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

ABSTRACT 

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. 

REFERENCE

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.

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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. 

Full-text article is available here (PDF)

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]

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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

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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]

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Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events

Free full-text article is available here (PDF)

ABSTRACT

Aim: This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.

Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.

Results: In total, 39 manuscripts were identified that met the inclusion criteria. Conclusion: In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).



Hutton A, Ranse J, Grey K, Turris S, Lund A, Munn BM. (2019). Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events. Prehospital and Disaster Medicine.

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Environmental factors at mass-gathering events: Considerations for health research and evaluation

ABSTRACT

Introduction:
This poster will document the environmental domain variables of a mass gathering. They include factors such as the nature of the event, availability of drugs or alcohol, venue characteristics and meteorological factors.

Method:
A systematic literature was used to develop a set of variables and evaluation regarding environmental factors that contribute to patient presentation rates.

Results:
Findings were grouped pragmatically into factors of crowd attendance, crowd density, venue, type of event, mobility, and meteorological factors.

Discussion:
This poster will outline a set of environmental variables for collecting data at mass gathering events. The authors have suggested that in addition to commonly used variables, air quality, wind speed, dew point, and precipitation could be considered as a data points to be added to the minimum standards for data collection.


Hutton, A., Ranse, J., Lund, A., Turris, S., Munn, B., Gray, K. (2019). Environmental factors at mass-gathering events: Considerations for health research and evaluation. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 7th May.

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Measuring the masses: Guidelines for publication of case reports on mass gatherings

ABSTRACT

Introduction: 
The science supporting event medicine is growing rapidly. In order to improve the ability of researchers to access event data and improve the quality of publishing mass gathering cases, it would be of benefit to standardize event reports to permit the comparison of similar events across local and national boundaries. These data would support the development of practice standards across settings.

Aim:
The authors propose the creation of a publication guideline to support authors seeking to publish in this field.

Method:
Derivation study via analysis of published case reports using the Delphi process.

Results:
Data elements were inconsistently reported within published case reports. Categories of variables included: event demographics (descriptors of date, time, genre, activity, risks), attendance and population demographics, data related to climate and weather conditions, composition and deployment of an onsite medical team, highest level of care available onsite, patient demographics, patient presentations and measures of impact on the local health care system such as transfer to hospital rates. Of note, there was a high incidence of “missing” variables that would be of central interest to researchers.

Discussion:
Approaches to standardizing the collection and reporting of data are often discussed in the health care literature. The benefits of consistent, structured data collection are well understood. In the context of mass gathering event case reporting, the time is ripe for the introduction of a guideline (with accompanying guidance notes and dictionary). The proposed guideline requires the input of subject matter experts (in progress) to enhances its relevance and uptake. This work is timely as there is ongoing work on improving an international event medicine registry. If the evolution of both proceeds in lockstep, there is a good chance that access to a rigorous data set will become a reality.



Turris, S., Rabb, H., Callaghan, C., Munn, M. B., Ranse, J., Lund, A., Chasmar, E. (2019). Measuring the masses: Guidelines for publication of case reports on mass gatherings. Poster presented at the 22nd World Congress on Disaster and Emergency Medicine, Brisbane, 8th May.

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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.

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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

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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):

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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.

Aim: This literature review aims to develop an understanding of the impact of mass gatherings on local health services.

Method: 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 utilisation.

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.

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. (2016) Health service impact from mass-gatherings: A systematic literature review; paper presented at the 14th International Conference for Emergency Nurses. Alice Springs, Australia. 20th October.

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National consistency in industrial awards for disaster release for Australian Nurses: An integrative review of enterprise agrrangements

Free full-text article is available here (PDF)

ABSTRACT
This research explores the types of provisions made available to nurses within Australian public employment agreements to respond to disasters and alternate provisions made available to provide personal property protection and personal care during a disaster. An integrative literature review methodology is used to collect, evaluate, analyse and integrate sources of evidence to inform a discussion on the current enterprise arrangements for nurses with respect to eight Australian jurisdictions. These were evaluated for the industrial provisions made available to nurses wanting to assist in responding to disasters. Only five of these agreements mentioned provisions for nurses to assist in disasters. Where these provisions exist, they vary in their consistency, terminology and the quantity of the entitlements, potentially leading to inequality and variability in the financial support frameworks for nurses involved in disaster events.



Lenson S, Ranse J, Cusack L. (2014). National consistency in industrial awards for disaster release for Australian nurses: An integrative review of enterprise arrangements. Asia Pacific Journal of Health Management. 9(2):53-58.

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Enhancing the minimum data set for mass-gathering research and evaluation: An integrative literature review

Free full-text article is available here (PDF)

ABSTRACT:
Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required.

Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework.

Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS.

Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature.


