| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 100 === Research Background
In recent years, international disaster news reports keep spreading out that have a great effect on human life. Taiwan is located on the Pacific island arc and its an island-type climate. It has also been reported that damage caused by typhoons in each year. Typhoon Morakot on August 7,2009 which led to damage and casualties, as the most serious typhoon in Taiwan over the years.
Health care workers for the first time to establish a disaster medical assistance team and went to the disaster area to provide healthy residents the service of health residents. For instance: death, injury, epidemic infectious diseases, chronic disease care, post traumatic stress disorder, and so on. Number of nurses of multi-disaster medical team, many of them of past have not had the disaster medical assistance experience. Facing disasters that may affect the safety of life environment, they have to provide services to maintain the health of residents of disaster situations.
Looking forward to the studies that provide clinical nursing staff substantive basis for the more practical and building-related disaster nursing programe to improve the quality of disaster rescue.
Research Objective
1.To investigate the motivation of nurses involved in medical care in 2009 Typhoon Morakot rescue.
2.To investigate the practice medical care plan content of nurses involved in 2009 Typhoon Morakot rescue.
3.To investigate the difficulties when nurses involved in medical care in 2009 Typhoon Morakot rescue.
4.To investigate the necessary assistance when nurses involved in medical care in 2009 Typhoon Morakot rescue.
5.To investigate the medical care plan recommendations about the nurses involved in 2009 Typhoon Morakot rescue.
Research Method
This study is a Explorative Qualitative Research. This study enrolls nurses, worked in different medical centers in North, Central and Southern Taiwan, joined medical care during 2009 Taiwan Morakot typhoon rescure. Total 27 nurses are enrolled in this study. This study processes by semistracture interview guideline, collect data by face-to-face interview, audio recording and complete text transcripts.
To concule, an in- depth analys would be conducted by apply the Qualitative Content Analysis Mothod in result.
Research Result
This study received a total of 27 nurses involved in medical care in 2009 Typhoon Morakot. There are one male and 26 female, the ages between 26 and 40 (mean 32.51 ± 4.20). Nine nurses work in emergency department, seven in intensive care unit, seven in ordinary ward, two in operation room, one in home care unit, and one in outpatient department. Most work departments are surgery and emergency. The clinical official “N2” are twelve nurses, “N3” are nine, “N4” are five, and “N1” is one. Most of them are nurses, three are clinical nurse specialist, and two are head nurses. The number of days involved in disaster medical care between 1 and 18 days (mean 7.5). The disaster locates in Kaohsiung and Chiayi County.
This study demonstrates the motives of nurses involved in medical care in Morakot as followed: 1. to be good (96.3%, n = 26); 2. Carry forward the nursing profession (48.1%, n = 13); 3. Playing a clinical professional director (44.4%, n = 12); 4. Relatives caught in the disaster area (18.5%, n = 5); 5.being given a mandate (18.5%, n = 5); 6. Experienced the disaster medical care (18.5%, n = 5); 7. Geopolitical position on the disaster area (11.1%, n = 3); 8. From the same tribe (7.4%, n = 2); and 9. Experience in disaster pain (7.4%, n = 2). Practical content of the disaster medical care plans are: 1. Physical health care (100%, n = 27); 2. Mental health care (100%, n = 27); 3. Resource Education Advisory (100%, n = 27); 4. Disaster information communication (96.2%, n = 26); 5. Public health maintenance (48.1%, n = 13); 6. In critically ill patients referral (44.4%, n = 12); and 7. Assist in the evacuation (22.2%, n = 7).
The difficulties faced by nurses can be staged into phase I (in the preparatory phase of disaster medical care prior to departure); phase II (Disaster ambulance execution stage); and phase III (Disaster medical aid completion). The difficulties in phase I are: the willingness contradictory to the contradiction (37.0%, n = 10); worries about disaster medical ambulance service (37.0%, n = 10). The difficulties from phase I to phase II are: 1. Lack of integration of disaster medical rescue plan (51.8%, n = 14); 2. Questioned team leader conditioning capacity (40.7%, n = 11); and 3. The safety of life threatened (37.0%, n = 10). The difficulties in phase II are: 1. Difficult in allocation of resources (48.1%, n = 13); 2. Difficult in counseling services (40.7%, n = 11); 3. Poor logistics management and control (37.0%, n = 10); 4. Friction between the medical teams (37.0%, n = 10); 5. Concerns of the quality of medical services (33.3%, n = 9); and 6. Medical services be refused and language restrictions (29.6%, n = 8). The difficulties from phase II to phase III are: 1. Cumbersome administrative matters (22.2%, n = 6); and 2. Helpless with self-recovery adjustment (14.8%, n = 4). The difficult in phase III is Disaster rescue plan lacks a complete review (22.2%, n = 6).
Nurses required assistance in phase I are: 1. To provide information (92.6%, n = 25); 2. Increase the confidence of the disaster rescue service (44.4%, n = 12); and 3. Adjust the clinical load (18.5%, n = 5). Assistance needed from phase I to phase II are: 1. Provide a complete disaster rescue plan (18.5%, n = 5); 2. The quality of communications (59.2%, n = 16); 3. Clear information to convey (51.8%, n = 14); 4. Professional training (48.1%, n = 13); and 5. Assistance of the logistics control (44.4%, n = 12). Required assistance in phase II are: 1. Assess the resource requirements (48.1%, n = 13); 2. Complete medical team configuration (44.4%, n = 12); and 3. Cooperation and coordination of the competent authority (25.9%, n = 8). From phase II to phase III, the assistance needed are: 1. Emotional support (44.4%, n = 12); 2. Simplification of administrative affairs (37.0%, n = 10); and 3. Rest and recovery (11.1%, n = 3). Required assistance in phase III is complete ambulance plan review.
The recommendations of the nurses for disaster medical care plan in phase I are: 1. Detail briefings before the disaster rescue line (96.2%, n = 26); 2. Equipment completely prepared (51.8%, n = 14); and 3. Scheduling of manpower, reduce clinical load (18.5%, n = 5). From phase I to phase II are: 1. Strengthen disaster medical profession training (100%, n = 27); 2. Clear disaster medical care plan (70.3%, n = 19); 3. Improve the accuracy of the disaster-related information conveyed (77.2%, n = 17); 4. Enhance the quality of communications (59.2%, n = 16); and 5. Strengthening the logistics management and control (44.4%, n = 12). In phase II are: 1. Express responsible for the duties of the competent authority (48.1%, n = 13); 2. Complete medical team configuration (40.7%, n = 11); 3. To provide accurate material requirements (33.3%, n = 9); and 4. Clear scheduling and coordination of the competent authority (40.7%, n = 11). From phase II to phase III are: 1. Essentials of praise in the administrative affairs (37.0%, n = 10); and 2. Set of cross-team ambulance review platform (29.6%, n = 8).
Conclusion
Due to the motivation to do good to help others and to carry forward the nursing profession, nursing staff involved in disaster medical service. They would face difficult choices in distribution of Criminal right of immunity supplies, counseling services, medical services were denied, the safety of life threatened, The Nursing Ethics (justice, autonomy, nonmaleficence, beneficence). This study also organize the necessary assistance and advice: construct a suitable disaster rescue plan, instructions before the detailed line (20 minutes of brief videotape teaching), strengthen disaster nursing expertise in education, development of diversified learning channels (classroom teaching, field simulation exercises, network interactive learning), criticism and discussion of practice and ethics, development of electronic medical records, legislation to establish the medical staff of civil and criminal immunity during the execution of disaster medical services. Hope to develop a more complete disaster nursing profession through the experience of nurses in this study
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