The recent extreme weather events in Queensland and Victoria highlight that natural disasters occur regularly in Australia. Arguably, the Australian health care system has had little experience with disasters that overwhelm health resources. This raises questions about the ability of health care providers to respond under conditions of increased demands and personal vulnerability. International experience, including earthquakes in Japan [2011], Christchurch [2011] and Haiti [2009], has shown that uncertainty about their safety and that of their family and friends may prevent nurses from attending work during a disaster. An understanding of the factors that enable or disable nurses’ disaster preparedness will underpin future disaster policy and planning for Australian and international health care organisations. A study of the willingness of Australian emergency nurses to respond to a disaster was conducted. A 3-phase mixed-method design was used, consisting of a national survey, focus groups and in-depth interviews with emergency nurses at four hospitals. This presentation builds upon preliminary results delivered at the 8th International Conference for Emergency Nurses (2010). The findings indicate that emergency nurses’ willingness to respond to disasters is dependent on a number of factors, including their out-of-work responsibilities, changes to their roles at work, their confidence in management, protective equipment and work teams, the information received, the type of disaster and the degree of risk involved. The nurses’ willingness also differs according to their age, family status, personal preparedness and disaster related qualifications. These and other factors will be examined, exploring the implications for individual nurses and planners.

1. To work or not to work: An analysis of the willingness of Australian emergency nurses to respond to a disaster

2. Research partners Disaster Research Centre Flinders University School of Nursing & Midwifery Institutions 1. Flinders University 2. University of Canberra 3. Griffith University 4. Princess Alexandra Hospital 5. Deakin University 6. Northern Health Investigators Ms Laura Bahnisch1 Prof Paul Arbon1 Mr Jamie Ranse1,2 Dr Ramon Shaban3,4 Dr Julie Considine5,6 Ms Belinda Mitchell5,6 Ms Karen Hammad1 Dr Lynette Cusack1 Dr Mayumi Kako1 Assoc Prof Richard Woodman1

3. Definition A disaster is defined by Emergency Management Australia as: ‘A serious disruption to communitylife which threatens or causes death or injury in that community and/or damage to property which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilisation and organisation of resources other than those normally available to those authorities’. (1998)

4. Background Disasters: part of life & can impair health & wellbeing & can cause premature death (Iserson et al, 2008).

5. Background The ED is the frontline of the hospital response to a disaster, with emergency nurses playing an essential role (Hammad, et al, 2011). ED – first point of contact & interface with other emergency services. Staff already work with pressures of overcrowding, access block and ambulance ramping (FitzGerald, et al., 2010).

6. Background Recent examples in Queensland and Victoria show that disasters occur regularly in Australia. Challenges to modern healthcare systems – increased demand, staffing issues, ageing infrastructure... Could Australian systems cope with a major disaster? Uncertainty about their own safety and that of their family and friends may prevent emergency nurses from attending work during a disaster.

7. Aims Willingness of health care workers to respond to disasters has been researched internationally. Little research in Australia, in particular around the role of emergency nurses in disasters. Willingness can be increased – importance of planning. Aim - Reducing absenteeism of emergency nurses is critical to disaster response.

8. Project design Flinders University, Industry Partnership Grant 2009 Three Phases (2010) Pilot study National online survey Focus groups Interviews Partners Royal Adelaide Hospital, SA Northern Health, Vic Princess Alexandra Hospital, Qld Calvary Health Care, ACT CENA & ACEN

9. Data analysis Quantitative Descriptive statistics – PASW Analysed using STATA Associations between willingness to participate in a disaster and the characteristics of the population assessed using chi2 statistics, with willingness assessed as total willingness, or willingness for a particular type of event. Qualitative Thematic analysis

10. Findings –How willing? 1 = completely unprepared to attend 2 = somewhat unprepared to attend 3 = neither prepared nor unprepared to attend 4 = somewhat prepared to attend 5 = completely prepared to attend

11. Findings –How willing? Participants who reported family disaster preparedness were more willing to respond across all disaster types.

12. Findings –How willing? Therefore, a much higher willingness to work in ‘conventional’ than ‘non-conventional events’. Harder to assess risk as less local and ‘visible’ (Smith et al, 2009). ‘It is the fear of the unknown. What you don’t know you fear. But trauma – that’s what we do.’ Risks weighed up against moral obligations to public: ‘I think you'd triage it in your mind, wouldn't you?’. Do they stay home with family or do they go to work?: ‘It would tear at the heart’.

13. Findings -Preparedness Degrees of preparedness: Experience in emergency nursing or with disasters ‘If you knew that you were working with someone that knew what they were doing and knew the plan...That makes you so much more confident and supported.’ 2. Opportunities to practise a disaster plan ‘If you were aware of what the plan was and knew what your role was you'd be more willing to be involved in it...’

14. Findings -Preparedness Degrees of preparedness: 3. Having further disaster qualifications Nurses who held a disaster-related qualification were more than twice as likely to respond to a disaster. In contrast, having done a disaster-related short course had no significant effect on willingness.

15. Findings -Willingness and other responsibilities Factors from the literature borne out by this study: type of event, personal safety, family & pet safety, professional duty, previous experience, trust in the employer, ability, psychological supports, knowledge. Other factors from this study: Age – highest level of unwillingness – 60-69, 22.2% (n=10). Related to physical health/ chronic illness or looking after older family members. Gender – not significant in this study. However... ‘Pregnant women should not be going to a disaster situation’.

16. Findings -Willingness and other responsibilities Family responsibilities Nurses with children would be the least willing to work during a disaster, with independent nurses being the most willing (p <0.001). Nurses with children under 5 were 81.9% less likely to respond to disasters than nurses without children that age.

17. Findings -Willingness and other responsibilities Volunteering in emergency services & having a partner with an emergency role – not statistically significant, but seen as important in decision making. ‘My husband's a policeman. So if there was something in the local area ... So it would then be the balance of depending on how severe it is, do two parents both go, or does just one parent go and one parent stay?’

18. Findings -How to improve willingness - emergency nurses’ views

24. Findings-Effect of willingness on the workforce Not willing Willing but not able to get to work Willing to go to work Disaster event Assessment of preparedness at home, work and professionally Work place Influence Influence Assessment of degree of risk: self, family, community

25. Recommendations Disaster plan information – during induction. Disaster plan should include: communication to staff & families; child, dependent & pet care options; clear senior staff responsibilities. Training packages for nurses to explore ethical issues, including altered standards of care. Support for nurses to undertake postgraduate education in disaster management.

26. Recommendations Preparedness tool for emergency nurses for themselves & families. Senior leadership, positive team culture.

27. References Emergency Management Australia. (Ed.) (1998). Canberra: Attorney-General's Department, Australian Government. Hammad, K., Arbon, P., & Gebbie, K. (2011). Emergency nurses and disaster response: An exploration of South Australian emergency nurses' knowledge and perceptions of their roles in disaster response. Australasian Emergency Nursing Journal, 14(2), 87-94. Iserson, K., Helne, C. E., Larkin, G. L., Moskop, J. C., Baruch, J., & Aswegan, A. L. (2008). Fight or flight: The ethics of emergency physician disaster response Annals of Emergency Medicine, 51(4), 345-353. Smith, E., Morgans, A., Qureshi, K., Burkle, F., & Archer, F. (2009). Paramedics' perceptions of risk and willingness to work during disasters. The Australian Journal of Emergency Management, 24(3), 21-27.

28. To work or not to work in a disaster It all depends…