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Understanding the willingness
 of Australian emergency nurses
 to respond to a health care disaster
Arbon P , Cusack L , Ranse J , Shaban R , Considine J , Mitchell B , Hammad K , Woodman R , Kako M , Bahnisch L .
             1                    1                1,2                 3                      4              5                                           1                                              1                              1                                         1

1. Flinders University, South Australia; 2. University of Canberra, Australian Capital Territory; 3. Griffith Institute for Health and Medical Research and Princess Alexandra Hospital,
Queensland, Australia; 4. Deakin University and Northern Health, Victoria, Australia; 5. Northern Health, Victoria, Australia



Introduction                                                                                                     Methods
Events such as bushfires, floods and cyclones occur regularly in Australia.1 Within the                          This study used three phases. Appropriate ethics approval was received for this project.
literature, eight key themes are evident that influence a health care professional’s
willingness to attend their workplace during a disaster; family responsibility and safety,2-4
                                                                                                                 Phase I                       A national online survey, distributed via the College of Emergency Nursing
                                                                                                                                               Australasia, Australian College of Emergency Nurses and promoted in four
personal safety,3-4 working conditions,5 professional duty,4-5 type of event,5-6 gender,5-6                                                    hospitals.
knowledge,6-8 and ability.8-9

A study focusing on Australian nurses willingness has not been previously undertaken.                            Phase II                      Six focus groups at four hospitals: 41 participants; and
It is important to understand the willingness of nurses to respond to disasters, and the
potential factors that enable or disable their response.                                                         Phase III                      In-depth interviews: 13 participants who participated in phase II.

                                                                                                                 Data analysis for phase I included descriptive and inferential statistics. The participant
                                                                                                                 narratives from phase II and III were transcribed and thematically analysed.




Findings                                                                                                         Qualitative Findings

Phase I                                                                                                          Phase II and Phase III
451 Emergency Department (ED) nurses completed the national survey.                                              The thematic analysis identified 3 main themes and a number of sub-themes.

                                                                                                                 Table 2: themes and sub-themes from the analysis
Participant Demographics
Table 1: Participant demographics                                                                                   Main Theme                                                            Sub-theme
                                                                                                                    Uncertainty                                                           It depends on what is happening at home
                        Male             71 (16%)                                                                                                                                         It depends on what is happening at work
 Gender                                                                                                                                                                                   It depends on the information provided
                        Female           373 (84%)
                                                                                                                                                                                          It depends on the type of disaster
 Age                                     M = 39.75 (21- 64)                                                                                                                               It depends on degree of risk
                                                                                                                                                                                          It depends on the team
The majority had no children (61.6%, n=277). Of the participants, 34% (n=152) lived with                            The unspoken                                                          Disasters are not talked about
a partner and 35.8% (n=160) lived with a partner and children.                                                                                                                            What is a disaster?
                                                                                                                                                                                          Emergency nurse’s current role
Descriptive Findings                                                                                                                                                                      Emergency nurse’s role in a disaster
                                                                                                                                                                                          Moral duty
Of the participants, 30.1% (n=135) worked as an ED nurse between 1 and 5 years, and                                 Choices                                                               Making a choice
33.3% (n=148) held a Postgraduate Certificate or Diploma.



Figure 1: Factors that influence the willingness of working in the ED in a disaster
                                                                                                                      Discussion
 500
                                                                                                  Agree               ED nurses demonstrated a willingness to work in disasters and describe themselves
 450
                                                                                                                      as being prepared. Willingness to assist does not equate to an ability to assist, which
 400                                                                                              Disagree            is influenced by factors such as transport availability and caring responsibilities.
 350                                                                                                                  Nurses were more willing to assist in transport/natural disasters, when compared to
 300
                                                                                                                      terrorist/pandemic/CBR events.
 250

 200                                                                                                                  Recommendations
 150

 100                                                                                                                  1. On occasions, nurses are not willing to assist in disaster response. Strategies to
                                                                                                                         overcome this should be implemented, such as enhancing PPE provisions,
  50

   0                                                                                                                  2. Reasons why nurses are willing, but not able to assist should be investigated and
         Having a            Having           Having a      Right to       Needing more      Managers
       responsibility      knowledge /    supportive work   say 'no'        knowledge /   should organise
                                                                                                                         strategies developed to enhance the ability of staff to assist, and
          to work             skills        environment                        skills       other sta
                                                                                                                      3. Further research, beyond the cohort of ED nurses explored, should be undertaken.


