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

09 November, 2018

Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis


Free full-text article is available here (PDF)


ABSTRACT 

Objective
The aim of this study was to describe the in‐event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition.

Methods
This research was set at one MGE in Australia. The MGE had one first aid post and one in‐event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in‐event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics.

Results
Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86–1.13], 9.85/1000) presented for in‐event first aid care, with 24/197 (12.2% [95% CI 8.33–17.49], 1.2/1000) referred to in‐event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71–78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti‐emetics (n = 11). Seven (29.2% [95% CI 14.92–49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5–12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission.

Conclusions
There was an impact on in‐event, ambulance and ED services from this MGE but the in‐event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED.



Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A, Johnston A, Crilly J. (2018). Impacts on in-event, ambulance and emergency department services from patients presenting from a mass gathering event: A retrospective analysis. Emergency Medicine Australasia.

17 October, 2018

Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster

The World Association for Disaster and Emergency Medicine launched a podcast series in 2018. I was invited to speak on the topic of 'Lived-relationships: Experiences of nurses in the out-of-hospital environment following a disaster'. The podcast relates to some of the findings from my Doctoral studies, focusing on the lived-relationships with patients and their families, colleagues, and self.



Ranse J (Interviewee), Hutton A (Producer). (2018). Lived-relationships of nurses in the out-of-hospital environment following a disaster; audio podcast for World Association for Disaster and Emergency Medicine, 17th October. Series 1, Episode 3. Retrieved from https://wadem.org/resources/podcasts/





13 October, 2018

End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice




ABSTRACT

Introduction: Despite the frequency with which critical care nurses’ engage in end-of-life care, preparation and support of nurses for this work through professional development opportunities or postgraduate education is reportedly limited.

Objectives: To identify and describe end-of-life care content in postgraduate critical care nursing courses in Australia.

Methods: A purposive sampling technique was used to invite a postgraduate course convener from each higher education institution, identified through a search of the internet as offering a postgraduate course in critical care nursing (n = 17). An individual structured telephone survey was undertaken with each participant (n = 13). Content analysis of participant responses was undertaken to identify and describe the end-of-life content and modes of content delivery.

Results: Participants agreed (92%) that end-of-life care content was important within post-graduate education, with 77% agreeing that more time should be allocated to focus on end-of-life care. The majority of courses addressed legal and ethical issues related to end-of-life care (77%), however this content was predominately covered in the context of organ donation (92%). The content least commonly addressed pertained to the work of the nurse in providing direct clinical care, including the physical changes to the dying patient (31%), the process of withdrawing life sustaining treatment (15%), withdrawal of ventilation and symptom management (23%), emotional support to the family (23%) and care of the body after death (23%).

Conclusion(s): The inclusion of end-of-life care content in critical care curricula is needed to address the complexity of this area of practice, including the care and inclusion of family, the physical care and emotional support of the patient and self-care for the nurse. It is recommended that targeted educational initiatives to improve the care that patients and their families receive and support nurses in the delivery of this care.




Ranse K, Delaney L, Ranse J, Coyer F, Yates P. (2018). End-of-life care in postgraduate critical care nurse curricula: An evaluation of current content informing practice. Poster presented at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting, Adelaide, 11th - 13th October.



14 September, 2018

Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review



Free full-text article is available here (PDF)


ABSTRACT
Background
There is a growing body of literature relating to mass-gathering events. A common thread amongst this literature, particularly the literature relating to music festivals, is the incidence of patients presenting with substance and/or alcohol intoxication. However, the impact of alcohol and/or drugs on the provision of in-event health care services has not been explored in detail.

Aim
The goal of this review was to develop an understanding of the impact of alcohol and/or drugs on in-event health care services at mass-gathering events.

Method
This paper used integrative review as a methodology. The articles included in this literature review were sourced by searching databases inclusive of Medline (Ovid; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Scopus (Elsevier; Amsterdam, Netherlands), PsycINFO (Ovid; American Psychological Association; Washington DC, USA), and Pub Med (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA). Identified manuscripts that met the inclusion criteria were thematically analyzed.

Results
In total, 12 manuscripts met the inclusion criteria for this review. A thematic analysis of these manuscripts identified three main themes: (i) predictive factors, (ii) patient presentation rates, and (iii) levels of care.

Conclusion
Substance use and/or intoxication can place a strain on in-event medical services at mass-gathering events. Of the various types of mass-gathering events, music festivals appear to be the most affected by substance use and intoxication.



