Cena 2011 presentation_28-09-11_LBahnisch
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Cena 2011 presentation_28-09-11_LBahnisch

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The recent extreme weather events in Queensland and Victoria highlight that natural disasters occur regularly in Australia. Arguably, the Australian health care system has had little experience with ...

The recent extreme weather events in Queensland and Victoria highlight that natural disasters occur regularly in Australia. Arguably, the Australian health care system has had little experience with disasters that overwhelm health resources. This raises questions about the ability of health care providers to respond under conditions of increased demands and personal vulnerability. International experience, including earthquakes in Japan [2011], Christchurch [2011] and Haiti [2009], has shown that uncertainty about their safety and that of their family and friends may prevent nurses from attending work during a disaster. An understanding of the factors that enable or disable nurses’ disaster preparedness will underpin future disaster policy and planning for Australian and international health care organisations.

A study of the willingness of Australian emergency nurses to respond to a disaster was conducted. A 3-phase mixed-method design was used, consisting of a national survey, focus groups and in-depth interviews with emergency nurses at four hospitals. This presentation builds upon preliminary results delivered at the 8th International Conference for Emergency Nurses (2010). The findings indicate that emergency nurses’ willingness to respond to disasters is dependent on a number of factors, including their out-of-work responsibilities, changes to their roles at work, their confidence in management, protective equipment and work teams, the information received, the type of disaster and the degree of risk involved. The nurses’ willingness also differs according to their age, family status, personal preparedness and disaster related qualifications. These and other factors will be examined, exploring the implications for individual nurses and planners.

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  • I'd like to acknowledge that we meet on the traditional lands of the Kaurna people.CENA 2010 presentation on background and survey demographics, early findings. Concentrate here on findings and recommendations.We particularly want to thank the nurses who spared their time to participate in our study.
  • Willingness has been defined as ‘whether an individual would report for duty or respond positively to a request to report for duty’, while ability has been defined as ‘whether an individual would be available and have the necessary means to report for duty’ (Dimaggio, Markenson, Loo, & Redlener, 2005, p.332). Although an HCW may be able to work during a disaster, they may not be willing to work. However, one of the purposes of this study was to explore the meaning of ‘willingness’ in this context ...
  • International experience, including earthquakes in Japan [2011], Christchurch [2011] and Haiti [2009], has shown that uncertainty about their safety and that of their family and friends may prevent nurses from attending work during a disaster.
  • Arguably, there is little experience in Australia with disasters that overwhelm health resources.Challenges increased further in disasters, particularly when it is protracted.International experience, including earthquakes in Japan [2011], Christchurch [2011] and Haiti [2009], has shown that uncertainty about their safety and that of their family and friends may prevent nurses from attending work during a disaster.
  • Need for in-depth research approach.AIM: To investigate the willingness of Australian emergency nurses to respond to a disaster.
  • Pilot survey (Feb – Mar 2010)Phase 1: Online survey (March – May 2010) N=451 Working Australian emergency nurses, included ENs & RNs.Phase 2: Focus groups (July – Aug 2010)The final numbers consisted of 41 participants.Phase 3: Interviews (Aug – Dec 2010)13 nurses, recruited from focus groupsCollege of Emergency Nursing Australasia (CENA) and Australian College of Emergency Nursing (ACEN)
  • This study used a mixed-method, multi-phased exploratory, descriptive approach.
  • The odds of emergency nurses being willing to attend work in transport/natural disasters was 23.9 times higher than the odds of being willing to attend work in terrorist/pandemic/CBR events (p <0.001).
  • The odds of emergency nurses who state that they have more prepared families being willing to attend work in transport/natural disasters was 25.6 times higher than the odds of being willing to attend work in terrorist, pandemic, CBR events (p <0.001). Chemical, biological & radiological.The odds of respondents with a disaster plan being willing to respond to a disaster were 7.7 times higher than the odds of nurses who did not have disaster plan being willing to respond (p = 0.008).
