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

22 September, 2017

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

AWARDS
Flinders University, Vice-Chancellors Prize for Doctoral Thesis Excellence





ABSTRACT
Disasters disrupt the normal functioning of communities. From a health perspective, disasters may place an increased demand on health services within affected communities. When a disaster occurs, Australian nurses may respond as part of a government or non-government disaster medical assistance team. There is an increasing international literature base of nurses’ personal experiences and descriptions of single disastrous events. However, Australian civilian hospital nurses’ lived experience of the out-of-hospital environment following a disaster has not yet been explored.

Phenomenology is concerned with the essence of things as they are appearing in the conscious awareness of the first person. This phenomenological study uncovered what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. Hermeneutics and phenomenology formed the theoretical framework for this study. While there is no one way to do phenomenology and get back to the things themselves as they are appearing in themselves, for this study, an epoché and reduction were the key methods of phenomenology in guiding a way.

To get to the essence of the phenomenon being uncovered, narrative was obtained from eight participants, using semi-structured interviews at two points in time. Participants were Australian civilian hospital nurses who had worked in the out-of-hospital disaster environment as part of a disaster medical assistance team. From the participant narratives, descriptive moments formed a lived-experience description as an anecdote of what it may be like being a nurse in an out-of-hospital environment following a disaster. The uncovered moments in this study included ‘on the way to a disaster’, ‘prior to starting work’, ‘working a shift in a disaster’, ‘end of a shift’ and ‘returning home’. Phenomenological reflections of the existentials of spatiality, corporeality, communality and temporality overlaid the moments of the lived-experience description. Commentary on the phenomenological reflections provided further depth to the insights of what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster.

A nurse’s experience following a disaster, from a spatial perspective, was described in this study as lived-space as shrinking then opening too-wide, and disaster health lived-space as occupying, sharing and giving back. From a corporeal perspective, their experience was described as a nurse’s lived-body, for nursing following a disaster, and a nurse’s lived-body, for patients following a disaster. From a communal perspective, their experience was described as with colleagues, being relationally close; with patients and their families, being an insider; and being with self. From a temporal perspective, their experience was described as kairos time speeding up and condensing and kairos time slowing down and stretching.

Chronos time emerged as a featured backdrop to the life-world of what it may be like being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. In particular, chronos time was described as intersecting between the uncovered moments and the phenomenological existentials as a way to gain greater insights of a possible experience. These insights, in turn, informed possibilities for future practice, future education and professional development, and future research related to the experience of an Australian civilian hospital nurse in the out-of-hospital disaster environment as part of a disaster medical assistance team following a disaster.


Ranse, J. (2017). Australian civilian hospital nurses’ lived experience of an out-of-hospital environment following a disaster. Doctorate of Philosophy, Flinders University, South Australia.







27 July, 2017

Caring during catastrophe: How nurses can make a difference



I was an invited guest speaker at the AusMed Education conference - Disaster Nursing - Not if, But when.



Ranse J. (2017). Caring during catastrophe: How nurses can make a difference; invited speaker for Disaster Nursing - Not If, But When… Melbourne, Vic, 27th July.


29 April, 2017

Health service impact from mass-gatherings: A systematic literature review


ABSTRACT:

Background: Mass gatherings are events where a large number of people congregate for a common purpose, such as sporting events, agricultural shows, and music festivals. When definitive care is required for participants of mass gatherings, municipal ambulance services provide assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and emergency department services from mass gathering events was the focus of this literature review.

Methods: This research used a systematic literature review methodology. Databases were searched to find articles related to aim of the review. Articles focused on mass gathering health, provision of in-event health services, ambulance service transportation and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital.

Conclusion: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering, to more accurately inform future health planning for mass-gatherings across the health care continuum


Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 17th WADEM Congress on Disaster and Emergency Medicine. Toronto, Canada 29th April








25 April, 2017

Australian civilian hospital nurses' lived experience of the out-of-hospital environment following a disaster: A lived-space perspective




ABSTRACT:

Study/Objective: This research explored what it may be like being an Australian civilian in-hospital nurse, in the out-of hospital disaster environment following a disaster, as part of a disaster medical assistance team. This presentation will explore the specific aspect of lived-space from a larger phenomenological research project.

