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

26 December, 2022

Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): Interrupted time series analysis


Objectives: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. Design Interrupted time series analysis. 

Setting: All 105 Queensland public hospital EDs. 

Main outcome measures: Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 – 30 June 2020) and the period of easing restrictions (1 July 2020 – 30 June 2021), compared with pre-pandemic period (1 January 2018 – 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). 

Results: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, –20.9% to –17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. 

Conclusions: The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.

Sweeny A, Keijzers G, Marshall A, Hall E, Ranse J, Zhang P, Grant G, Huang YL, Palipana D, Teng YD, Gerhardy B, Greenslade J, Jones P, Crilly J. Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): Interrupted time series analysis. Medical Journal of Australia.

31 October, 2022

Experiences of rural and remote nurses during and following disasters: a scoping review

Introduction: Rural and remote nurses are often involved in disaster response. These nurses are faced with unique challenges in their daily practice due to geographical isolation and reduced resources. Nurses’ roles and experiences in times of disaster have been discussed in the past; however, in the setting of rural and remote areas it remains largely underreported. The aim of this article is to provide an overview of the literature regarding the experiences of rural and remote nurses during and following disasters. Disasters affect all areas of the world. 

Methods: This scoping review was guided by Arksey and O’Malley’s methodological framework for scoping reviews. Electronic databases CINAHL, MEDLINE, Scopus, Cochrane, Joanna Briggs Institute and Embase were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Key concepts and themes were identified using Braun and Clarke’s six-step framework for thematic analysis. 

Results: Eight articles met the inclusion criteria for this review. Themes that were identified included disaster roles, pre-disaster preparations, psychological and emotional states, and community involvement and relationships. 

Conclusion: Minimal literature exists that explores what rural and remote nurses experience in times of disaster. In this review, the experience of rural and remote nurses included the relationships between their personal and professional obligations and their influence on nurses’ ability to respond to disasters. Further research is required in this domain to better understand the phenomena and address knowledge gaps that exist in the existing literature. 

Brewer C, Hutton A, Hammad K, Ranse J. Experiences of rural and remote nurses during and following disasters: a scoping review. Rural and Remote Health. 22(4), 7230-7230.

24 June, 2022

Expression of ethical principles in Australia's disaster plans


Objective: This qualitative study explores whether Australian mass casualty and disaster plans explicitly acknowledge or implicitly draw upon ethical principles. 

Methods: Federal, state and territory governmental websites were searched to identify mass casualty incident and/or disaster plans. The authors examined the documents to identify whether ethical principles were overtly stated or implied, and what those values or principles were. 

Results: Ten governmental documents were identified – two federal and one for each of the eight States and Territories. One of the documents had an explicit statement of the ethical values that informed the mass casualty and disaster planning decisions which were present. Utilitarianism was the dominant ethical principle informing the document in another seven documents. 

Conclusion: In Australian government documents for mass casualty and disaster management, although ethics is definitely considered, the ethical principles on which decisions are made are rarely explicit. Mass casualty and disaster decision-making could be improved by making the ethical basis for decision-making clear, transparent and comprehensively reasoned. 

Coco A, Patel B, Jensen M, Ranse J. The Expression of Ethical Principles in Australia's Disaster Plans. Emergency Medicine Australasia. 34(6):989-994.

09 May, 2022

Psychosocial problems and support for disaster medical assistance team members in the preparedness, response and recovery phases of natural hazards resulting in disasters: A scoping review

Background: Clinicians responding to disasters are at risk of experiencing psychosocial problems that can negatively impact them during, upon their return and years after the deployment. Clinicians often respond to disasters as members of organised Disaster Medical Assistance Teams (DMATs). The aim of this paper was to review and synthesise the literature regarding psychosocial problems and support provided to medical personnel in the preparedness, response, and recovery phases of a disaster. 

Methods: A comprehensive search for literature was conducted using four databases: EMBASE; CINAHL; MEDLINE; and PsychInfo. Medical Subject Heading and key terms used in the search included: Disasters; First Responder; Disaster Medical Assistance Team (DMAT); Post-Traumatic Stress Disorder. 

Results: Psychosocial problems were identified amongst DMAT members in all phases (preparedness, response and recovery) of disaster assistance. These ranged from pre-existing stress and anxiety to Post-Traumatic Stress Disorder. Psychosocial support was mostly reported in the recovery phase of the disaster deployment. 

Conclusion: A range of strategies exist to support psychosocial problems DMAT members experience, however, these tend to focus on the recovery phase of deployment with limited focus on preparedness and response phases. Further research is required to identify, implement, and evaluate short and long term psychosocial support needs and strategies for DMAT members in all phases of a disaster deployment. 


17 April, 2022

Disaster education in undergraduate nursing curriculum: A Delphi study to prioritise content for nursing students

Background: When a disaster occurs, a health response must adapt to meet the needs of the community. Nursing students may be able to assist in supporting the nursing workforce to meet the community’s health needs during and/or following a disaster. However, there is a paucity of literature regarding the educational needs of nursing students regarding disaster preparedness. Further, the disaster-related content that is important to be included in undergraduate nursing curricula is poorly understood. 

Methods: This study used a modified three-round Delphi design guided by the principles of the Guidance on Conducting and REporting DElphi Studies. Data was collected from Australian clinical and academic nurses via online surveys. Analysis was undertaken using descriptive statistics including means of central tendency, with disaster content topic areas and statements considered a priority if they obtained a mean score of four out of five, or greater. 

Results: A total of 38 nurses participated in this study. Across the three rounds, eight topic areas and 37 different statements were included. High priority statements for topic inclusions in undergraduate curricula were “disaster knowledge,” “assessment and triage,” “critical thinking,” and “technical skills.” Additionally, statements relating to “mental wellbeing” and “teamwork in stressful situations” were ranked as the highest. 

Conclusions: Disaster-related content should be included in undergraduate nursing curricula. This content could be embedded within existing units of study and/or delivered as a standalone unit of study. The educational method for delivering disaster content could vary from a didactic approach to simulation exercises depending on the content and local context.

Ranse J, Ituma W, Bail K, Hutton A. Disaster education in undergraduate nursing curriculum: A Delphi study to prioritise content for nursing students. Collegian. 29(5):590-597

14 April, 2022

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


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.

24 March, 2022

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]

10 February, 2022

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


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

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