  • Interviews
  • Interview, then focus group
  • Qualifications:included paramedic qualification, infectious disease certificate, infection control, disaster management, public health, MIMMS or other Incident command system training or another relevant course at a minimum of certificate/diploma level. The courses included hospital education sessions, military training, short courses in MIMMS or other incident command systems training, Emergency Management Australia courses, postgraduate study, Emergo Train or another relevant course.
  • Professional & personal responsibilitiesWillingness depends on a range of factors that they would consider & weigh up on the day.Emergency nurses agreed that an exception was women who are pregnant or have small children: ... Focus group
  • For living status, 39.4% (n=176) of respondents lived with children (either with their partner/spouse or as a sole parent)
  • Focus groupVolunteering in emergency services & having a partner with an emergency role – not statistically significant, but seen as important in decision making – family, community & professional responsibilities.A total of 26.7% (n=97) of participants stated that they had partners with a disaster responsibility. Almost one-tenth (9.8%, n=43) of participants were involved in volunteer emergency activities in their community. There
  • Personal Protective Equipment
  • Nurses from focus groupsThere was no significant difference in willingness to respond to a disaster of respondents who reported a supportive environment and those who did not report a supportive environment. However, in the focus groups and interviews, emergency nurses’ confidence in management’s support and preparedness to respond in a disaster situation was very important, particularly in disasters with a higher risk to self and family (terrorist, pandemic and CBR events). Emergency nurses need to feel confident that those in management would not put them at risk and that managers would also be at work and visible in the department. 
  • Nurses from focus groupsInformation must be frequent, timely and accurate - used use to assess their personal safety.They did not want their family to be worrying about them. They also wanted to hear that their family, friends and pets were all right.
  • Nurses from focus groupsThe stronger the workplace culture is in building a positive team environment and sense of collegiality, the more willing emergency nurses would be to go to work.
  • Interview, focus group.Here there was no consideration of retribution for their colleagues if they chose not to go to work. It was recognised that the contributing factors towards willingness varied between individuals and depended on their family and personal needs. This was respected. Incentives to go to work outside of ensuring protective equipment, providing ongoing communication with their families, access to somewhere to sleep, a shower, psychological support and opportunities for training were not expected by Australian emergency nurses. If emergency nurses perceive that their employers, managers, medical & allied health staff, unit/ ward staff and nursing colleagues are more prepared, the emergency nurses will be more willing to work in the ED during a disaster (p=0.001 or less).
  • Willingness of an emergency nurse to go to work is influenced by the type of disaster. The type of disaster will determine the degree of risk to self, family and community. Willingness can be influenced by increasing the feeling of preparedness to respond to a disaster and manage the risks at home, work and professionally. By increasing preparedness the emergency nurse will then feel more confident in their own and their families safety, their work environment and their professional ability to respond and therefore more willing to go to work, if they are able to get there.
  • In our study, responding to a natural disaster seemed to be quite an easy decision to make. Responding to disasters such as pandemics, toxic waste and terrorism would remain a very difficult and complex process of decision making as emergency nurses weighed up all of the factors to determine just how willing they are.

Cena 2011 presentation_28-09-11_LBahnisch Cena 2011 presentation_28-09-11_LBahnisch Presentation Transcript

  • To work or not to work:
    An analysis of the willingness of Australian emergency nurses to respond to a disaster
  • Research partners
    Disaster
    Research
    Centre
    Flinders University School of Nursing & Midwifery
    Institutions
    1. Flinders University
    2. University of Canberra
    3. Griffith University
    4. Princess Alexandra Hospital
    5. Deakin University
    6. Northern Health
    Investigators
    Ms Laura Bahnisch1
    Prof Paul Arbon1
    Mr Jamie Ranse1,2
    Dr Ramon Shaban3,4
    Dr Julie Considine5,6
    Ms Belinda Mitchell5,6
    Ms Karen Hammad1
    Dr Lynette Cusack1
    Dr Mayumi Kako1
    Assoc Prof Richard Woodman1
  • Definition
    A disaster is defined by Emergency Management Australia as:
    ‘A serious disruption to communitylife which threatens or causes death or injury in that community and/or damage to property which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilisation and organisation of resources other than those normally available to those authorities’. (1998)
  • Background
    Disasters: part of life & can impair health & wellbeing & can cause premature death (Iserson et al, 2008).
