Australian Emergency Nurses' Willingness to Respond in Healthcare Disasters
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Paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 14th October 2010.
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Australian Emergency Nurses' Willingness to Respond in Healthcare Disasters
- 1. Understanding the willingness of Australian emergency nurses to respond to a health care disaster Jamie Ranse LecturerDisciplines of Nursing and MidwiferyFaculty of Health University of Canberra Phone: +61 (0)2 6201 5380Email: jamie.ranse@canberra.edu.au Blog: www.jamieranse.com Twitter: jamieranse Image from: Centre for Research on the Epidemiology of Disasters (http://www.cred.be)
- 2. Research team Prof Paul Arbon1 Mr Jamie Ranse1,2 Mr Ramon Shaban3,4 Dr Julie Considine5,6 Ms Belinda Mitchell5,6 Ms Karen Hammad1 Dr Lunette Cusack1 Dr Mayumi Kako1 Ms Laura Bahnisch1 1. Flinders University 2. University of Canberra 3. Griffith University 4. Princess Alexandra Hospital 5. Deakin University 6. Northern Health Research Grant Flinders University, Industry Partnership Grant
- 4. Aims
- 5. Methods
- 6. Results
- 8. EDs are likely to be involved
- 10. Perceived risk of the event
- 11. Previous knowledge and experience
- 12. Personal concerns of family
- 14. Conventional versus non-conventional Cone & Cummings 2006; Considine & Mitchell 2008; Dimaggio et al. 2005; Hope et al. 2010; Irvin et al. 2008; Masterson et al. 2009; Shaw et al. 2006; Syrett et al. 2007; Tzeng 2004
- 16. Emergency Nurses employed in Australia
- 18. Phase 1: A national survey
- 19. Phase 2: Focus Groups
- 20. Phase 3: Individual Interviews
- 21. Data analysis
- 24. Demographics
- 27. Willingness
- 29. Female = 373 (82.7%)
- 37. Results: Willingness s1= A professional nurse has a responsibility to work under any circumstances. s2= I have knowledge/ skills to deal with health-care disasters. s3= My work environment supports working in health-care disasters
- 38. Results: Willingness ns1= I have a right to say ‘no’ to exposing myself and my family/ dependents to risk. ns2= I need more knowledge and skills before I am able to attend health-care disasters. ns3= Managers should organise other staff / employers who agree to attend such circumstances.
- 42. Important to have an understanding of the factors that may influence willingness
- 43. Education
- 44. Framework for disaster education
- 45. Research
- 47. Focus groups
Editor's Notes
- Image: number of ‘victims’ of disasters in 2007: http://www.preventionweb.net/files/4166_2victims.jpg
- Prof Paul Arbon, Dean & Professor of Nursing (Population Health), School of Nursing & Midwifery, Flinders University, SAMr Jamie Ranse, Clinical Manager – Research Portfolio, Calvary Health Care, ACTMr Ramon Shaban, Senior Research Fellow, Princess Alexandra Hospital Griffith University Clinical Partnership, QLDDr Julie Considine, Senior Research Fellow in Nursing, Northern Health Deakin University-Northern Health Clinical Partnership, VICMs Belinda Mitchell, Clinical Risk Coordinator, Acute Services, Northern Health Deakin University-Northern Health Clinical Partnership, VICMs Karen Hammad, Honours Graduate, School of Nursing & Midwifery, Flinders University, SADr Lynette Cusack, Post doctoral Research Fellow, School of Nursing & Midwifery, Flinders University, SADr Mayumi Kako, Research Assistant (Population Health), School of Nursing & Midwifery, Flinders University, SAMs Laura Bahnisch, Research Assistant (Population Health), School of Nursing & Midwifery, Flinders University, SA
- This proposed research is significant because the factors influencing emergency nurses’ willingness to respond to disaster are poorly understood. Research approaches used to date to investigate ‘willingness’ to respond have relied on survey methods which may not provide valid and reliable findings. Many emergency care workers, including nurses, feel a strong obligation to respond and survey research findings may be influenced by the Hawthorne Effect whereby respondents overestimate their willingness to respond to a disaster event. Within the Australian and New Zealand literature, willingness to respond has not been the focus of research conducted to date. This is an important research gap because nurses provide much of the capability and capacity of our health services. This study aims to utilise a more sophisticated and in depth method to explore the willingness of emergency nurses in Australia to respond to the range of disasters. Reports from real incidents, such as the experience of Canadian nurses in responding to the SARS outbreak, raise concern about our understanding of nurses’ willingness to respond to disasters and the factors which may influence their response. Many disaster plans rely on untested and poorly understood ‘lifelines’. The response of emergency nurses is one such lifeline and it is important that we have an accurate assessment of the availability of emergency nurses to report for duty during a health related disaster and understand the strategies that could be adopted to bolster their willingness to respond. This research contributes to disaster planning by providing insight into the factors that affect the willingness of Australian emergency nurses to respond to disasters. This research will facilitate disaster planning and policy development at national and health agency levels that better supports the personal needs of emergency nurses during disaster response.
