccionadas, utilizando palabras clave y descriptores. Tras su lectura completa, se procedió a la extracción de datos y análisis de contenido de 28 publicaciones. Resultados: Se identificaron 24 publicaciones en inglés, 20 de ellas realizadas en Estados Unidos de América. Se mapearon 24 competencias de los enfermeros forenses en situaciones de catástrofes, entre ellas: formación; gestión de recursos; vínculo con el servicio de justicia; atención directa; atención psicoemocional; recogida y preservación de vestigios; registro y documentación con fotografía; gestión de cadáveres; mantenimiento de la cadena de custodia; y vigilancia epidemiológica. Conclusión: El personal de enfermería forense actúa en todas las fases de las catástrofes con las personas afectadas, familias y comunidades, en una perspectiva interdisciplinar. El desarrollo de competencias dirigidas a la práctica de la Enfermería Forense en catástrofes debe incorporarse a las estrategias de formación de estos profesionales, con el fin de obtener mejores estándares de respuesta.

Competencies for aeromedical evacuation practices in emergencies and disasters: a scoping review / Competencias para prácticas de evacuación aeromédica en emergencias y desastres: revisión del alcance / Competências para práticas de evacuações aeromédicas em emergências e desastres: revisão de escopo

ABSTRACT Objective: to map the competencies developed in training strategies for air transport practices for patients, in the face of emergency situations and disasters involving chemical, biological, radiological and nuclear (CBRN) agents. Method: this is a scoping review structured in accordance with the JBI and Preferred Reporting Items for Systematic reviews and Metanalyses extension for Scoping Reviews recommendations. The study was carried out in five stages: search for sources in 17 databases, an information portal and two repositories of gray literature, using 125 DeCS, MeSH and Emtree descriptors, without temporal and idiomatic clipping; selection; critical reading of the texts selected by two double-blind reviewers; summary of results and presentation of mapped competencies. Results: a total of 878 studies were analyzed, of which 18 composed the sample. In all, 11 competencies were mapped, with emphasis on the technical training domain. Competencies refer especially to technical-scientific knowledge in disaster situations involving CBRN agents and the safety of patients and professionals involved. Conclusion: the operationalization of artifices to improve qualification processes based on competencies proved to be strategic to increase the quality and safety of patient air transport practices. The approach of the sources on specific aspects of the particularities of practices related to emergencies and disasters involving CBRN agents in training/training processes demonstrates the academic effort to promote the reduction of the risk of these events when, in due course, civil and military institutions and their health operators are activated.

RESUMEN Objetivo: mapear las competencias desarrolladas en estrategias de formación en prácticas de transporte aéreo de pacientes, ante situaciones de emergencia y desastres con agentes químicos, biológicos, radiológicos y nucleares (QBRN). Método: una revisión de alcance estructurada de acuerdo con las recomendaciones del JBI y la lista de verificación Elementos de informe preferidos para revisiones sistemáticas y la extensión Metanalyses para revisiones de alcance. El estudio se realizó en cinco etapas: búsqueda de fuentes en 17 bases de datos, un portal de información y dos repositorios de literatura gris, utilizando 125 descriptores DeCS, MeSH y Emtree, sin recorte temporal e idiomático; selección; lectura crítica de los textos seleccionados por dos revisores doble ciego; resumen de resultados y presentación de competencias mapeadas. Resultados: se analizaron 878 estudios, de los cuales 18 compusieron la muestra. En total, se mapearon 11 competencias, con énfasis en el dominio de formación técnica. Las competencias se refieren especialmente al conocimiento técnico-científico en situaciones de desastres que involucran a agentes QBRN y la seguridad de los pacientes y profesionales involucrados. Conclusión: la operacionalización de artificios para mejorar los procesos de calificación basados ​​en competencias demostró ser estratégica para aumentar la calidad y seguridad de las prácticas de transporte aéreo de pacientes. El abordaje de las fuentes sobre aspectos específicos de las particularidades de las prácticas relacionadas con emergencias y desastres que involucran a agentes QBRN en los procesos de formación/capacitación demuestra el esfuerzo académico por promover la reducción del riesgo de estos eventos cuando, en su momento, se activan las instituciones civiles y militares y sus operadores de salud.