Bulloack M, Ranse J, Hutton A. (2018). Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: An integrative literature review. Prehospital and Disaster Medicine.

21 August, 2018

Working in the dark – The impact of a state-wide black systems event on emergency departments: A case study from clinician perspectives





Free full-text article is available here (PDF)

ABSTRACT
Background: A black system event (BSE) is a large scale black-out where there is a loss of a major power supply. From a health perspective a BSE may disrupt essential equipment within a health service that may be necessary for providing care. There is a paucity of literature relating to BSE and their impact on emergency departments (EDs).

Aim: The research aimed to understand the impact of a BSE on ED clinicians in South Australia.

Method: This research used a cross sectional survey design by surveying South Australian ED clinicians who worked during the BSE. Data was collected via a survey with closed and open questions. Quantitative data was analysed using descriptive statistics and qualitative narrative was analysed using a thematic analysis.

Results: Surveys were returned from 42 nurses and 7 doctors. The respondents were mostly female and most worked in a metropolitan ED. The majority of participants had undertaken some form of disaster education and/or training, despite never been involved in a major incident or disaster. A lack of lighting radiography systems not working, communication systems not working and patient tracking systems not working were the most common ways the ED was impacted.

Conclusion: This research is the first to focus exclusively on the impact of a BSEs on EDs in Australia. Emergency departments are encouraged to educate and train staff to be prepared for BSEs, test electrical systems and improve communication with the ED



Hammad K, Wake M, Zampatti C, Neumann S, Ranse J. (in-press, 2018). Working in the dark – the impact of a state-wide black systems event on emergency departments: A case study from clinician perspectives. Collegian.

10 August, 2018

Phenomenology: Moving from philosophical underpinnings to a practical way of doing


Presentation notes (word document)



Biography
Dr Jamie Ranse is an Early Career Researcher currently working as a Research Fellow in Emergency Care. This is a joint appointment between Griffith University and the Gold Coast Health Service. His work focuses on emergency health care, primarily in the areas of high visibility, high consequence events that are either planned (such as mass gatherings / major events) or unplanned (such as disasters). His work has been supported by competitive research grants, published in peer-reviewed journals and presented at national and international conferences.

Jamie completed his Doctor of Philosophy in 2017 at Flinders University, where he researched the experience of Australian nurses who assist in the out-of-hospital disaster environment. He received the Flinders University Vice-Chancellor's Prize for Doctoral Thesis Excellence.

Jamie is an active member of a number of national and international nursing associations. He is a Fellow of the Australian College of Nursing and College of Emergency Nursing Australasia. He is an Associate Editor for the Australasian Emergency Care Journal, holding the disaster portfolio. Additionally, he Chairs the World Association for Disaster and Emergency Medicine, International Mass Gathering Special Interest Group and Chairs the Australian College of Nursing Disaster Health Community of Interest. Jamie volunteered with St John Ambulance Australia for over 20 years; previously holding the role of Chief Nurse. In this role, he engaged in high-level strategic decisions regarding mass gathering and emergency health care.

He has been involved in a number of research projects using phenomenology as a research methodology. His interest in phenomenology lies in how the underlying philosophical assumptions of phenomenology are applied to the practical way of doing phenomenological research in the health care context.


Ranse J. (2018). Phenomenology: Moving from philosophical underpinnings to a practical way of doing; presentation at the University of Newcastle, School of Nursing and Midwifery, Research Week, Newcastle, NSW, 10th August.



28 June, 2018

How do you actually care during a catastrophe?



I was an invited guest speaker at the AusMed Education conference - Disaster Nursing - Not if, But when. This presentation covers aspects of nurses education and willingness to assist following a disaster. Furthermore, this presentation provides insight into a possible experience of what it may be like being a nurse following a disaster.



Ranse J. (2018). How do you actually care during a catastrophe?; invited speaker for Disaster Nursing - Not If, But When… Brisbane, Qld, 28th June.

15 May, 2018

Mass gatherings: Impacts on emergency departments


I presented this work to the clinical staff of the Royal Adelaide Hospital, Emergency Department. This presentation provided an overview of mass gathering event health-related topics. In particular, this presentation focused on the impact of mass gathering events on the emergency department. The discussion concluded with questions relating to the preparedness of the emergency department when mass gathering events are situated in the region of the hospital. This discussion explored factors pre, during and post a mass gathering.



