Doctoral thesis

Australian civilian hospital nurses’ lived experience of an out-of-hospital environment following a disaster

Mass Gathering Health / Mass Gathering Medicine

Various publications and presentations relating to Mass Gathering and Major Event health

Disaster Health

Various publications and presentations relating to disaster health

29 November, 2010

Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting

 

Background: In February 2009, bushfires devastated the state of Victoria, Australia, resulting in the loss of property and life — this event was named ‘Black Saturday’. Pre, during and post the impact of this event, health care professionals, such as nursing members of St John Ambulance Australia, provided clinical care in the pre-hospital environment. There is a paucity of literature regarding the clinical and disaster background, education and preparedness of those health care professionals who assist in similar emergencies, as such the characteristics of responders are not well understood.

Method: This research used a retrospective descriptive postal survey design, to survey nursing members of St John Ambulance Australia regarding their nursing experience; pre-hospital experience; disaster education, training and experience; and their role during the response to the 2009 Victorian bushfires.

Results: A total of 53 nurses were approached for inclusion in this research, of which 24 (45%) voluntarily participated. Males represented 46% and females represented 54% of participants. Participants had more combined years of nursing experience in the medical and surgical environments, then other areas of practice. Post-graduate critical care nursing was the primary area of completed post-graduate education. The previous disaster experience of participants was principally related to bushfire emergency response. Most participants had undertaken disaster related education, however this varied in type and duration. Similarly, most had participated in training or mock disasters; however this was commonly not related to bushfire emergencies. During the response to the Victorian bushfires, those nurses who undertook a clinical role did so at a staging area, caring for fire fighters and working with other members of their organisation. Half of the participants undertook an administrative role.

Conclusions: This research has provided insight into the characteristics and level of preparedness, of nurses who responded to the 2009 Victorian bushfires. Previously, such information has not been available in the literature. In this research, males were overrepresented when compared to the national average of nurses. The most amount of nursing experience was in the medical and surgical environment, this is consistent with national nursing workforce trends. Whilst most had clinical experience in bushfires, no training or mock scenarios focused specifically to bushfires. There is a need to explore further, the various roles undertaken by nurses during response, as this research has focused on one event — the 2009 Victorian bushfires.

Changes to Australian nursing and midwifery registration: implications for interstate disaster response


This editorial discusses the recent changes to Australian nursing and midwifery registration and the subsequent implications for interstate disaster response.

Reference: Ranse J, Cusack L. (2010) Changes to Australian nursing and midwifery registration: implications for interstate disaster response. Collegian. [editorial]. 17(4):207-208

What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper


During times of disaster, the front-line nursing workforce and the health services in which they work may be overwhelmed by a surge in patient demand. As a result, assistance will be required to bolster the nursing workforce. Commonly, discussions regarding workforce supply and sustainability during disasters are isolated within particular health service institutions. The aims of this discussion paper are to; firstly, consider the potential contribution of nursing students and schools of nursing within Australian universities to increase the health workforce during a disaster, and secondly, to present a number of recommendations that universities and schools of nursing could consider in developing their own emergency and disaster plans.
Reference: Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties What is the role of nursing students and of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

25 November, 2010

The pre-hospital and emergency department interface during disasters: workforce, education and other contemporary issues


This presentation explored the nexus between the pre-hospital and hospital issues in delivering disaster healthcare. In particular, issues such as triage differences, workforce pressures, and educational preparedness were discussed. This presentation was delivered to the ACT Ambulance Service and ACT Branch of the Australasian Paramedics.
Reference: Ranse J. The pre-hospital and emergency department interface during disasters: workforce, education and other contemporary issues; presentation to the ACT Ambulance Service Continuing Medical Education, 25th November 2010.

16 October, 2010

Exploring the disaster content in Australian postgraduate emergency nursing programs


This presentation outlined recent research regarding the type and amount of disaster content in post-graduate tertiary emergency nursing programs in Australasia.

