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

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. 

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. 

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]

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