RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
01 / NAME OF THE CANDIDATE AND ADDRESS / MS. SUBAJA KUMARIIst YEAR MSc NURSING
ACHARYA COLLEGE OF NURSING, BANGALORE.
02 / NAME OF THE INSTITUTION / ACHARYA COLLEGE OF NURSING
BANGALORE
03 / COURSE OF THE STUDY AND SUBJECT / M.Sc NURSING Ist YEAR
MEDICAL AND SURGICAL NURSING
04 / DATE OF ADMISSION TO COURSE / 30-06-2008
05. / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVESNESS OF STRUCTURED TEACHING PROGRAM REGARDING THE KNOWLEDGE AND ATTITUDE OF DISASTER PREPAREDNESS AMONG THE STAFF NURSES IN SELECTED HOSPITALS AT BANGALORE.
BRIEF RESUME OF INTENDED WORK
“THINKING ABOUT THE UNTHINKABLE”
6. INDRODUCTION
A disaster is any natural event that overwhelms a community, district or country’s ability to respond.
In 2002, more disasters were reported than in any year of the preceding decade. Fortunately the disasters appeared less deadly than before- 24,500 people were reported killed, compared to the decade’s average of 62000 per year. But they had more impact than ever.. 608 million people were affected, which was 3 times the annual average from 1992 to 2001. Drought in INDIA alone affected 3 million people during 20021
There are many types of disasters such as earth quakes, cyclones, floods, tidal waves, land slides, volcanic eruptions, tornadoes, fires, hurricanes, snow storms, severe air pollution, heat waves, famines, epidemics, building collapses, toxicological accidents (eg: release of hazardous substances), nuclear accidents and warfare2
A disaster may cause an unexpected number of deaths, injury or illness. They may destroy local health infrastructure such as hospitals which will therefore not be able to respond to the emergency. It disrupts the provision of routine health services and preventive activities leading to long term health consequences in terms of increased morbidity, mortality, adverse effect on the environment, potential risk of communicable diseases and environment hazards3.
Medical treatment for a large number of causalities are likely to be needed only after certain types of disasters. Most injuries are sustained during the impact and thus the greatest need for emergency care occurs in the first few hours. The management of mass casualties can be further divided into search and rescue, first aid, triage and stabilization of victim, hospital treatment and redistribution of patients to other hospitals if necessary.
Disaster preparedness is an on going multisectoral activity. It forms an integral part of the national system responsible for developing plans and programmes for disaster management, prevention, mitigation, preparedness, response, rehabilitation and reconstruction2.
A critical responsibility of a nurse is to manage in times of crisis and disaster. While natural disasters cannot be prevented, important steps can be taken before a disaster strikes to minimize the extent of damage. Disaster preparedness is every one’s responsibility. It is equally important to be prepared when a disaster strikes and to know where to turn for help and the steps to be taken to begin the recovery following a disaster 4
Nurses should remember that nursing care in a disaster focuses on essential care from a perspective of what is best for all patients.
New settings and atypical roles for nurses arise during a disaster. The nurse may provide shelter care in a temporary housing area or bereavement support and assistance with identification of deceased loved ones. Individual may require crisis intervention, or the nurse may participate in counseling other staff members and in Critical Incident Stress Management (CISM).
Nurses can assist disaster victims by providing active listening and emotional support, giving information, and referring patients to a therapist or social worker. Healthcare worker must refer individuals to mental health care services, because experience has shown that few disaster victims seek this service and early intervention minimizes psychological consequences. Nurses can also encourage them to return to normal activities and social roles when appropriate5
In a Rapidly changing world facing natural and man-made disasters as well as threats of terrorism and pandemics, nurses will be needed to serve in the event of a disaster. Since nurses make up the largest portion of the health care workforce in the country, it is critical that nurses in all specialty areas are trained in disaster nursing. Nurses are an increasingly important part of disaster response. There is an urgent need to expand their knowledge base and experience in disaster nursing.
