In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment.

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Aim: A systematic literature review was conducted to explore research on the subject of nurse leadership competencies during disasters. Methods: A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)search and review method was used, with pre-specified inclusion and exclusion criteria, definition of terms, and documentation of selection decisions, to retrieve articles published in the last 5 years that contained some or all of the desired search criteria. Articles were excluded if they were unrelated to leadership during disasters, or had solely an education-or clinical-care focus. Three reviewers performed the screening process. Results: Interrater reliability (0.81) was confirmed through two rounds of title review and two rounds of abstract review. Twenty-two articles from a total of 207 identified were deemed relevant from a search using PubMed, CINAL, Scopus, Embase and Web of Science. Conclusion: Results from the literature search were limited, and few articles were directly related to the specific search. Three articles that were reviewed addressed disaster competencies; no articles were found to focus on nursing or nursing leadership disaster competencies. This negative literature search revealed that more rigorous research on nurse leadership needs to be conducted and available, from then which a cohort of standardized competencies can be shaped to address future disaster management.