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

13 August, 2021

Phenomenology of Australian civilian hospital nurses’ lived experiences of the out-of-hospital environment following a disaster


ABSTRACT

Background: Disasters disrupt the fabric of communities. This includes disruption to the healthcare system that supports a disaster-affected community. Nurses are important members of disaster response teams. However, there is limited literature that describes nurses’ roles or experience in responding to disasters. 

Aim: This paper employs a phenomenological approach to uncover moments of being an Australian civilian hospital nurse in the out-of-hospital environment following a disaster. 

Method: This study uncovers moments of what it is like being an Australian civilian hospital nurse deployed to the out-of-hospital environment following a disaster. Individual interviews were undertaken at two points in time with each participant. Audio-recorded interviews were transcribed to textual narratives, which was then analysed. Several activities were undertaken to uncover moments and provide exemplars of moments, from the narrative. 

Findings: Eight hospital nurses participated in this study. Five moments were uncovered: ‘on the way to a disaster’, ‘prior to starting work’, ‘working a shift in a disaster’, ‘end of a shift’, and ‘returning home’. Each moment has its uniqueness and singularity exemplifying an experience of nurses in the out-of-hospital disaster environment. 

Discussion: When compared to a hospital context, assisting during and/or following a disaster in the out-of-hospital environment is challenging. For example, nurses may need to do more with less resources, provide more frequent psychosocial support for more extenuating circumstances, and experience an unsettling return home at the end of the deployment. 

Conclusions: This paper has provided new insights into what it may be like being an Australian civilian hospital nurse in the out-of-hospital disaster environment as part of a disaster medical assistance teams. Strategies to support nurses who assist during and/or following a disaster are important, so nurses can in turn provide care to people in disaster-affected communities.


16 July, 2021

Novel respiratory viruses in the context of mass-gathering events: A systematic review to inform event planning from a health perspective



ABSTRACT 
Background: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

Method: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

Results: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

Conclusions: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.


Ranse J
, Beckwith D, Khan A, Yezli S, Hertelendy A, Hutton A, Zimmerman PA. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective. Prehospital and Disaster Medicine. [in-press]

02 June, 2021

Disaster education for Australian nursing students: An integrative review of published literature to inform curricula

ABSTRACT

Background: Globally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster. 

Aim: To explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters. 

Method: This study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted. 

Results: A total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum. 

Discussion: This review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools’ curriculum. Conclusion The incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.


The full-text article is available here (PDF)


Ituma W, Ranse J, Bail K, Hutton A. Disaster education for Australian nursing students: An integrative review of published literature to inform curricula. Collegian

21 May, 2021

Disaster preparedness: A concept analysis and its application to the intensive care unit


Objectives: The aim of the study is to understand the concept of disaster preparedness in relation to the intensive care unit through the review and critique of the peer-reviewed literature. 

Review method used: Rodgers' method of evolutionary concept analysis was used in the study. Data sources: Healthcare databases included in the review were Cumulative Index to Nursing and Allied Health Literature, Public MEDLINE, Scopus, and ProQuest. Review methods: Electronic data bases were searched using terms such as “intensive care unit” OR “critical care” AND prep* OR readiness OR plan* AND disaster* OR “mass casualty incidents” OR “natural disaster” OR “disaster planning” NOT paed* OR ped* OR neonat*. Peer-reviewed articles published in English between January 2000 and April 2020 that focused on intensive care unit disaster preparedness or included intensive care unit disaster preparedness as part of a facility-wide strategy were included in the analysis. 

Results: Eighteen articles were included in the concept analysis. Fourteen different terms were used to describe disaster preparedness in intensive care. Space, physical resources, and human resources were attributes that relied on each other and were required in sufficient quantities to generate an adequate response to patient surges from disasters. When one attribute is extended beyond normal operational capacities, the effectiveness and capacity of the other attributes will likely be limited. 

