RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCE, BANGLORE KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MISS. KINJAL R. PANDYA1ST YEAR M.Sc. NURSING
KARNATAKA COLLEGE OF NURSING, BANGALORE
2 / NAME OF THE INSTITUTION / KARNATAKA COLLEGE OF NURSING
33/2, THIRUMENAHALLI, HEDGE NAGAR MAIN ROAD, YELAHANKA HOBLI, BANGALORE – 64
3 / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING
SPECIALITY 5– PSYCHIATRIC NURSING
4 / DATE AND ADMISSION TO COURSE / 01.06.2009
5 / TITLE OF THE TOPIC / A STUDY ON THE AWARENESS OF MOTHERS REGARDING CHILD ABUSE IN SELECTED URBAN AREAS IN BANGLORE.
6. BRIEF RESUME OF INTENTED WORK
INTRODUCTION
According to International Strategy for Disaster Reduction (ISDR), disaster is defined as a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.1
We do not expect disasters, but they happen. Be an act of god, or an act of man, a wide spectrum of disasters play havoc in the Indian sub-continent as well as around the world. It is a fact; disasters are on the rise around the world. Disasters are either natural, like floods, earthquakes, tsunamis, cyclones and droughts or man-made such as wars, fires, epidemics, refugee situations, environmental fallouts etc. Most of the disasters, it strikes anytime, any where, and it builds over days or weeks, or hits suddenly without warning. Every year, millions of people face disaster, and its terrifying consequences.
Disasters can significantly lead to degradation of social and economic progress achieved over decades of initiatives by the people. According to one estimate, the 1990s saw a tripling of disasters and a nine-fold increase in economic costs when compared with the 1960s. In the developing countries the root cause of vulnerability to hazards are poverty and inequitable development. Rapid population growth, urban and mass migration, inequitable patterns of land ownership, lack of education and subsistence of agriculture on marginal lands lead to vulnerable conditions such as unsafe settings of buildings, and settlements, unsafe homes, deforestation, malnutrition, unemployment, underemployment and illiteracy.2
The disadvantages of disasters like deaths, disabilities, destitution, as well as loss of livelihoods and property impose enormous social and economic losses to already precarious social structures. To improve this situation we need to build an information and knowledge base.
According to World Health Organization, In 2008, 321 natural disasters killed 235 816 people – a death toll that was almost four times higher than the average annual total for the seven previous years. This increase was due to just events. Cyclone Nargis left 138 366 people dead or missing in Myanmar, and a major earthquake in south-western china’s Sichuan province killed 87 476 people, according to the United Nation’s International Strategy for Disaster Reduction (UNISDR). Asia, the worst-affected continent, was home to nine of the world’s top 10 countries for disaster-related deaths. Along with other weather-related events, floods remained one of the most disasters last year, according to UNISDR. Conflicts around the globe have also led to great human suffering and have stretched health care services to the extreme.
Disasters also exact a devastating economic toll. In 2008, disasters cost an estimated US $ 181 billon- more than twice the US$ 81 billon annual average for 2000-2007 (WHO).
Although only 11% of the people exposed to natural hazards live in developing countries, they account for more than 53% of global deaths due to natural disasters in developing countries and that the key ingredient in these tragedies is human inaction.3
According to Disaster Management in India- a status report (2004), India is highly prone to natural disasters on account of its unique geo-climatic conditions. Floods, droughts, cyclones, earthquakes and landslides have been recurrent phenomena. About 60% of the landmass is prone to earthquakes of various intensities; over 40 million hectares is prone to floods; about 8% of the total area is prone to cyclones and 68% of the area is susceptible to drought.4
Disaster management occupies an important place in India’s policy framework as it is the poor and the under-privileged who are worst affected on account of calamities/disasters.
Table below shows the major disasters of India in recent past.