6.1. NEED FOR THE STUDY
Disastersare not confined to a particular part of a world. They can occur anywhere and anytime2.
The types of emergencies vary according to the kind of disaster and how and when itstrikes3.
From 1999 to 2003 reported disasters averaged 707 disasters each year up to two – thirds from the previous five years. Globally, 818 people have been killed by earth quakes in 2004 as of Friday according to the US Geological survey. Mean while more than 100 people in the continental United States were killed by hurricanes during summer. The storms killed 1000 in the Caribbean in one of the worst Atlantic hurricane seasons on record. The cost of the hurricanes, as measured by insured losses, is expected to exceed dollar 18 billion
Comparing the decades 1983 to 1992 and 1993 to 2002 reported global deaths from natural and technological disasters have fallen by 38 percent. However numbers of people reported affected have risen by 54 percent over the same period1.
INDIA is a highly disaster prone country in Asia-pacific region with an average of 8 major natural calamities a year, where floods, cyclones, draughts, earth quakes and epidemics are frequent from time to time2
The tsunami disaster in the Indian Ocean is one of the worst natural disasters in modern times. Well over200,000 people died and more then 1.5 million people lost their homes and also their livelihoods. Losses are estimated to total more than US dollar 7 billion6.
The recent earthquakes in Gujarat, India on 26th January 2001, was the worst earthquake of the decade. The impact of the earthquake was felt in the neighboring Pakistan and Afghanistan too. Asia and the pacific are among the most disaster-prone regions in the world. According to world disaster 41 percentage of people killed, 88 percentage affected, 87 percentage rendered homeless and 78 percentage injured during 1993 to 1997. 7
India also saw worlds worst man made disaster in 1984, when methyl isocyanides gas leaked at Union Carbide Pesticide Plant in Bhopal killing about 3000 people. People are still suffering from a variety of diseases as an after effect of this tragedy2.
Seven serial bomb blast rocked Nayandahalli, Madivala, Adugodi areas of Bangalore city on Friday August 2008. One woman was killed and several have been injured. Bangalore has experienced several minor earthquakes in the 20th century. The recent terror attacks in November 2008 on a number of luxury hotels in Mumbai has let to a large number of casualties. Karnataka experienced a water famine in the summer of 2004, following failure of rains in the state for the third consecutive year in 2003.
The responsibilities of a Nurse are to preserving open lines of communication, providing good quality patient care, providing current education regarding disaster, influencing policies and financial decisions and providing security for staffs, patients and families8.
The majority of the medical staff did not know their roles as well as the role of their hospitals in case of a chemical accident. Nurses realize they are too vulnerable to the effects of an emergency situation and they can be protected from enduringpsychosocial effects.
Nursing education must ensure that graduates are prepared with the necessary knowledge and skills for mass causality incidents. Training, interventions for healthcare providers are effective in improving knowledge and skills in disaster response. So nurses need sound knowledge regarding disaster preparedness and related care during disaster. Therefore researcher should be motivated to the study regarding preparedness for disaster.
6.2: REVIEW OF LITERATURE:
The review of literature entails the systematic identification, reflection, critical analysis and reporting of existing information in relation to the problems of interest. The purpose of review of literature is to obtain comprehensive knowledge and in depth information about effectiveness of structured teaching programme on Disaster preparedness.
The literature gathered from extensive review is depicted under the following headings.
Section A: Studies related to Disaster
Section B: Studies related to disaster preparedness
Section C: Studies related to effectiveness of structured teaching programme on disaster preparedness.
Studies related to disaster.
A study was conducted to evaluate the effect of the earthquakes on the health practices in the rural town of San Sebastian. They used a convenient sample survey of subjects affected by the earthquakes. The sample included 594 people within 100 households. The 32 question survey assessed post earthquake conditions in the areas of health care and access to care, housing, food, water and sanitation. The result has shown that communicable diseases affected a number of family members. After the earthquakes, 38% of households reported new injuries and 79% reported acute exacerbations of chronic illness9.