Reference: Ranse J, Arbon P, Shaban R, Considine J, Mitchell B, Lenson S. Exploring the disaster content in Australian postgraduate emergency nursing programs; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 16th October 2010.

H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia


This presentation highlighted the collaboration of an Australian Emergency Department and Influence Assessment Clinic. In particular this presentation explored the demographics, acuity and disposition of patients presenting to these services with influenza-like symptoms. This presentation makes recommendations for future practice in the event of another influenza-like outbreak.

Reference: Ranse J, Lenson S, Luther M, Xiao L. H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 16th October 2010.

14 October, 2010

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


This presentation outlined the findings from the first phase of a national project exploring the willingness of emergency nurses to attend their workplace during a disaster.

Ranse J, Arbon P, Shaban R, Considine J, Mitchell B, Hammond K, Cusack L, Kako M, Bahnisch L.
Understanding the Willingness of Australian Emergency Nurses to Respond to a Health Care Disaster; paper presented at the 8th International Conference for Emergency Nurses, Canberra, Australia, 14th October 2010.

03 September, 2010

A cultural perspective in the health response to an offshore disaster


This article was submitted within the Transcultural National Network section of the Royal College of Nursing, Australia publication ‘Connections’. The article outlined the importance of disaster response agencies to consider the inclusion of health care professionals who are linguistically diverse and culturally aware, of the country they are responding to.

Reference: Ranse J. (2010). A cultural perspective in the health response to an offshore disaster. Connections [Royal College of Nursing, Australia – newsletter publication]. 13(3):42-43

31 August, 2010

Chain of survival at mass gatherings: A case series of resuscitation events


Background: At a large public event, or mass gathering, various factors influence patient presentations, which bring challenges to patient care. The chain of survival has been investigated in the prehospital setting; however this has not explicitly included the mass-gathering environment.

Objective: This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.

Methods: This case series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.

Results: The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.

Conclusions: This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.

Reference: Ranse J, Zeitz K: Chain of survival at mass gatherings: A case series of resuscitation events. Prehospital Disaster Medicine. 2010;25(5):465–471.

26 May, 2010

Oration: Inspiring, progressing and promoting the profession of nursing in disaster health


Oration title ‘Inspiring, progressing and promoting the profession of nursing in disaster health’, delivered to the Royal College of Nursing, Australia 2010 Nursing Summit – Canberra, ACT, 26th May 2010.



Orator Biography
Throughout his nursing career, Jamie has held various clinical, education, research and management roles, primarily within the critical care environment. Jamie is currently employed as a Clinical Manager of the Emergency Department at Calvary Health Care ACT. In this role Jamie contributes to elements of clinical leadership and research facilitation. Jamie guides and mentors staff in research design and writing for publication. Additionally, Jamie is employed as a Research Associate at the Flinders University Research Centre for Disaster Resilience and Health. His research interests are in the areas of disaster and mass gathering health. To date, his work has been supported by competitive research grants, published in peer-reviewed journals and presented at national and international conferences.

Jamie volunteers with St John Ambulance Australia, holding the high-level strategic position of Chief Nurse. In this role, Jamie develops nursing policy and guidelines, and provides strategic advice on clinical and professional topics to the organisation. Additionally, Jamie promotes internally and externally, to professional nursing organisations and government, the variety of roles and activities nurses undertake in the pre-hospital environment.

Jamie is an Associate Editor for the Australasian Emergency Nursing Journal, holding the pre-hospital portfolio, and peer-reviews for a number of national and international journals relating to disaster, emergency and primary health care. Additionally, Jamie has a close affiliation with the University of Canberra where he holds an adjunct position.


01 May, 2010

Disaster Triage


This disaster triage chapter is now published in the text 'International Disaster Nursing'. This chapter provides an overview of triage categories, systems and processes, as they relate to triage in both the pre-hospital and in-hospital settings during normal activities and during a disaster.

Reference: Ranse J, Zeitz K. Chapter 5: Disaster Triage in Power R, Daily E (eds). International Disaster Nursing. 2010. World Association of Disaster and Emergency Medicine with Cambridge Press. pp:57-79.