EVENT / YEAR / DEAD / AFFECTEDQuake / 1993 / 9475 / 1 million
Cyclone / 1999 / 10086 / 15 million
Quake / 2001 / 13805 / 1.8 million
Tsunami / 2004 / 12405 / 3.5 million
Sources: from copy right (2007) SAARC DISASTER MANAGEMENT CENTRE.
6.1. NEED FOR THE STUDY
When an emergency or disaster occurs, most lives are lost or saved in the immediate aftermath of the event. People count on hospitals, health facilities and professional nurses to provide skilled and competent care to respond swiftly and efficiently, as the lifeline for survival and the backbone of support. The tragedy of a major emergency or disaster is compounded when all these health facilities fail. In the Statement for World Health Day 2009, Dr Margaret Chan, The Director of the WHO assert that it is smart to think and plan ahead, as worldwide, the number of emergencies and disasters is rising. This trend is certain to continue as urbanization crowds people together on unsafe sites and climate change brings more sever extreme weather events. We need to anticipate a growing number of areas that will become disaster-prone and accordingly prepare for these situations.
WHO 2009 focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centers and staffs are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people's health needs. So to commemorate World Health Day this year i.e. on 14th October, WHO is advocating a series of best practices that can be implemented, in any resources settings, to make hospital safe during emergencies. Apart from safe setting and resilient construction, good planning and carrying out emergency exercises in advance can help maintain critical functions. Proven measures range from early warning systems to a simple hospital safety assessment, from protecting equipment and supplies to preparing staff to manage mass casualties and infection control measures.5
Nurses role in disasters becomes all the more significant in view of their ability to take roles as first responder, direct care provider, on-site coordinator of care, information provider or educator, mental health counselor and triage officer. Thus, to prepare nurses on disaster management is important and essential that nurses learn the knowledge and skills needed to respond to disaster situations.
So in this study the researcher is going to assess the effectiveness of structured teaching program on disaster management among the nursing students, those who are going to graduate soon and will be posted in different settings as full fledge nurses where they will face with all types disaster situation. Therefore, i felt it is essential that their knowledge level is increased and plays a vital role in handling the situation with competencies at the site of disaster and in the hospital.
6.2. REVIEW OF LITERATURE
Review of literature is defined as systematic collection of study material pertaining to the topic to update the knowledge. For the present study review of literature is collected from books, journals, and articles retrieved from electronic or online literature. It helps the researcher to develop deeper insight into the topic and gain more information. This can help students gain knowledge regarding disaster management.
Review of literature for the present study has been organized under the following headings.
- Studies related to effectiveness of disaster training.
- Studies related to knowledge about disaster management among nursing personnel.
Ali and Fikree (2008) conducted a study in Moin Rashid Hospital in Dubia on “effectiveness of training new standard of operating procedures (SOP) of the hospital disaster plan”. To assess the effectiveness of training of three SOPs of the hospital disaster plan and three key disaster management figures by using appropriate assessment tools [the performance indicators].To strengthen the concept that the planning, drills, and training improve a hospital’s ability to respond to a disaster. Using a control as an exercise drill without antecedent training, subsequent measurements of the SOPs and specific disaster management roles were obtained and analyzed during three real life disasters. The success rate of the overall result of all 6 performance indicators used was only 45.5% in a disaster drill without any prior training but after training, there was a significant increase in the success rates to 79.5%, 87.9%, and 94.7% respectively in three successive disaster over three months period. All the results were subjected to statistical analysis. The odds ratio before and after the training were calculated and the difference was found to be highly significant Effectiveness of training can be measured quantitatively by using appropriate tools [i.e., the performance indicators]. It is also possible to evaluate standard operating procedures [SOPs] of a hospital disaster plan in real time disaster scenarios.6
