To work or not to work: An analysis of the willingness of Australian emergency nurses to respond to a disaster
Cena 2011 presentation_28-09-11_LBahnisch
Dec 13, 2014
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.
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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To work or not to work:
An analysis of the willingness of Australian emergency nurses to
respond to a disaster
Research partnersInvestigatorsMs 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
Disaster
Research
Centre Flinders University School of
Nursing & Midwifery
Institutions1. Flinders University2. University of Canberra 3. Griffith University 4. Princess Alexandra Hospital 5. Deakin University6. Northern Health
Definition
A disaster is defined by Emergency Management Australia as:
‘A serious disruption to community life 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
1. National online survey
2. Focus groups
3. 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?
transport incident
natural disaster
pandemic outbreak
CBR terrorist attack
0
50
100
150
200
250
300
350
400
12345N
o.
of
nu
rse
s
1 = completely unprepared to attend2 = somewhat unprepared to attend3 = neither prepared nor unprepared to attend4 = somewhat prepared to attend5 = 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:
1. 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
care pro-visions
working conditions
PPE education other0
50
100
150
200
250
Types of improvements
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
Influence
Assessment of degree of risk:
self, family, community
Assessment of preparedness at home, work and
professionally
Not willing
Willing but not able to get to work
Willing to go to work
Influence
Disaster event
Work place
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…
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