Inferential statistics                                                                                           Acknowledgements:
                                                                                                                 This research was supported by funds from a Flinders University Industry Partnership Grant.
                                                                                                                 The authors would like to thank the Royal Adelaide Hospital, Calvary Health Care ACT, Princess Alexandra Hospital and Northern Health who were partner organisations in this research. The authors would
The odds of being willing to attend work in transport/natural disasters was 23.9 times                           like to thank the CENA and the ACEN for the distribution of the survey.


higher than the odds of being willing to attend work in terrorist/pandemic/CBR events                            References:
                                                                                                                 1: Nicopolous N & Hansen E, 2009, ‘How well prepared are Australian communities for natural disasters and fire emergencies?’, The Australian Journal of Emergency Management, 24(1): 60-66. 2: Dalton CB,
                                                                                                                 Durrheim DN, & Conroy MA, 2008, ‘Likely impact of school and childcare closures on public health workforce during an influenza pandemic: a survey’, Communicable Diseases Intelligence, 3292): 261-262. 3:
(95% CI: 10.85 – 52.8, p <0.001).                                                                                Damery S, Wilson S, Draper H, Gratus C, Greenfield S, Ives J, Parry J, Petts J, & Sorell T, 2009, ‘Will the NHS continue to function in an influenza pandemic? A survey of healthcare workers in the West Midlands,
                                                                                                                 UK’, BMC Public Health, 9(142): 1-13. 4: Ehrenstein BP, Hanses F, & Salxberger B, 2006, ‘Influenza pandemic and professional duty: family or patients first? A survey of hospital employees’, BMC Public Health,
                                                                                                                 6:311. 5: Masterson L, Steffen C, Brin M, Kordick MF & Christos S, 2009, ‘Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events’,
                                                                                                                 The Journal of Emergency Medicine, 36(1): 43-49. 6: Grimes DE, & Mendias EP, 2010, ‘Nurses’ intentions to respond to bioterrorism and other infectious disease emergencies’, Nursing Outlook, 58(1): 10-16.

Of the participants, 35.7% (n=161) reported wanting improvement to Personal Protective                           7: Irvin CB, Cindrich L, Patterson W, & Southall A, 2008, ‘Survey of hospital healthcare personnel response during a potential Avian influenza pandemic: will they come to work?’, Prehospital and Disaster
                                                                                                                 Medicine, 23(4): 328-335. 8: Watt K, Tippett VC, Raven SG, Jamrozik K, Coory M, Archer F, & Kelly HA, 2010, ‘Attitudes to living and working in pandemic conditions among emergency prehospital medical care
                                                                                                                 personnel’, Prehospital and Disaster Medicine, 25(1): 13-19. 9: O’Sullivan TL, Amaratunga C, Phillips KP, Corneil W, O’Connor E, Lemyre L & Dow D, 209, ‘If schools are closed, who will watch our kids? Family
Equipment (PPE)                                                                                                  caregiving and other sources of role conflict among nurses during large-scale outbreaks’, Prehospital and Disaster Medicine, 24(4): 321-325.



                                                                                                                                                                                                                                                               © 2011 DESIGNED & PRINTED BY MULTIMEDIA SERVICES, CANBERRA HOSPITAL

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Understanding the willingness of Australian emergency nurses to respond to a health care disaster