Background: In the minutes following a disaster, reports from the media focus on the measurable impact. For example, the magnitude of an earthquake or the number of hectares burnt by a wildfire. Lived-space is concerned with felt space, going beyond these measurable physical, visible and touchable spaces. Lived-space is the way in which we find ourselves in our lifeworld through the spaces of our day-to-day existence

Methods: For this phenomenological study, narrative was obtained from eight Australian civilian hospital nurses following a disaster. Semi-structured interviews were conducted at two points in time. Descriptive moments of a possible lived experience were identified from participant narrative. These moments formed a lived experience description as an anecdote of an experience. A preparatory epoché-reduction and reduction proper was used to guide a reflection on the lived-space of being a nurse, following a disaster from the lived experience description.

Results: Lived-space was described as shrinking then being open too-wide, where nurses were drawn into the disaster lived-space, then returning home to a wide-open but crowded lived-space. Disaster health lived-space was described as occupying, sharing and giving back. Conclusion: This research provides insight into Australian civilian in-hospital nurse in the out-of-hospital disaster environment, following a disaster as part of a disaster medical assistance team. In particular, this work adds a lived-space perspective to the existing literature. These insights may inform future education, research, clinical practice, and policy.


Ranse J, Arbon P, Cusack L, Shaban R. (2017) Australian civilian hospital nurses' lived experience of the out-of-hospital environment following a disaster: A lived-space perspective; paper presented at the 17th WADEM Congress on Disaster and Emergency Medicine. Toronto, Canada 25th April.

13 March, 2017

Health service impact from mass-gatherings: A systematic literature review



Free full-text article is available here (PDF)

ABSTRACT:
Background: During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review.

Aim: This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.

Method: This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.

Results: Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n = 23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.

Conclusions: There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum.



Ranse J, Hutton A, Keene T, Lenson S, Luther M, Bost N, Johnston A, Crilly J, Cannon M, Jones N, Hayes C, Burke B. (2017) Health service impact from mass-gatherings: A systematic literature review. Prehospital and Disaster Medicine. 32(1):

13 February, 2017

Development of a mass-gathering triage tool: An Australian perspective




Free full-text article is available here (PDF)


ABSTRACT
Many health service organizations deploy first responders and health care professionals to mass gatherings to assess and manage injuries and illnesses. Patient presentation rates (PPRs) to on-site health services at a mass gathering range from 0.48-170 per 10,000 participants. Transport to hospital rates (TTHRs) range from 0.035-15 per 10,000 participants. The aim of this report was to outline the current literature pertaining to mass-gathering triage and to describe the development of a mass-gathering triage tool for use in the Australian context by first responders. The tool is based on the principles of triage, previous mass-gathering triage tools, existing Australian triage systems, and Australian contextual considerations. The model is designed to be appropriate for use by first responders.


Cannon M, Roitman R, Ranse J, Morphet J. (2017) Development of a mass-gathering triage tool: An Australian perspective. Prehospital and Disaster Medicine. 32(1).

18 January, 2017

Being health prepared for a disaster

I was interviewed by Chris Coleman on 1206AM Canberra 2CC regarding ways to keep people prepared for a disaster, from a health perspective. The interview was initiated on the background of impending hot weather and high fire danger in the Canberra region.

Key points for being health prepared that were discussed included:
  • Have a current list of medications, ailments and previous medical/surgical history. 
  • Keep this list with other items you might take in an evacuation, such as photo albums or computers 
  • Keep a stocked first aid kit in your car
  • Learn first aid and know basic first aid principles such as how to control bleeding, how to open an airway and how to do CPR 
  • Get to know your neighbours, you might need each other’s help in an emergency

The 27th December 2016: Live interview ‘Being health prepared for a disaster’, on: 1206 2CC (Canberra) can be found below:




On 18th January 2017, a number of large grass fires were burning in the Canberra region, resulting in emergency warnings for the region. I was interviewed by Chris Coleman on 1206AM Canberra 2CC regarding the immediate action people should take to keep safe and be prepared from a health perspective.



27th December 2016: Live interview ‘Being health prepared for a disaster’, on: 1206 2CC (Canberra)

18th January 2017: Live interview, bushfire update ‘Considerations during evacuation’, on: 1206 2CC (Canberra). (During Bushfire Emergency near Sutton, NSW).



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