O’sullivan TL et al. (2008) conducted a study in University of Ottawa (Canada) on “Disaster and emergency management: Canadian nurses' perceptions of preparedness on hospital front lines”. Nurses from emergency departments and intensive care units across Canada were recruited via flyer mail outs and e-mail notices to complete a 30-minute online survey. A total of 1,543 nurses completed the survey (90% female; 10% male). The results indicate that nurses feel unprepared to respond to large-scale disasters/attacks. The sense of preparedness varied according to the outbreak/disaster scenario with nurses feeling least prepared to respond to a CBRN (chemical, biological, radiological, and nuclear) event. A variety of socio-demographic factors, notably gender, previous outbreak experience (particularly with SARS), full-time vs. part-time job status, and region of employment also were related to perceptions of risk. Approximately 40% of respondents were unaware if their hospital had an emergency plan for a large-scale outbreak. Nurses reported inadequate access to resources to support disaster response capacity and expressed a low degree of confidence in the preparedness of Canadian healthcare institutions for future outbreaks. The study revealed that Canadian nurses have indicated that considerably more training and information are needed to enhance preparedness for frontline healthcare workers as important members of the response community.7
A study conducted by Jakeway CC et al. (2008) in USA on “role of public health nurses in emergency preparedness and response: a position paper of the Association of State and Territorial Directors of Nursing”. Public health nurses bring critical experience to each phase of a disaster: mitigation, preparedness, response, and recovery. Public health nurses strive to achieve individual competencies so that they may better collaborate with others and contribute to emergency preparedness and response. Twelve Emergency Preparedness Competencies are listed in this position paper that will assist public health nurses with disaster prevention, planning, response, recovery, drills, exercises, and training. This position paper will be useful in clarifying the expertise that public health nurses can contribute to teams that serve to protect the health and safety of communities against disaster threats and realities.8
Polivka BJ et al (2008) conducted a study in The Ohio State University College of Nursing, Columbus (USA) on “public health nursing competencies for public health surge events related to disaster”. Public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health department's disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. The study revealed that identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.9
Sonopant J (2007) conducted a descriptive study in Maharashtra to “assess the nurse’s knowledge about disaster nursing and explore their ability to react when disaster strikes”. The total of 60 nurses of various cadres was selected by simple random sampling method. Semi structured questionnaire was prepared with 30 questions. According to the study overall knowledge is good but still majority of the nurses have gaps in the knowledge and the overall ability of all cadres of nurses is not satisfactory because only 34% of nurses have excellent score, still 38% of nurses show poor ability to respond to the disasters. Mean knowledge score of nurses is 10.58 and mean ability score is 7.82 which clearly indicates that nurses have adequate knowledge regarding disaster nursing but have poor ability to respond when disaster strikes. The study concluded that disaster nursing should be included in all types of nursing programmes and to increase the ability of nurses for disaster situation nurses should be involved in planning cycle of the city disaster management and mock disaster drill should be organized involving nursing services. She also suggested that even in the present curricula triage, tagging and CPR may be included in procedure demonstration and disaster nursing be taught by nursing faculty as a specialty in nursing programs.10
Edbert et al. (2006) conducted a study in Johns Hopkins University School of Medicines (USA) on “healthcare worker competencies for disaster training”. The need for effective evidence-based disaster training of healthcare staff at all levels, including the development of standards and guidelines for training in the multi-disciplinary health response to major events, has been designated by the disaster response community as a high priority. The study describes the application of systematic evidence-based consensus building methods to derive educational competencies and objectives in criteria-based preparedness and response relevant to all hospital healthcare workers. The results developed seven healthcare worker competencies for disaster training: (1) Recognize a potential critical event, and implement initial actions; (2) Apply the principles of critical event management: (3) Demonstrate critical event safety principles: (4) Understand the institutional emergency operations plan; (5) Demonstrate effective critical communications; (6) Understand the incident command system and your role in it; (7) Demonstrate the knowledge and skills needed to fulfill your role during a critical event. This systematic evidence-based consensus building approach may serve as a foundation for future hospital healthcare worker training and education in disaster preparedness and response.11