Factors Affecting The Disaster Nursingand Emergency Preparedness Of Nurses Of Leyte Provincial Hospital

CHAPTER I

INTRODUCTION

Background of the Study

The World Disasters Report 2007 confirmed a 60% increase in the occurrence of disasters in the last decade (1997–2006) compared to the previous decade.1 The number of reported deaths associated with disasters increased from 600,000 to more than 1.2 million while disasters are increasing in frequency, intensity and impact due to increasing population pressure, climatic change, and new and re-emerging communicable diseases.( Fritsch, 2011) at the same time, the number of people affected rose from 230 million to 270 million — a 17% increase. No nation, region, community, or individual is immune to the potential devastations of a disaster (Mireile Kingma, 2010 in Powers & Daily, 2010).

Fritsch (2011), Regional Adviser for Nursing, noted that the Asia Pacific region is vulnerable to disasters and crises. Two billion people are at risk of crisis conditions, more than 3 million people in the region were killed in natural disasters in the past 20 years and 800 million were adversely affected. Challenges facing many communities include chronic under-investment, poor infrastructure, lack of staff, inadequate finance, inequitable distribution, and inefficient use of resources.

The South-East Asia Region accounted for approximately 44% of all disasters globally in the past decade, and 62% of all deaths due to natural disasters. One of the main problems of emergencies and disasters is its impact on health care services—overloaded facilities, lack of supplies, overworked staff due to no back-up, unorganized response, and multiple health issues requiring facility or public health interventions (WHO, 2012).

In Philippines, Eastern Visayas was a hard-hit of historical super-typhoon Yolanda in November 2013.The Philippine National Disaster Risk Reduction and Management Council (PNDRRMC) reported that at the peak of the event 6,283 people died. WHO (2014) reported 12,544 injuries and 1,186 persons were missing. The DOH (2014) reported that figures ticked higher with 11,904 more deaths after Yolanda, from January to September 2014 in whole Eastern Visayasdue to diseases and other causes. (Geronimo, 2014, in Riel, 2016).

According to World Health Organization findings, an estimated 800,000 Yolanda victims have suffered mental health effects over the past year and that a tenth of those victims need continuing medication and support, including those suffering from post-traumatic disorder, depression, anxiety, and schizophrenia. The WHO has been training community workers to offset the lack of professionals who can detect mental health conditions and provide support (Aseo, 2014).

Since the typhoon struck, WHO-led health recovery operations have been focused in the following four thematic areas as set out in the Strategic Response Plan: (1) TREAT: Address the immediate health needs of the affected especially for obstetric and neonatal care, mental health and psychosocial support, and the care of the deceased and bereaved;(2) PREVENT: Strengthen the alert and surveillance capability to address public health threats and inform the provision of health care including immunization and outbreak response;(3). REBUILD: Establish an equitable basic system of primary and secondary healthcare functions, and access to a tertiary referral system in all areas (including management of victims of gender based violence) without financial barriers to access for affected populations; and (4) LINK: Strengthen the coordination and integration of health care with other services and clusters including protection issues around mental health and psychosocial support and gender based violence. Workshops for nurses from the South-East Asia Region (WHO, 2012) were conducted dubbed as “Empowerment for disaster preparedness. ”The objectives of the workshop include (1) sharing experiences among nurses from the countries prone to disaster; (2) to master the core competencies of disaster nursing; and (3) to establish a foundation for collaborative networking among nurses.

However, evaluation and action for organizational resources are missed which affect directly and indirectly (competency level) the disaster nursing and emergency response preparedness.

The nurses themselves are resources beyond institutions and with a lot of potentials in expanding and strengthening concerted resources and efforts. “There is a potential for a very positive legacy of improved, strengthened mental health services after disasters and that is what we're hoping will happen here as well…[that] mental health services can be reoriented so they are focused on treating people in the community and not in institutions,”reported byJulie Hall of the World Health Organization (Geronimo, 2014).

The researcher will describe the preparedness level of nurses of LPH and identify the factors affecting them.

Statement of the Problem

The study aims to determine the disaster and emergency response preparedness level of LPH nurses and factors affecting them.

The study will searchto answer to the following questions:

1. What is the socio-economic profile of the LPH nurses in terms of:

1.1 Age

1.2 Sex

1.3 Civil Status

1.4 Designation/Position

1.5 Highest Educational Attainment

1.6 Disaster Preparedness and Humanitarian Response Trainings Attended

1.7 Monthly Family Income;  and

1.8 Years of Health Care Work experience?

2. What are the self-rated preparednesslevels of LPH nurses?

3. What is the level of preparedness of LPH nurses?

4. What are the organizational factors that affect the preparedness of LPH nurses?

5. Is there a significant difference in the levels of preparedness of LPH nurses affected by organisational factors?

6. What alternatives can be recommended to LPH and Leyte Health Office for LPH nurses based on the findings of the study?

Hypotheses

 There is no significant difference among the levels of preparedness of LPH nurses affected by the factors to be identified by the study.

Theoretical Framework of the Study

Thestudy will enquire the status of LPH nurses within the theoretical framework discussed below.The Social Vulnerability Index -SoVI® (Cutter, 2003) measures the social vulnerability of U.S. counties to environmental hazards. The index is a comparative metric that facilitates the examination of the differences in social vulnerability among counties. SoVI® is a valuable tool for policy makers and practitioners because it graphically illustrates the geographic variation in social vulnerability. It shows where there is uneven capacity for preparedness and response and where resources might be used most effectively to reduce the pre-existing vulnerability. SoVI® also is useful as an indicator in determining the differential recovery from disasters using empirically-based information.

The index synthesizes 29 socioeconomic variables (originally 42 variables but later reduced to 11 independent factors and according to University of South Carolina it was 32 variables which evolved to 29 due to SoVI metrics improvement) , which the research literature suggests contribute to reduction in a community’s ability to prepare for, respond to, and recover from hazards (Cutter, Boruff&Shirly, 2003, University of South Carolina, 2017).

The theory of Cutter is worth adopting with other theories and concepts as framework in this study to be the guide for the process of research. Although SoVI® is intended for environmental hazards, the presentation and discussion will go beyond environmental to all any other hazards including man-made hazards including fire, armed conflict, terrorism, bioterrorism, and so on. The presentation of Cutter’s theory by the researcher is limited however to 4 variables, namely; (1) Children; (2) Women;

3. Special Needs population; and (4) Elders for relevancy to the study about disaster nursing and emergency response preparedness of nurses.

Children and Elders are great variables to social vulnerability because of their nature affects their mobility out of harm’s way; they need special care; more susceptible to harm while women is mostly at care-giving role and special needs population is difficult to identify (infirm, transient) let alone measure; invariably left out of recovery efforts or politically persecuted and discriminated; often invisible in communities (Cutter, 2014).