RESUMO Objetivo: mapear as competências desenvolvidas em estratégias de capacitação para práticas de transporte aéreo de pacientes, diante de situações de emergência e desastres envolvendo agentes químicos, biológicos, radiológicos e nucleares (QBRN). Método: revisão de escopo estruturada conforme as recomendações do Joanna Briggs Institute e do checklist Preferred Reporting Items for Systematic reviews and Metanalyses extension for Scoping Reviews. O estudo foi desenvolvido em cinco etapas: busca de fontes em 17 bases de dados, um portal de informação e dois repositórios de literatura cinzenta, utilizando 125 descritores DeCS, MeSH e Emtree, sem recorte temporal e idiomático; seleção; leitura crítica na íntegra dos textos selecionados por dois revisores em duplo cego; síntese dos resultados e apresentação das competências mapeadas. Resultados: foram analisados 878 estudos, dos quais 18 compuseram a amostra. Ao todo, foram mapeadas 11 competências, com destaque para o domínio capacitação técnica. As competências referem-se especialmente ao conhecimento técnico-científico em situações de desastre envolvendo agentes QBRN e à segurança do paciente e dos profissionais envolvidos. Conclusão: a operacionalização de artifícios para aperfeiçoar os processos de capacitação baseados em competências mostrou-se estratégica para elevar a qualidade e a segurança das práticas de transporte aéreo de pacientes. A abordagem das fontes sobre aspectos específicos das particularidades das práticas relacionadas às emergências e desastres envolvendo agentes QBRN em processos de formação/capacitação demonstra o esforço acadêmico de promover a redução do risco desses eventos quando, oportunamente, forem acionadas instituições civis e militares e seus operadores de saúde.

A epidemia da dengue no Estado do Rio de Janeiro e as ações assistenciais como estratégia para gestão de risco de desastres: estudo de caso / The dengue epidemic in the state of Rio de Janeiro and assistance actions as a strategy for disaster risk management: a case study

Epidemias de dengue e as estratégias de preparação adequadas para enfrentá-las têm sido um desafio constante. A partir do estudo do modelo assistencial desenvolvido em 2008 no Rio de Janeiro, buscou-se compreender as intervenções que abrandaram seus efeitos, e assim (re)pensar os planos de contingência e outras ações de gestão de risco de desastres. O objetivo geral foi sintetizar evidências a partir do modelo assistencial implementado, para sustentar o desenvolvimento de planos de contingência frente à epidemia de dengue, voltados a atenção à saúde. Com objetivos específicos de: Descrever os desafios para a resposta à epidemia de dengue no estado do Rio de Janeiro. Analisar o modelo assistencial desenvolvido para resposta à epidemia de dengue. Discutir as ações de gestão de risco de desastres, voltadas para a resposta a epidemias de dengue. O método foi Estudo de caso único, e qualitativo e com fontes de evidência de entrevistas semiestruturadas, documentos da imprensa não oficial (jornais) e oficial, documentos administrativos, arquivos através dos TabNet, documentos iconográficos e documentos do acervo da pesquisadora e fontes de informação técnico-científica de bases de dados. Para tratar os dados utilizou-se o software Iramuteq®, análise documental e seleção de estudos por Revisão Sistemática. Epidemias de dengue, na dependência de sua magnitude, das vulnerabilidades socioeconômicas e ambientais, da infestação vetorial, da circulação viral e da capacidade de resposta local, têm potencial para conturbar as rotinas dos serviços de saúde. Os desafios trazem a necessidade de adoção de ações de gestão de risco de desastres, que se desdobram em resiliência social. A análise do modelo assistencial descortinou as ações para a reorganização assistencial, sua possível reprodução em outras epidemias e sua adoção nos planos de contingência, importante ferramenta de planejamento, que congrega os esforços e contribuições dos entes públicos e privados, além da participação popular. A atenção à saúde nas epidemias, parte da organização da rede básica, apoiada por políticas públicas e planos de contingência, protagonizados pelos gestores públicos, construídos com a participação da sociedade e dos diversos setores públicos e privados e conduzidos pelo setor saúde.