- Specifically we wanted to know:To what extent are Australian emergency nurses prepared and willing to respond to a health-related disaster?How prepared are Australian emergency nurses to respond in a health-related disaster in terms of the amount of education received, their knowledge of health related disaster responses and professional and home responsibilities?How willing are Australian emergency nurses to respond to a health-related disaster in terms of their professional and personal responsibilities?What do Australian emergency nurses consider would improve their preparedness and willingness to respond to a health-related disaster?What effect does willingness have on the nursing workforce capacity to respond to health-related disasters?
- Survey at 4 clinical institutionsAdditionally, supported and promoted via CENA and ACENNational Survey –pre-test conducted with a sample of approx 20 post-grad emergency nursing students – they did not complete the following surveyPilot Survey: (Feb-March 2010) A comprehensive review of the literature related to willingness to participate in health care disasters, failed to identify an existing data collection tool suitable for this study. Therefore, a draft survey was developed by the researchers focusing on the five research questions. The draft survey was reviewed by a panel of emergency care key stakeholders (Associate Nurse Unit Managers, Nurse Unit Managers, Clinical Nurse Educators, and Directors of Emergency Medicine) to establish content and face validity. The panel was asked to comment on content, identify misleading or ambiguous questions and comment on ease of completion and clarity of writing style. The survey was then piloted with 21 emergency nurses (24 was the original aim) and these nurses were subsequently excluded from the final study sample. Contact and recruitment to test the pilot survey occurred through two of the participating sites, Northern Health and Calvary Health Care. The sample also included some graduate students, all working as Emergency Nurses. Pilot participants were asked to comment on the ease of completion, vocabulary, mixed or difficult questions, ease of use of skip patterns, overall format and flow, any cultural barriers, language used and time taken to complete the survey. Results were summarised, discussed within the Research Team and adapted accordingly. Survey: (March – May 2010)The final version of the Survey was distributed at a population level to emergency nurses across Australia via the College of Emergency Nursing Australasia (CENA) and Australian College of Emergency Nurses (ACEN) membership. An introduction about this research project was made available through the use of CENA and ACEN websites and through the CENA newsletter. The population survey was available on-line using Remark Web Survey. Three emails were sent to members of these professional bodies, giving them information about the survey and inviting their participation at the survey website. Research partners at the participating sites also publicised the online survey through local email, intranet and staff noticeboards. A paper version of the survey was produced and distributed to staff at two sites. Surveys were anonymous and consent assumed when the survey was returned, either online or in sealed collection boxes within the hospital departments. The survey was self administered, taking less than 10 minutes to complete. The exact pool is not known. The final survey numbers were N=451 (400 was the aim). Demographic data related to participant characteristics (age, gender, years of experience, and nursing classification level) was collected as a component of the survey.
- Age: Min 21, Max 64, Mean: 40.
- Gender: There were 71 male (15.7%) and 373 female nurses (82.7%) participants
- Q8. State/ territory of participant’s work setting VIC 114 (26%), QLD 83(19%), NSW 80 (18%), SA 71 (16%), WA 38 (9%), ACT 22 (5%), TAS 10 (2%), NT 9 (2%).
- Q2. Current classification of participants More than half the population identified themselves as RNs. There were 145 RN Div1 (32%) and 81 RN level 2/ Clinical Nurses (18%). The second largest population was Clinical Nurse Specialist/ CNCs with 90 responses (20%).
- Q3. Highest level of qualification The largest group had Postgraduate Certificates or Diplomas as the highest level of qualification (148), with 105 with a Bachelor Degree and 90 with Masters. The smallest group was 4 with a PhD, then 19 with a Certificate IV.
- When we asked nurses ‘who do you live with?’, the majority of answered that they live with partner/spouse (and) children. Within these groups, 206 nurses answered that they live with either older family members (65 and over or ATSI and over), younger family members (under 65 and over or ATSI under 45), children. The second major group was ‘live alone’ with 67 people (15%).
- For the number of dependent children, 277 had none (61%), 72 participants (16%) had 1 child and 69 had (15%) 2 children.
- The majority of participants who have child/children answered that they have excellent social support (71 answers; 16%) and good (54 answers; 12%).
- When we asked to describe this person’s paid work/ volunteer emergency activities, there were 94 responses. 41 (9.1%) indicated that they work as a nurse, 28 (6%) indicated that they work as emergency services workers such as fire-fighters, police, paramedics and emergency government officers.
- Q5. Is there anything that would need to occur to improve your willingness to attend work when there is a health-disaster? There were 271 responses (61%) to ‘yes’ and 172 (38%) to ‘no’. The detail of improvements were as follows.
- 1=completely unprepared to attend2=somewhat unprepared to attend3=neither prepared nor unprepared to attend4=somewhat prepared to attend5=completely prepared to attend.
- Carer responsibilities,Partner with other ‘emergency’ responsibilities
- Image: number of ‘victims’ of disasters in 2007: http://www.preventionweb.net/files/4166_2victims.jpg