  • 1. Understanding the willingness of Australian emergency nurses to respond to a health care disaster Arbon P , Cusack L , Ranse J , Shaban R , Considine J , Mitchell B , Hammad K , Woodman R , Kako M , Bahnisch L . 1 1 1,2 3 4 5 1 1 1 1 1. Flinders University, South Australia; 2. University of Canberra, Australian Capital Territory; 3. Griffith Institute for Health and Medical Research and Princess Alexandra Hospital, Queensland, Australia; 4. Deakin University and Northern Health, Victoria, Australia; 5. Northern Health, Victoria, Australia Introduction Methods Events such as bushfires, floods and cyclones occur regularly in Australia.1 Within the This study used three phases. Appropriate ethics approval was received for this project. literature, eight key themes are evident that influence a health care professional’s willingness to attend their workplace during a disaster; family responsibility and safety,2-4 Phase I A national online survey, distributed via the College of Emergency Nursing Australasia, Australian College of Emergency Nurses and promoted in four personal safety,3-4 working conditions,5 professional duty,4-5 type of event,5-6 gender,5-6 hospitals. knowledge,6-8 and ability.8-9 A study focusing on Australian nurses willingness has not been previously undertaken. Phase II Six focus groups at four hospitals: 41 participants; and It is important to understand the willingness of nurses to respond to disasters, and the potential factors that enable or disable their response. Phase III In-depth interviews: 13 participants who participated in phase II. Data analysis for phase I included descriptive and inferential statistics. The participant narratives from phase II and III were transcribed and thematically analysed. Findings Qualitative Findings Phase I Phase II and Phase III 451 Emergency Department (ED) nurses completed the national survey. The thematic analysis identified 3 main themes and a number of sub-themes. Table 2: themes and sub-themes from the analysis Participant Demographics Table 1: Participant demographics Main Theme Sub-theme Uncertainty It depends on what is happening at home Male 71 (16%) It depends on what is happening at work Gender It depends on the information provided Female 373 (84%) It depends on the type of disaster Age M = 39.75 (21- 64) It depends on degree of risk It depends on the team The majority had no children (61.6%, n=277). Of the participants, 34% (n=152) lived with The unspoken Disasters are not talked about a partner and 35.8% (n=160) lived with a partner and children. What is a disaster? Emergency nurse’s current role Descriptive Findings Emergency nurse’s role in a disaster Moral duty Of the participants, 30.1% (n=135) worked as an ED nurse between 1 and 5 years, and Choices Making a choice 33.3% (n=148) held a Postgraduate Certificate or Diploma. Figure 1: Factors that influence the willingness of working in the ED in a disaster Discussion 500 Agree ED nurses demonstrated a willingness to work in disasters and describe themselves 450 as being prepared. Willingness to assist does not equate to an ability to assist, which 400 Disagree is influenced by factors such as transport availability and caring responsibilities. 350 Nurses were more willing to assist in transport/natural disasters, when compared to 300 terrorist/pandemic/CBR events. 250 200 Recommendations 150 100 1. On occasions, nurses are not willing to assist in disaster response. Strategies to overcome this should be implemented, such as enhancing PPE provisions, 50 0 2. Reasons why nurses are willing, but not able to assist should be investigated and Having a Having Having a Right to Needing more Managers responsibility knowledge / supportive work say 'no' knowledge / should organise strategies developed to enhance the ability of staff to assist, and to work skills environment skills other sta 3. Further research, beyond the cohort of ED nurses explored, should be undertaken. Inferential statistics Acknowledgements: This research was supported by funds from a Flinders University Industry Partnership Grant. The authors would like to thank the Royal Adelaide Hospital, Calvary Health Care ACT, Princess Alexandra Hospital and Northern Health who were partner organisations in this research. The authors would The odds of being willing to attend work in transport/natural disasters was 23.9 times like to thank the CENA and the ACEN for the distribution of the survey. higher than the odds of being willing to attend work in terrorist/pandemic/CBR events References: 1: Nicopolous N & Hansen E, 2009, ‘How well prepared are Australian communities for natural disasters and fire emergencies?’, The Australian Journal of Emergency Management, 24(1): 60-66. 2: Dalton CB, Durrheim DN, & Conroy MA, 2008, ‘Likely impact of school and childcare closures on public health workforce during an influenza pandemic: a survey’, Communicable Diseases Intelligence, 3292): 261-262. 3: (95% CI: 10.85 – 52.8, p <0.001). Damery S, Wilson S, Draper H, Gratus C, Greenfield S, Ives J, Parry J, Petts J, & Sorell T, 2009, ‘Will the NHS continue to function in an influenza pandemic? A survey of healthcare workers in the West Midlands, UK’, BMC Public Health, 9(142): 1-13. 4: Ehrenstein BP, Hanses F, & Salxberger B, 2006, ‘Influenza pandemic and professional duty: family or patients first? A survey of hospital employees’, BMC Public Health, 6:311. 5: Masterson L, Steffen C, Brin M, Kordick MF & Christos S, 2009, ‘Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events’, The Journal of Emergency Medicine, 36(1): 43-49. 6: Grimes DE, & Mendias EP, 2010, ‘Nurses’ intentions to respond to bioterrorism and other infectious disease emergencies’, Nursing Outlook, 58(1): 10-16. Of the participants, 35.7% (n=161) reported wanting improvement to Personal Protective 7: Irvin CB, Cindrich L, Patterson W, & Southall A, 2008, ‘Survey of hospital healthcare personnel response during a potential Avian influenza pandemic: will they come to work?’, Prehospital and Disaster Medicine, 23(4): 328-335. 8: Watt K, Tippett VC, Raven SG, Jamrozik K, Coory M, Archer F, & Kelly HA, 2010, ‘Attitudes to living and working in pandemic conditions among emergency prehospital medical care personnel’, Prehospital and Disaster Medicine, 25(1): 13-19. 9: O’Sullivan TL, Amaratunga C, Phillips KP, Corneil W, O’Connor E, Lemyre L & Dow D, 209, ‘If schools are closed, who will watch our kids? Family Equipment (PPE) caregiving and other sources of role conflict among nurses during large-scale outbreaks’, Prehospital and Disaster Medicine, 24(4): 321-325. © 2011 DESIGNED & PRINTED BY MULTIMEDIA SERVICES, CANBERRA HOSPITAL