Dengue epidemics and adequate preparedness strategies to face them have been a constant challenge. From the study of the care model developed in 2008 in Rio de Janeiro, we sought to understand the interventions that mitigated its effects, and thus (re)think contingency plans and other disaster risk management actions. The general objective was to synthesize evidence from the implemented care model, to support the development of contingency plans against the dengue epidemic, aimed at health care. With specific objectives to: Describe the challenges for the response to the dengue epidemic in the state of Rio de Janeiro. To analyze the care model developed to respond to the dengue epidemic. Discuss disaster risk management actions aimed at responding to dengue epidemics. The method was a single case study, qualitative and with sources of evidence from semi-structured interviews, documents from the unofficial (newspapers) and official press, administrative documents, files through TabNet, iconographic documents from the researcher's collection and sources of information technical-scientific databases. To treat the data, the Iramuteq® software, document analysis and selection of studies by Systematic Review were used. Dengue epidemics, depending on their magnitude, socioeconomic and environmental vulnerabilities, vector infestation, viral circulation and local response capacity, have the potential to disrupt the routines of health services. The challenges bring the need to adopt disaster risk management actions, which result in social resilience. The analysis of the care model revealed actions for care reorganization, its possible reproduction in other epidemics and its adoption in contingency plans, an important planning tool that brings together the efforts and contributions of public and private entities, in addition to popular participation. Health care in epidemics, part of the organization of the basic network, supported by public policies and contingency plans, led by public managers, built with the participation of society and the various public and private sectors and conducted by the health sector.

Las epidemias de dengue y las estrategias adecuadas de preparación para enfrentarlas han sido un desafío constante. A partir del estudio del modelo de atención desarrollado en 2008 en Río de Janeiro, buscamos comprender las intervenciones que mitigaron sus efectos, y así (re)pensar los planes de contingencia y otras acciones de gestión del riesgo de desastres. El objetivo general fue sintetizar evidencias del modelo de atención implementado, para sustentar el desarrollo de planes de contingencia frente a la epidemia de dengue, dirigidos a la atención en salud. Con objetivos específicos: Describir los desafíos para la respuesta a la epidemia de dengue en el estado de Río de Janeiro. Analizar el modelo de atención desarrollado para responder a la epidemia de dengue. Discutir las acciones de gestión del riesgo de desastres destinadas a responder a las epidemias de dengue. El método fue un estudio de caso único, cualitativo y con fuentes de evidencia de entrevistas semiestructuradas, documentos de la prensa no oficial (periódicos) y oficial, documentos administrativos, archivos a través de TabNet, documentos iconográficos y administrativos de la colección del investigador y fuentes de información técnico- bases de datos científicas. Para el tratamiento de los datos se utilizó el software Iramuteq®, análisis de documentos y selección de estudios por Revisión Sistemática. Las epidemias de dengue, dependiendo de su magnitud, vulnerabilidades socioeconómicas y ambientales, infestación de vectores, circulación viral y capacidad de respuesta local, tienen el potencial de perturbar las rutinas de los servicios de salud. Los desafíos traen consigo la necesidad de adoptar acciones de gestión del riesgo de desastres, que resulten en resiliencia social. El análisis del modelo de atención reveló acciones para la reorganización de la atención, su posible reproducción en otras epidemias y su adopción en planes de contingencia, una importante herramienta de planificación que reúne esfuerzos y contribuciones de entidades públicas y privadas, además de la participación popular. La atención en salud en epidemias, parte de la organización de la red básica, sustentada en políticas públicas y planes de contingencia, liderada por gestores públicos, construida con la participación de la sociedad y de los diversos sectores público y privado y conducida por el sector salud.

Terapia ocupacional e trabalho: desafios e perspectivas de uma prática emergente durante e após a pandemia da Covid-19 / Occupational therapy and work: challenges and perspectives of an emerging practice during and after the Covid-19 pandemic

Resumo Este ensaio discute as possibilidades de intervenção da terapia ocupacional no campo do trabalho em período pandêmico, bem como apontar os desafios e perspectivas de atuações pós-pandemia. As intervenções foram discutidas a partir de três estágios: i) preparação pré-pandemia; ii) estratégias de preparação durante a pandemia; iii) recuperação pós-pandemia, considerando os níveis micro, meso e macroestruturais, a partir da perspectiva de uma prática centrada na pessoa e no ambiente de trabalho. A atenção às (in)capacidades laborais e a atuação no processo de retorno ao trabalho foram consideradas as principais intervenções do terapeuta ocupacional, articuladas com os diversos atores, instituições, serviços e entidades de classe, de forma a ampliar as ações e promover uma rede de atenção integrada. As novas configurações do trabalho resultantes da inovação tecnológica ampliaram o diálogo interdisciplinar da terapia ocupacional com o campo do trabalho. Espera-se contribuir com reflexões teóricas para pensar a prática profissional e o fortalecimento desse campo na contemporaneidade.

