Nurses' preparedness, readiness and competencies for critical incidents to meet the needs of vulnerable clients in Hong Kong

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Nurses' preparedness, readiness and competencies for critical incidents to meet the needs of vulnerable clients in Hong Kong

 

Author: Fung, Wai Man Olivia
Title: Nurses' preparedness, readiness and competencies for critical incidents to meet the needs of vulnerable clients in Hong Kong
Degree: D.H.Sc.
Year: 2012
Subject: Nurses -- China -- Hong Kong.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xix, 224 leaves : col. ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2551430
URI: http://theses.lib.polyu.edu.hk/handle/200/6837
Abstract: Background: Unforeseen adverse happenings in a society can cause widespread destruction leading to human suffering, properties loss, injuries and death tolls. While humans do not have the ability to escape from disastrous critical incidents, being prepared can reduce its damaging impacts. Nurses have its important roles to provide care before, during and after a critical incident by their participation in prevention, mitigation, and relief operations. Due to lack of education and systematic training, not many nurses in Hong Kong are prepared or ready to deal with critical incidents, their ability to meet the needs of vulnerable clients in the community they served are also uncertain. Aims: This study aims to examine Hong Kong nurses' preparedness, readiness and competencies for critical incidents to protect themselves, their families and the health of the community vulnerable groups such as families with young children and the elderly. Design and Method: This research project used a mixed study method. A series of cross-sectional quantitative studies were done using various questionnaires to explore Hong Kong nurses' preparedness at home as well as their preparedness and readiness to report to work when critical incident strikes. The preparedness of vulnerable community groups including families with young children and the elderly for unforeseeable adverse happenings were explored. Focus group interviews were conducted to collect nurses' perceived professional competencies if critical incidents strike. Three groups of nurses working in the critical care setting, the general medical and surgical wards and the community health setting were selected for interviews in a qualitative study. Nurses from the three working areas were also invited to list the competencies required for critical incident in form of written inquiry.
Results: A total of 433 practicing nurses were responded to the quantitative part of the study that solicit information on nurses' perception of disasters, their preparedness and willingness to report to work. For the study of nurses' perception and preparedness (n=164), almost all nurses (97.6%) considered the Hospital Authority to be the organization most involved in disastrous situations followed by the police force (97.0%) and the fire department (95.7%). The top three unfortunate events nurses considered as most likely to happen in Hong Kong are major fires in tall buildings (61.6%), infection disease outbreaks (61%) and stampedes resulting from overcrowding (48.8%). Majority of the respondents (94%) felt inadequately prepared to handle disaster at work. They recognized that a protocol for disaster management (85.4%) and training courses and drills for disasters (both at 84.1%) are useful tools for preparing them to deal with disastrous critical incidents. In the nurses' readiness at home and readiness to report to work study (n=269), during a disaster that may threaten the safety of nurses' family members, only 68.7% of nurses were willing to report to work, while 20.8% will not report to work. In a life threatening infection disease outbreak, only half (53.2%) will report to work, while 30.1% of them will not report to work. Influencing factors of nurses' decision whether to report to work including the type of disaster (p=0.0002), the gender difference (p=0.002) and having children at home (p=0.033). Three focus groups of nurses were selected for interview in a qualitative study. To substantial the interviewed data, a written inquiry was then conducted among thirty nurses from the three selected clinical areas. Based on the International Council of Nursing (ICN) disaster competencies with four main themes (prevention, preparedness, response and recovery) were used to code and categorize the nurses' perceived competencies. A total of 15 nurses were interviewed and 30 more nurses were invited to complete the written inquiry. The nurses had 3 to 28 years of clinical experience. The domains mostly focused by Hong Kong nurses were on disaster implementation. In contrast, the domains of ethical and legal practice during disaster were mostly neglected. Both the families with young children and the elderly were not adequately prepared for disasters. For the study of families with young children (n=220), families reported having stocked up on 'young children's necessities' (82.8%, 73.7%) and 'medications' (82.8%, 60.1%) sufficient for 3 and 7 days respectively. These families also kept a flashlight with adequate batteries (74.7%), extra blankets (69.2%), and a first aid kit (60.6%) at home for safety. They reported 'panic buying' for necessities during previous typhoon strikes (68.2%) and infectious disease outbreaks (46.0%). However, only 9.1% families considered themselves adequately prepared for disasters. In the study of the elderly (n=1137), the elderly reported of having survival pack easily accessible (86.9%), knowing how to shut down water, gas, and electricity (79.2%), and know how to contact their family members (54%). Only 255 (22.4%) elderly were classified as being prepared for disaster. Those who were born in Hong Kong (OR=1.471), living with other family members (OR=1.742), have neighbors to provide support (OR=2.92), and perceived of having ability to help oneself (OR=1.34) were more prepared. Conclusion: This study identified the inadequate preparation of nurses and community's vulnerable groups for disaster. With the frequent happening of critical incidents, Hong Kong nurses should be prepared at individual and professional level, prepared at home and ready to report to work. To meet the need of the community, nurses should be equipped with competencies to help building a disaster resilience community which can reduce health risks and damages. The preparation of the community especially the vulnerable groups is one of the concerns. Training and preparing of nurses to handle critical incidents are crucial; this will facilitate the ability of nurses in building a disaster resilience community to meet the needs of Hong Kong.

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