Conclusion: This concept analysis has shown the varied language used when referring to disaster preparedness relating to the intensive care unit within the research literature. Attributes including space, physical resources, and human resources were all found to be integral to a disaster response. Future research into what is required of these attributes to generate an all-hazards approach in disaster preparedness in intensive care units will contribute to optimising standards of care. 



REFERENCE 
Sellers D, Crilly J, Ranse J. Disaster preparedness: A concept analysis and its application to the intensive care unit. Australian Critical Care. [in-press]

19 May, 2021

Planning and assessment approaches towards disaster resilient hospitals: A systematic literature review


Background: Hospitals play a critical role as a frontline agency in disasters, with staff often working within extraordinary circumstances in these facilities to deliver care. This study was inspired by the authors’ interdisciplinary experiences in health and resilience engineering. Observing increasing dialogue about how hospitals could improve their resilience to disasters we sought to understand the construct of ‘hospital resilience during disasters’ and how it could be improved. 

Method: The study involved a systematic literature review of publications related to hospital resilience during disasters, conducted at the end of January 2020. Of the 553 articles found initially, 49 remained after applying inclusion and exclusion criteria. Quality appraisal tools designed for different types of research were used. 

Results: The findings are described using language and constructs drawn from the Plan-Prepare-Respond-Recover (PPRR) discourse and Resilience Engineering Theory. The review found broad consensus that staff awareness, education, and training about disaster-related plans needs to be improved. The articles documented a wide variety of approaches to evaluating hospital resilience to disasters, wherein the importance of infrastructure and organisational resilience is clear. This included insightful guidance for developing, disseminating, communicating, and implementing disaster plans. 

Conclusion: Through distilling the literature review findings, we propose a ‘Decision-Support Model for Disaster Resilient Hospitals’ to foster proactive and systemic improvements, from anticipating to managing and monitoring organisational performance during disasters. We also propose a hybrid of two methods towards a more holistic evaluation of hospital disaster resilience. The findings have immediate implications for supporting hospital leadership strategically and operationally. 




REFERENCE
Ali HM, Desha C, Ranse J, Roiko A. Planning and assessment approaches towards disaster resilient hospitals: A systematic literature review. International Journal of Disaster Risk Reduction. [in-press]

05 March, 2021

Drug- and alcohol-related emergency department patient presentations during the 2018 Commonwealth Games: A multi-site retrospective analysis




Objective: To examine the impact of the 2018 Commonwealth Games on ED patient presentations related to drug(s) and/or alcohol. 

Methods: Retrospective observational study comparing ED patient presentations made pre, during and post the 2018 Commonwealth Games with either an International Classification of Diseases-10 diagnosis or presenting complaint related to drug and or alcohol misuse. 

Results: Drug- and alcohol related presentations accounted for 5% (n = 890) of all ED presentations across the 36-day study period with no significant difference between pre (n = 312), during (n = 301) and post (n = 277) periods (P = 0.2). Overall, drug- and alcohol-related patient presentations made to the EDs tended to be young (median age 35 years, interquartile range 24–48), Australian (n = 820, 92%) and male (n = 493, 55%). The majority arrived by ambulance (n = 650, 73%), were allocated an Australasian Triage Scale category of 3 (n = 505, 57%), and arrived between 15.00 and 22.59 hours (n = 365, 41%). No demographic characteristics, ED characteristics or outcomes differed significantly over time. 

Conclusions: During the 2018 Commonwealth Games, minimal impact on the ED was noted pertaining to drug and alcohol misuse. Further research is required to understand whether this held true for other types of ED presentations and during other types and locations of mass gathering events.



Delany C, Crilly J, Ranse J. (2021). Drug- and alcohol-related emergency department patient presentations during the 2018 Commonwealth Games: A multi-site retrospective analysis. Emergency Medicine Australasia.