  • Background
    The ED is the frontline of the hospital response to a disaster, with emergency nurses playing an essential role (Hammad, et al, 2011).
    ED – first point of contact & interface with other emergency services.
    Staff already work with pressures of overcrowding, access block and ambulance ramping (FitzGerald, et al., 2010).
  • Background
    Recent examples in Queensland and Victoria show that disasters occur regularly in Australia.
    Challenges to modern healthcare systems – increased demand, staffing issues, ageing infrastructure...
    Could Australian systems cope with a major disaster?
    Uncertainty about their own safety and that of their family and friends may prevent emergency nurses from attending work during a disaster.
  • Aims
    Willingness of health care workers to respond to disasters has been researched internationally.
    Little research in Australia, in particular around the role of emergency nurses in disasters.
    Willingness can be increased – importance of planning.
    Aim - Reducing absenteeism of emergency nurses is critical to disaster response.
  • Project design
    Flinders University, Industry Partnership Grant 2009
    Three Phases (2010)
    Pilot study
    National online survey
    Focus groups
    Interviews
    Partners
    Royal Adelaide Hospital, SA
    Northern Health, Vic
    Princess Alexandra Hospital, Qld
    Calvary Health Care, ACT
    CENA & ACEN
  • Data analysis
    Quantitative
    Descriptive statistics – PASW
    Analysed using STATA
    Associations between willingness to participate in a disaster and the characteristics of the population assessed using chi2 statistics, with willingness assessed as total willingness, or willingness for a particular type of event.
    Qualitative
    Thematic analysis
  • Findings –How willing?
    1 = completely unprepared to attend
    2 = somewhat unprepared to attend
    3 = neither prepared nor unprepared to attend
    4 = somewhat prepared to attend
    5 = completely prepared to attend
  • Findings –How willing?
    Participants who reported family disaster preparedness were more willing to respond across all disaster types.
  • Findings –How willing?
    Therefore, a much higher willingness to work in ‘conventional’ than ‘non-conventional events’.
    Harder to assess risk as less local and ‘visible’ (Smith et al, 2009).
    ‘It is the fear of the unknown. What you don’t know you fear. But trauma – that’s what we do.’
    Risks weighed up against moral obligations to public: ‘I think you'd triage it in your mind, wouldn't you?’.
    Do they stay home with family or do they go to work?: ‘It would tear at the heart’.
  • Findings -Preparedness
    Degrees of preparedness:
    Experience in emergency nursing or with disasters
    ‘If you knew that you were working with someone that knew what they were doing and knew the plan...That makes you so much more confident and supported.’
    2. Opportunities to practise a disaster plan
    ‘If you were aware of what the plan was and knew what your role was you'd be more willing to be involved in it...’
  • Findings -Preparedness
    Degrees of preparedness:
    3. Having further disaster qualifications
    Nurses who held a disaster-related qualification were more than twice as likely to respond to a disaster.
    In contrast, having done a disaster-related short course had no significant effect on willingness.
  • Findings -Willingness and other responsibilities
    Factors from the literature borne out by this study: type of event, personal safety, family & pet safety, professional duty, previous experience, trust in the employer, ability, psychological supports, knowledge.
    Other factors from this study:
    Age – highest level of unwillingness – 60-69, 22.2% (n=10). Related to physical health/ chronic illness or looking after older family members.
    Gender – not significant in this study. However...