A prospective study was conducted on disaster and subsequent health care utilization among victims of their family members and control subjects. The study results implies that (95% C I, 1.35-1.78) uninjured victims contact the family practitioner more often for mental health problems than adolescent community control subject (95% C I,1.69-12.20).In the adult family members in loss of child predicts overall utilization (95% C I, 1.35-2.63) and utilization for mental health (95% C I,2.10-35.92) during the first year post fire. The study concluded that attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster. 10
A study was conducted on health services useful for earthquake- related psychological problems resulting from the 1999 earthquakes in Turkey. A random sample of 2007 survivors was assessed in too sites , using self- report measures of traumatic stress, depression and use of health services .The results show that earthquake survivors who need treatment might not be receiving it .11
A study was conducted on Hurricane-related orthopedic surgical admissions to an emergency department in December 1999.They examined records of all patients treated at the emergency department in the same time interval on the first three Fridays in December from 1994 to1998. 68% of the recorded injuries were injuries to the upper and lower extremities and 22% of the head and neck. The study concluded that Hurricanes can lead to substantial morbidity and mortality. Early warning is the most effective way of reducing the number of deaths and injury. People should seek cover and follow the instructions given by the news media. Educational programs for the medical staff of the emergency department should be made available.12
Studies related to disaster preparedness:
A study was conducted to examine the hospital preparedness for incidents involving chemical or biological weapons. They used questionnaire survey of 224 hospitals, emergency departments in 4 northwestern states and they examined administrative plans, training, physical resources and representative medication inventories. The result has shown that hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism.13
A pilot study was conducted to assess the effectiveness of disaster conferences among 200 health care providers. The result has shown that among the 200 respondents, registered nurses (37%) and physicians (24%) were the largest categories of providers. Basic clinical care(39%) and triage (26%) were the most frequent response skills reported; the areas wherein respondents felt least prepared were disaster- specific response skills (22%) and systems issues (34%). Only 22% respondents reported that they did not know a specific skill. They made 495 individual recommendations for future responders, including actions to improve the respondent’s personal preparedness (23%) and the need for training (25%). 14
A study was conducted to describe the disaster preparedness concerning personnel at the hospitals. Questionnaire was sent to the chief doctor and chief nurse for the involved department, and a personal questionnaire was sent to all the doctors and nurses in the region, who had participated in one or more courses in disaster medicine during the period 1990-1995. The findings have shown that 7% of the residents, 29% of the senior residents and 56% of consultants, 33% of the Nurses had taken a course in disaster medicine. Only 15% had taken more than one course, and as few as 2% had a follow up course to primary one given in the region. 41% had used their acquired knowledge either in theory or practice: 55% for educational purposes, 11% for disaster planning and 12% for buying equipment for the hospital.15
A study was conducted on assessment of emergency preparedness. They used questionnaires, observation, and interviews to gather data. The target population was comprised of 10 professional cohorts: physicians, nurses, public health and mental health professionals, health educators, veterinarians, pharmacists, dental professionals, law enforcement and emergency/ fire personal. The findings revealed that the highest awareness and knowledge levels occurred with physicians, nurses and public health professionals. On- site coordination and communication systems were the weakest aspects of coordinated community response.16
A Study was conducted on mental health and psycho-social aspects in disaster preparedness in Nepal. Nepal has high venerability to natural disasters. Floods, land slides and earthquakes are the most regularly occurring disasters in Nepal. There is a health sector emergency and disaster response plan of the ministry of health. But mental health and psycho-social relief is not adequately addressed in this plan. They concluded that further strengthening of the mental health and psycho social aspects of disaster preparedness is needed17.
Studies related to effectiveness of structured teaching programme on disaster preparedness:
A study was conducted to assess the effectiveness of emergency preparedness training for medical students and other health care professional students. The students were assigned roles in small groups such as community physicians, hospital personnel, public health officials, veterinarians, school nurses and emergency managers about training. They concluded that experiential exercise is an effective, inexpensive, and easily adapted tool for promoting multiple competencies in mass health emergency preparedness for a varsity of health care students.18