19 February, 2021

Measuring the masses: A series of papers


I was part of an international team that published a number of papers relating to mass gatherings. These papers focused on the need for consistency in the reporting of mass gathering events from a health perspective. These papers were published in a series in the journal Prehospital and Disaster Medicine. The various papers in this series are listed below.


REFERENCES
Lund A, Turris S, Rabb H, Munn MB, Chasmar E, Ranse J, Hutton A. (2021). Measuring the masses: mass gathering medical case reporting, conceptual modelling – The DREAM model (Paper 5). Prehospital and Disaster Medicine. Full-text article available here (PDF)

Turris S, Rabb H, Chasmar E, Munn MB, Callaghan CW, Hutton A, Ranse J, Lund A. (2021). Measuring the masses series: A proposed template for post-event medical reporting (Paper 4). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Lund A, Munn MB, Chasmar E, Rabb H, Callaghan CW, Ranse J, Hutton A. (2021). Measuring the masses series: Domains driving data collection and analysis for the health outcomes of mass gatherings (Paper 3). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Rabb H, Chasmar E, Callaghan CW, Ranse J, Lund A. (2021). Measuring the masses: Understanding health outcomes arising from mass gatherings, reporting gaps and recommendations (Paper 2). Prehospital and Disaster Medicine. Full-text article available here (PDF) 

Turris S, Rabb H, Munn MB, Chasmar E, Callaghan CW, Ranse J, Lund A. (2021). Measuring the masses: The current state of mass gathering medical case reporting (Paper 1). Prehospital and Disaster Medicine. Full-text article available here (PDF)

22 January, 2021

The impact of Chemical, Biological, Radiological, Nuclear and Explosive events on Emergency Departments: An integrative review

 

I was invited to speak at the Qatar Health 2021 conference on the topic of disaster health. This presentation focused on the findings of an integrative literature review relating to Chemical, Biological, Radiological and Nuclear [CBRN] events and their impact on Emergency Departments [EDs]. The literature review aimed to identify papers relating to the impact of CBRN events on ED and to analyze these papers for lessons learnt to strengthen ED preparedness. The presentation explored the global epidemiology of disasters, the nature of CBRN events, ED preparedness, clinician education, willingness and resources. The Qatar Health 2021 conference theme related to mass gathering events. As such, this presentation discussed the intersect between ED preparedness for CBRN events in the context of mass gathering events. 

REFERENCE 
Ranse J. (2021). The impact of Chemical, Biological, Radiological, Nuclear and Explosive events on Emergency Departments: An integrative review; invited speaker for Qatar Health 2021, Doha, Qatar, 22nd January. [online]

Recommencing mass gathering events in the context of COVID-19: Lessons from Australia


I was invited to speak at the Qatar Health 2021 conference on the topic of mass gathering events. This presentation focused on the recommencement of mass gatherings in the Australian context. In particular, this presentation focused on the Australian COVID-19 epidemiology, an overview of mass gathering events and COVID-19 in Australia, case studies from national and grass-root sports, and strategies for recommending mass gathering events during COVID-19. 

REFERENCE 
Ranse J. (2021). Recommencing mass gathering events in the context of COVID-19: Lessons from Australia; invited speaker for Qatar Health 2021, Doha, Qatar, 22nd January. [online]



21 January, 2021

Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective


I was invited to speak at the Qatar Health 2021 conference on the topic of mass gathering events. This presentation focused on a review of the literature regarding novel respiratory viruses in the context of mass gathering events. This presentation synthesised the literature relating to SARS-CoV-1, H1N1pdm09, and SARS-CoV-2 (COVID-19) in the context of mass gathering events.  Previously published infection prevention and control strategies were presented against a framework of pre, during, and after mass gathering event considerations. These infection preventions and control strategies o have implications for both event organisers and health officials when recommencing events in the context of COVID-19.



Ranse J. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective; invited speaker for Qatar Health 2021, Doha, Qatar, 21st January. [online]





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