    ‘Pregnant women should not be going to a disaster situation’.
  • Findings -Willingness and other responsibilities
    Family responsibilities
    Nurses with children would be the least willing to work during a disaster, with independent nurses being the most willing (p <0.001).
    Nurses with children under 5 were 81.9% less likely to respond to disasters than nurses without children that age.
  • Findings -Willingness and other responsibilities
    Volunteering in emergency services & having a partner with an emergency role – not statistically significant, but seen as important in decision making.
    ‘My husband's a policeman. So if there was something in the local area ... So it would then be the balance of depending on how severe it is, do two parents both go, or does just one parent go and one parent stay?’
  • Findings -How to improve willingness - emergency nurses’ views
  • Findings -How to improve willingness - emergency nurses’ views
    Supportive workplace:
    • Confidence in management & leadership in the workplace
    ‘If you knew that you were working with someone that knew what they were doing and knew the plan...That makes you so much more confident and supported.’
    • Protective equipment
    ‘I would come in here for almost anything if I was guaranteed some form of safety… If we were falling short of masks, I would not come in ...’
  • Findings-How to improve willingness - emergency nurses’ views
    Supportive workplace:
    • Availability & quality of information, about the risks before an event…
    ‘It is knowing what the disaster is - or having as much information as you can get … you know how you're going to respond to it and what it is ...’
    • Communication during an event - with family/ friends.
    ‘I think it would just be communication. Like with your family … even to know that somebody else has rung, to say, yes I'm still here, yes I'm okay.’
  • Findings -How to improve willingness - emergency nurses’ views
    Collegiality:
    • Quality of the team
    ‘I just think if we had a disaster, we're not prepared, but as emergency nurses we - as an emergency team we'd get in there and we'd do the best we could.’
    • Supportive management
    ‘And senior management as well - like not just the medical officer but support from above. You need that support I think....not just have a good day, I realise you're really busy and pat you on the back. Get on with it....
  • Findings -How to improve willingness - emergency nurses’ views
    Collegiality:
    • Overtime, but no other financial incentives needed.
    • ‘The right to say no’ was supported.
    ‘... I think everyone should have the right to make that decision.’
    • Not letting the team down –
    ‘Well there's also the colleagues aspect of it as well. I mean ... that guilt is because I know if I don't come in, I'm dumping it on my colleagues and that's terrible.’
  • Findings-Effect of willingness on the workforce
    Not willing
    Willing but not able to get to work
    Willing to go to work
    Disaster event
    Assessment of preparedness at home, work and professionally
    Work place
    Influence
    Influence
    Assessment of degree of risk: self, family, community
  • Recommendations
    Disaster plan information – during induction.
    Disaster plan should include: communication to staff & families; child, dependent & pet care options; clear senior staff responsibilities.
    Training packages for nurses to explore ethical issues, including altered standards of care.
    Support for nurses to undertake postgraduate education in disaster management.
  • Recommendations
    Preparedness tool for emergency nurses for themselves & families.
    Senior leadership, positive team culture.
  • References
    Emergency Management Australia. (Ed.) (1998). Canberra: Attorney-General's Department, Australian Government.
    Hammad, K., Arbon, P., & Gebbie, K. (2011). Emergency nurses and disaster response: An exploration of South Australian emergency nurses' knowledge and perceptions of their roles in disaster response. Australasian Emergency Nursing Journal, 14(2), 87-94.
    Iserson, K., Helne, C. E., Larkin, G. L., Moskop, J. C., Baruch, J., & Aswegan, A. L. (2008). Fight or flight: The ethics of emergency physician disaster response Annals of Emergency Medicine, 51(4), 345-353.
    Smith, E., Morgans, A., Qureshi, K., Burkle, F., & Archer, F. (2009). Paramedics' perceptions of risk and willingness to work during disasters. The Australian Journal of Emergency Management, 24(3), 21-27.
  • To work or not to work in a disaster
    It all depends…