Abstract This essay discusses the intervention possibilities of occupational therapy in the field of work in the pandemic period, as well as points out the challenges and perspectives of post-pandemic actions. Interventions were discussed from three stages: i) pre-pandemic preparation; ii) pandemic preparedness strategies; iii) post-pandemic recovery, considering the micro, meso and macrostructural levels, from the perspective of a practice centered on the person and the work environment. Attention to work (in)capacities and acting in the process of returning to work were considered the main interventions of the occupational therapist, articulated with the various actors, institutions, services and class entities, in order to expand actions and promote a network integrated care. The new configurations of work resulting from technological innovation have expanded the interdisciplinary dialogue between occupational therapy and the field of work. It is expected to contribute with theoretical reflections about professional practice and the strengthening of this field in contemporary times.

Simulação e cooperação interdisciplinar e interinstitucional: desenvolvimento de competências do estudante de enfermagem em desastres / Simulación y cooperación interdisciplinaria e interinstitucional: desarrollo de competencias del estudiante de enfermería en desastres / Interdisciplinary and interinstitutional simulation and cooperation: development of nursing students competencies in disaster

Resumo Objetivo identificar a importância atribuída à utilização da prática simulada na ação pedagógica do estudante do Curso de Licenciatura em Enfermagem no domínio de desastres e no âmbito interdisciplinar e interinstitucional em Portugal. Métodos estudo enquadrado no paradigma qualitativo, apoiado no raciocínio indutivo e exploratório. Como técnica de coleta de dados, recorreu-se à entrevista semiestruturada, aplicada a coordenadores/diretores dos Cursos de Licenciatura em Enfermagem de escolas públicas e privadas de Portugal. Resultados a metodologia de simulação no domínio de desastres constitui uma estratégia de ensino/aprendizagem, para os estudantes de enfermagem desenvolverem competências nesse âmbito. Este tipo de metodologia de ensino/aprendizagem terá maior vantagem, se realizada em parceria com organizações que intervêm nas operações de proteção e socorro e de âmbito interdisciplinar, uma vez que potencializa a qualidade de prevenção e de resposta de todos os atores envolvidos. Considerações finais e implicações para a prática face à complexidade específica e à imprevisibilidade das situações de desastres, o estabelecimento de parcerias estratégicas de cooperação com organizações com responsabilidade nesse domínio, que promova nos estudantes de enfermagem o desenvolvimento de competências e diminua a visão determinística errada das organizações, relativamente à capacidade de o estudante integrar estas ações, é fundamental.

Resumen Objetivo identificar la importancia atribuida al uso de la práctica simulada en la acción pedagógica del estudiante del Curso de Pregrado en Enfermería en el dominio de los desastres y en el ámbito interdisciplinario e interinstitucional en Portugal. Método s: estudio enmarcado en el paradigma cualitativo, apoyado en el pensamiento inductivo y exploratorio. Como técnica de los datos, se aplicaron entrevistas semiestructuradas a los coordinadores/directores de escuelas de enfermería públicas y privadas de Portugal. Resultados la metodología de simulación en el ámbito de las catástrofes es una estrategia de enseñanza/aprendizaje para que los estudiantes de enfermería desarrollen competencias en este ámbito. Este tipo de metodología de enseñanza/aprendizaje será más ventajosa si se realiza en alianza con organizaciones que intervienen en operaciones de protección y socorro y en un ámbito interdisciplinario, ya que mejora la calidad de la prevención y respuesta de todos los actores involucrados. Consideraciones finales e implicaciones para la práctica dada la complejidad específica e imprevisibilidad de las situaciones de desastre, el establecimiento de alianzas estratégicas de cooperación con organizaciones con responsabilidad en este dominio, lo que promueve el desarrollo de competencias en los estudiantes de enfermería y reduce la visión determinista equivocada de las organizaciones, en cuanto a la capacidad del estudiante para integrar estas acciones, es fundamental.

Abstract Objective to identify the importance attributed to simulated practice use in nursing undergraduate students' pedagogic actions in the field of disasters, in an interdisciplinary and interinstitutional scope in Portugal. Methods a study framed in the qualitative paradigm, supported by inductive and exploratory reasoning. As a data collection technique, semi-structured interviews were applied to coordinators/directors of nursing courses at public and private schools in Portugal. Results simulation methodology in the field of disasters is a teaching/learning strategy for nursing students to develop skills in this area. This type of teaching/learning methodology will have a greater advantage if carried out in partnership with organizations involved in protection and rescue operations and with an interdisciplinary scope, since it enhances prevention quality and response of all actors involved. Final considerations and implications for practice considering the specific complexity and unpredictability of disaster situations, the establishment of strategic cooperation partnerships with organizations with responsibility in this field, which promotes the development of nursing students' skills and reduces the erroneous deterministic view of organizations, regarding the ability of students to integrate these actions, is fundamental.