Ranse J, Hutton A, Turris S, Lund A. (2014). Enhancing the minimum data set for mass gathering research and evaluation: An integrative literature review. Prehospital Disaster Medicine. 29(3):1-10.

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What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature

Free full-text article is available here (PDF)

ABSTRACT

Background: An earthquake and tsunami hit the east coast of Japan on March 11, 2011. Nurses were actively involved in the health response to this disaster and, subsequently, many authors have reported on the role nurses played in these efforts in Japanese nursing professional journals.

Aim: To describe the role of nurses who assisted in the 2011 Great East Earthquake of Japan by reviewing Japanese literature and reporting the findings in English.

Method: This research used an integrative literature review methodology. Manuscripts were obtained from the Japanese database Ichushi Ver. 5 (Japan Medical Abstracts Society, Tokyo, Japan). A total of 44 manuscripts were identified and included in a thematic analysis.

Results: Three main themes were identified: (1) nursing roles, (2) specialized nursing roles, and (3) preparedness education. Nurses fulfilled different roles in the period after the disaster (ie, as a clinician, a communicator, a leader, and a provider of psychosocial support). Additionally, the specialized nurse role was identified, along with the need for preparedness education to support the nurse’s role in a disaster.

Conclusion: The understanding of the role of nurses in disasters is expanding. There is a need to further explore the roles of specialized nurses in disasters. Further disaster education opportunities should be available as a part of continuing education for all nurses. Radiation aspects of disaster assistance should be included in disaster education programs where there are radio-nuclear hazards present in the environment

Kako M, Ranse J, Yamamoto A, Arbon P. (2014). What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature. Prehospital Disaster Medicine. 29(3):1-5.

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Industrial considerations for Australian nurses responding to disasters

This presentation was undertaken by Shane Lenson.


ABSTRACT
Within the Australian out-of-hospital environment, nurses have been deployed from various States and Territories to assist in the response to events such as the Victorian Bushfires [2009] and the Queensland floods [2011]. Similarly, nurses have been deployed overseas to assist in events including the Christchurch earthquake [2011] and Sumatra-Andaman earthquake and tsunami [2004]. Nurses are likely to continue in the health response to a disaster. However, consideration needs to be given to the industrial agreements for nurses when released from their normal employment arrangements to assist in disastrous events.

An integrative literature review methodology was used to collect, evaluate, analyse and integrate sources of evidence to inform this discussion on the current enterprise arrangements for nurses with respect to disaster response. Nursing and midwifery public sector enterprise agreements were sourced from each of the eight Australian jurisdictions. These were evaluated for the industrial provisions made available to nurses wanting to assist in responding to disasters.

Only five enterprise agreements mentioned provisions for nurses to assist in disasters. Where these provisions exist they vary in the their consistency, terminology and the quantity of the entitlements potentially leading in inequality and variability in the financial support frameworks of nursing involved in disaster events.

There is no national approach by nursing industrial organisations to standardise provisions related to an emergency event or disaster. Those agreements that had provisions were notable in their variability in the definition of disasters and the terminology used to define the entitlements for nurses willing to respond to disasters. This variability may leads to inequity and sustainability of nurses who are willing to respond to disaster with nurses sent from some states or territories being financially supported compared to nurses from other regions possibility not being renumerated for undertaking the same role and responsibilities.

Lenson S, Ranse J, Cusack L. (2013). Industrial considerations for Australian nurses responding to disasters; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

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Biomedical data collection for mass gathering research and evaluation: A review of the literature

ABSTRACT
Internationally, planned events such as mass gatherings occur frequently. Known factors influencing the usage of health services, or patient presentations, at mass-gatherings are acknowledged within the environmental, psychosocial and biomedical domains. Health-related research and evaluation from mass gatherings commonly include biomedical information pertaining to patient presentations. The aim of this research was to review the various categorisations reported by authors to describe the patient populations at mass-gatherings, with a focus only on the biomedical domain.

This research utilised an integrative literature review methodology to identify papers from within the last ten years that included research or evaluation from a mass-gathering event in which the authors included published biomedical information.

Numerous papers were identified that included information pertaining to biomedical information from mass gathering events. It was noted that the coding and categorisation of patient-level biomedical information seems inconsistent, varied, haphazard and author dependent.

Recently, there has been literary discussion about the need for consistency and consensus in reporting on biomedical information. This literature review supports this notion. In particular, this presentation builds on a previously published minimum data set proposed by Ranse and Hutton and enhances it by including additional categorisations of biomedical information. As such, a revised minimum data set with a data dictionary is proposed in an effort to generate conversation about a possible agreed minimum amount and the type of information that should be collected consistently for research and evaluation at mass gatherings.


Ranse J, Hutton A. (2013). Biomedical data collection for mass gathering research and evaluation: A review of the literature; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

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