28 March, 2010

Pre-hospital clinical management of heat stress


The purpose of this clinical update is to firstly, increase the awareness of nurses and midwives to the clinical dangers of heat stress, and secondly, provide the best evidence in the first aid and emergency nursing response related to the management of people with the range of heat stress illnesses.

Reference: Cusack L, Arbon P, Ranse J. Pre-hospital clinical management of heat stress. Australian Nursing Journal. 2010;17(8):30-33.

27 March, 2010

H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia


Background: In June 2009, the World Health Organisation elevated their pandemic index indicating that the spread H1N1 2009 influenza was global. Many emergency departments (EDs) implemented strategies to divert patients with influenza-like symptoms, such as having separate triage and treatment areas. The establishment of influenza assessment clinics (IAC), also known as fever clinics, was a common strategy to achieve this diversion and separation. Calvary Health Care ACT (Calvary Hospital) established an IAC, supported predominately by ED nursing staff, as a strategy to enhance the health response capacity to H1N1 2009 influenza.

Aim: This study described the profile of patients presenting to the IAC and ED with influenza-like symptoms, and tested the relationships that influenced the collaboration between the IAC and ED.

Method: This was a retrospective, descriptive study using the existing patient information system to collect data. The sample for this study included all patients that presented with influenza-like symptoms to the IAC or ED during the IAC operational period; 3 June 2009—3 July 2009.

Results: 1106 patients presented with influenza-like symptoms during the study period, 967 (87.4%) presented during the operational times of the IAC (0900—1700). Patients who presented to the ED were younger than those who presented to the IAC (p = 0.001). A significantly higher proportion of patients presented in the morning period (0900—1300) in comparison to any other time (p<0.0005). Proportionately, the ED admitted more patients to hospital than the IAC (p< 0.0005). However, there were a significantly higher proportion of discharges from the ED than expected (p<0.0005).

Conclusions: Most patients with influenza-like symptoms presented during the operational hours of the IAC. Commonly, this was during the morning period which has staffing and resource implications in order to enhance the ED response capacity. A large proportion of patients were aged less than 65 years of age. Triage processes and guidelines should be enhanced to stream patients according to their likely disposition. A sustainable IAC like model should be implemented to support situations where increased ED patient presentations are experienced or expected. An evaluation of such a model should occur outside pandemic or increased patient presentation periods as this is the first study to provide an understanding of the relationship between an ED and IAC during the H1N1 2009 influenza pandemic. The results have staffing and resource implications, in order to enhance the ED response capacity.

Reference: Ranse J, Lenson S, Luther M, Xiao L. H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia. Australasian Emergency Nursing Journal. 2010;13(3):46-52.

25 March, 2010

Medical response to mass gatherings

This presentation highlights what we currently know about the health response to mass gatherings. In particular, it focuses models for predicting ‘patient presentation rates’ and ‘transport to hospital’ rates from mass gathering events. Additionally, this presentation explored the factors that influence patient presentation rates, such as; the weather, crowd mood and time of day. This presentation focused on a number of case studies to highlight the varied approaches to predicting workload.

Ranse J. Medical response to mass gatherings; presentation to the ACT Ambulance Service Continuing Medical Education, 25th March 2010.

31 January, 2010

Engaging volunteers in an emergency management organisation



Free full-text article is available here (PDF) 

ABSTRACT

The recruitment and retention of volunteers is a perennial and significant concern for emergency management organisations. This research aimed to identify factors associated with the successful engagement and retention of volunteers in an emergency management organisation. Six focus groups were undertaken with participants from both rural and metropolitan areas of one Australian jurisdiction. A number of themes were identified for the volunteer’s reasons to join, leave and stay in a volunteer emergency management organisation. The notion of retention should not be a focus for organisations; rather volunteer emergency management organisations should implement and enhance strategies to engage volunteers.

Reference: Ranse J, Carter S. Engaging volunteers in an emergency management organisation. Australian Journal of Emergency Management. 2010;25(1):36-41.

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