Ranse J. (2018). Mass gatherings: Impacts on emergency departments; presentation to nurses and doctors of the Royal Adelaide Hospital, Emergency Department, Adelaide, SA, 16th May.



23 April, 2018

Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach

Background: In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family.

Aim: To explore nursing students’ lived experience of caring for a dying patient and their family.

Design: Hermeneutic phenomenology.

Methods: Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants’ narratives (n = 6) were thematically analysed.

Findings: Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope.

Conclusions: Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.


Ranse K, Ranse J, Pelkowitz M. 2018. Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemporary Nurse. [in-press].

17 April, 2018

Introduction to disaster nursing: for undergraduate students



Ranse, J. [jamieranse]. (2018, 5th April). Introduction to disaster nursing: for undergraduate students. https://youtu.be/dh2Oy5Di1qw

This presentation was developed for undergraduate nursing students at Griffith University in the course: 3803NRS Complex Clinical Care

INTRODUCTION:
This topic will:
1. Discuss the incidence of disasters.
2. Describe the role of undergraduate nursing students following disasters.
3. Discuss the willingness and role of nurses following disasters.
4. Illustrate key concepts in (disaster) triage.
5. Throughout the above; discuss aspects of natural disasters, pandemic-like disasters and disasters that are human-made such as chemical, biological, radiological, nuclear or explosion (CBRNE) in nature

BACKGROUND
Definition of disaster 
A disaster can be defined as ‘a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources’ (United Nations Office for Disaster Risk Reduction [UNISDR], 2009, p. 9). From a health perspective, this can relate to natural disasters, pandemic-like disasters or disasters that are human-made such as chemical, biological, radiological, nuclear or explosion (CBRNE) in nature.

Incidence of disasters 
Internationally, on average, there were 384 disasters annually for the decade 2004–2013, affecting 199.2 million people and resulting in 99,820 deaths. During this decade, three disasters led to deaths well above the annual average: the Indian Ocean tsunami [226,408 deaths], Cyclone Nargis [138,366 deaths] and the Haiti earthquake [225,570 deaths] (Guha-Sapir, Hoyois & Below, 2015).

In addition to a human cost, disasters have an economic cost. During the period 1980–2012, the World Bank (2013) reported an estimated US$3.8 trillion loss related to disasters. These disasters were primarily (74%) related to extreme weather events (World Bank, 2013).

Nursing students and schools of nursing 
There is an increasing international body of literature relating to the role of nursing students and schools of nursing following a disaster. From an Australian perspective, the literature is speculative of what some possibilities may be for students in disasters, such as assisting in the department or unit where students undertook their most recent clinical practice experience (Cusack, Arbon, & Ranse, 2010).

Role of nurses in disasters 
Following a disaster, nurses undertake a variety of roles in a variety of settings. Following the 2009 Victorian Bushfires, nurses did not focus exclusively on clinical activities. Instead, nurses undertook minimal clinical activities, spending most of their patient contact time coordinating care, problem solving and providing psychosocial support to colleagues and members of the disaster affected communities (Ranse, Lenson & Aimers, 2010; Ranse & Lenson, 2012).

Willingness of nurses to assist in disasters 
Not all nurses may be willing to assist following a disaster. There are a number of factors that influence a nurses willingness to assist, such as the type of disaster and commitments at home (Arbon, Cusack, et al., 2013; Arbon, Ranse, et al., 2013). Nurses are more willing to assist following a natural disaster when compared to a human-made disaster such as a CBRNE event.

Triage 
The key principle of triage is to do the greatest good for the greatest number of people. In normal day-to-day activities, this involves caring for the patient with the highest acuity and health needs first. However, following a disaster, there may not be an appropriate level of resources to assist in the care of all high-acuity patients. As such, triage is reversed, whereby to achieve a goal of doing the greatest good, those patients with a lower acuity may be cared for in the first instance. There are a number of algorithms designed to support decision-making during triage (Ranse & Zeitz, 2010).


REQUIRED READING AND ACTIVITY

Required readings 

Arbon P, Cusack, L, Ranse J, Shaban R, Considine J, Kako M, Woodman R, Mitchell B, Bahnisch L, Hammad K. (2013). Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australasian Emergency Nursing Journal.16(3):103-109.

Arbon P, Ranse J, Cusack L, Considine J, Shaban R, Woodman R, Bahnisch L, Kako M, Hammad K, Mitchell B. (2013). Australasian emergency nurses’ willingness to attend work in a disaster: A survey. Australasian Emergency Nursing Journal. 16(2):52-57.

Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

Activity 
Given what you have learnt from the above two manuscripts and the YouTube presentation provide an answer to the following scenario: You are a nursing student who is on their way home from a clinical shift in the medical ward of a local hospital. As you are commuting home, a bushfire impacts the suburb near your home and the local hospital.
  • Question: Are you willing to assist with this disaster? Provide a justification for your answer. 
  • Question: What do you think your role will be following this disaster? Provide a rationale for your answer.


REFERENCES

Arbon P, Cusack, L, Ranse J, Shaban R, Considine J, Kako M, Woodman R, Mitchell B, Bahnisch L, Hammad K. (2013). Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australasian Emergency Nursing Journal.16(3):103-109.

Arbon P, Ranse J, Cusack L, Considine J, Shaban R, Woodman R, Bahnisch L, Kako M, Hammad K, Mitchell B. (2013). Australasian emergency nurses’ willingness to attend work in a disaster: A survey. Australasian Emergency Nursing Journal. 16(2):52-57.

Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

Guha-Sapir, D., Hoyois, P., & Below, R. (2015). Annual disaster statistical review 2014: The numbers and trends. Retrieved from http://www.cred.be/sites/default/file...

Ranse J, Hammad K, Ranse K. (2013). Future considerations for Australian nurses and their disaster educational preparedness: a discussion. Australian Journal of Emergency Management. 28(4):49-53.

Ranse J, Lenson S, Aimers B. (2010). Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting. Collegian. 17(4):153-159

Ranse J, Lenson S, Luther M, Xaio L. (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. Australasian Emergency Nursing Journal. 13(3):46-52.

Ranse J, Lenson S. (2012). Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009. Australasian Emergency Nursing Journal. 15(3):156-163.

Ranse J, Shaban R, Considine J, Hammad K, Arbon P, Mitchell B, Lenson S. (2013). Disaster content in Australian tertiary postgraduate emergency nursing courses: A survey. Australasian Emergency Nursing Journal. 16(2):58-63.

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

United Nations Office for Disaster Risk Reduction (UNISDR). (2009). UNISDR terminology on disaster risk reduction. (UNISDR-20-2009). Geneva.

Usher K, Mayner L. (2011). Disaster nursing: a descriptive survey of Australian undergraduate nursing curricula. Australasian Emergency Nursing Journal. 14(2): 75-80.

World Bank. (2013). Building resilience: Integrating climate and disaster risk into development: Lessons from World Bank Group experience. Washington, DC: The World Bank.


21 February, 2018

Developing public health initiatives through understanding motivations of the audience at mass gathering events



Free full-text article is available here (PDF)

ABSTRACT
This report identifies what is known about audience motivations at three different massgathering events: outdoor music festivals, religious events, and sporting events. In light of these motivations, the paper discusses how these can be harnessed by the event organizer and Emergency Medical Services. Lastly, motivations tell what kinds of interventions can be used to achieve an understanding of audience characteristics and the opportunity to develop tailor-made programs to maximize safety and make long-lasting public health interventions to a particular “cohort” or event population. A lot of these will depend on what the risks/hazards are with the particular populations in order to “target” them with public health interventions. Audience motivations tell the event organizer and Emergency Medical Services about the types of behaviors they should expect from the audience and how this may affect their health while at the event. Through these understandings, health promotion and event safety messages can be developed for a particular type of massgathering event based on the likely composition of the audience in attendance. Health promotion and providing public information should be at the core of any mass-gathering event to minimize public health risk and to provide opportunities for the promotion of healthy behaviors in the local population. Audience motivations are a key element to identify and agree on what public health information is needed for the event audience. A more developed understanding of audience behavior provides critical information for event planners, event risk managers, and Emergency Medical Services personnel to better predict and plan to minimize risk and reduce patient presentations at events. Mass-gathering event organizers and designers intend their events to be positive experiences and to have meaning for those who attend. Therefore, continual vigilance to improve public health effectiveness and efficiency can become best practice at events. Through understanding the motivations of the audience, event planners and designers, event risk managers, and emergency medical personnel may be better able to understand the motivation of the audience and how this might impact on audience behavior at the event.



Hutton A, Ranse J, Munn B. (2018). Developing public health initiatives through understanding motivations of the audience at mass gathering events. Prehospital and Disaster Medicine.

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