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Nurses put hand up for disaster work

If Australia were to experience a nuclear disaster a big majority of emergency nurses say they would be willing and able to respond. By Linda Belardi

Only 30 per cent of emergency nurses said they would be unwilling to respond to a chemical or biochemical event, such as a Japan-like nuclear disaster, a national survey has found.

Professor Paul Arbon, director of the Flinders University Disaster Research Centre and the study's chief investigator, said the personal situation of nurses was most likely to influence their decision-making, especially caregiver responsibilities.

Australia's first large-scale survey of professional preparedness found the major concern to nurses was situations that threaten their own personal safety or the safety of their family. Domestic living arrangements and whether a nurse has a dependent such as an elderly or disabled family member were important factors.

"If they can't return home to look after family or older parents or, indeed, if they do return home and they transmit an infectious disease or in some other way endanger their family - that is of significant concern," Arbon said

A good proportion of emergency nurses also have a partner who is in a role in disaster response, such as fire service or police, which will affect their likely response and sense of personal responsibility.

The research, An analysis of the willingness of Australian emergency nurses to respond to a disaster, comprised a national survey, focus groups and in-depth interviews with 450 emergency nurses at four different hospitals.

Arbon said overall nurses were very willing to respond to a disaster as they see it as part of their professional and moral obligation to their community. He said it was critical to study the attitudes of nurses because they formed the dominant response in a disaster and in the community recovery phase.

"The nursing workforce plays a key role in emergency response and our interest is in their availability and preparedness and the issues that might make it easier or harder for them to attend work."

To overcome these barriers, it is important to build the confidence of nurses to feel that their family can cope effectively in their absence. "It's about pre-planning, providing good advice to support your family and dependents when you are away.

"How an emergency nurse decides whether to go to work or not during a disaster is not a straightforward, linear process - there are many factors at play," Arbon said.

"It is important to understand this, as issues such as family responsibilities and preparedness at home can affect the response of emergency nurses, and could have a significant impact on the ability of the health system to function effectively," he said.

While many Australian nurses have signed up to disaster response efforts overseas, for example in Banda Aceh or the Pakistani floods, locally Australia had very little experience with incidents that totally overwhelm the capacity of hospital systems.

Nurses said they would most likely respond to transport accidents followed by natural disasters, pandemics, a terrorist attack and lastly chemical, biological and radiation disasters.

While emergency nurses have a strong sense of professional responsibility or obligation, they also talked about having the right to make a choice. Competing professional and personal obligations can present nurses with important ethical dilemmas, he said.

"This is a group of nurses who their first response is always, 'of course I'll be there', but it isn't until you do a focus group and interview them that they start to really think it through," Arbon said.

If there are ways to make nurses feel that their families will be supported then many of these tensions can be resolved, he said, adding that childcare arrangements should be considered for nurses in emergency situations.

"There needs to be a step change in how those services are offered for the essential workers in hospitals."

Orientation of nurses in emergency department plans to build confidence will also offer important support.

To improve the confidence of nurses, a number of strategies need to be introduced including the development of a preparedness tool kit.

"We are recommending a program of awareness-raising and education for emergency department nurses about their own personal preparedness at home," Arbon said. Having confidence in department emergency plans is also a critical factor.

The final report was officially launched by South Australia's Health Minister John Hill at the 9th International Conference for Emergency Nurses in Adelaide.

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