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In Central Thailand basic health care services were affected by a natural disaster in the form of a flood situation. Flood Relief Operations Centers were established from the crisis. Nakhon Pathom Rajabhat University and including the faculty of nursing volunteered to care for those affected and assist in re-establishing a functioning health care system.
Study objectives
The aim of this study was to make explicit knowledge of concept, lesson learned, and the process of management for re-establishing a health care service system at a flood victims at Relief Operations Center, Nakhon Pathom Rajabhat University.
Methods
We used a qualitative design with mixed methods. This involved in-depth interviews, focus group, observational participation and non-observational participation. Key informants included university administrators, instructors, leaders of flood victims and the flood victims. Data was collected during October–December, 2010. Data were analysed using content analysis and compared matrix.
Results
We found that the concept and principle of health care services management were community based and involved home care and field hospital services. We had prepared a management system that placed emphasise on a community based approach and holistic caring such as 24 h Nursing Clinic Home, visits with family, a referral system, field hospital. The core of management was to achieve integrated instruction started from nursing students were practiced skills as Health promotion and nursing techniques practicum.
Conclusions
Rules were established regarding the health care service system. The outcomes of Health Care Service at the Flood Relief Operations Center were direct and sincere help without conditions, administrations concerned and volunteer nursing students instructors, University Officer have sympathetic and charitable with flood victims and environment.
In Central Thailand our health care system was severely affected by a flood crisis situation, which reached the highest level when Salaya, Nakhonchisri, Sampran, Hueypool and Huangphoplen hospitals in Nakhon Pathom province could not provide a service. Patients who stayed at Hospital could not be discharged home, and they were made homeless overnight.
Patients who had chronic diseases needed follow up medication management. Accordingly they were moved to the flood shelter at Nakhon pathom Rajabhat University. The flood victims were of all ages and genders from newborn infants, pre-school children, school children, teenagers, pregnant women to the elderly with chronic diseases such as hypertension, diabetes, heart diseases or stroke symptoms etc. need caring and curative. Some people arrived with their pets only increasing the seriousness of the situation.
Almost all of them had lost hope and were highly stressed suffering from mild depression and anxiety because of the flood since some of them already had for the second or third time to abandon a place they believed save before reaching the field hospital.
The Faculty of Nursing, Nakhon Pathom Rajabhat University urgently setup systems including a field hospital, organised health volunteers, primary health care services, a 24 h clinic and referral systems.
The aim of this study was to make explicit the knowledge of concept, lesson learned, process of management for health care service system among flood victims at Relief Operations Center, Nakhon Pathom Rajabhat University.
Materials and methods
Study design
This study used a qualitative research design. We employed a mixed methods approach involving in-depth interviews, focus group, observational participation and non-observational participation. All participants were required to verbal consent conform before prior to data collection. The data were secreted and damaged after analysis.
Study setting
Flood victims at Relief Operations Center, Nakhon Pathom Rajabhat University.
Population
All of 30 participants were university administrators, instructors, leaders of flood victims and the flood victims themselves at flood victims at Relief Operations Center, Nakhon Pathom Rajabhat University.
Data collection
The data was collected using in-depth interview, focus group, observational participation and non-observational participation
Data were analysed using content analysis and compared matrix between health care service, medication management, other provided service and cost effectiveness.
Results
Concept and principle of health care services management for the shelter at Nakhon Pathom Rajabhat University
The concept of health care services management of the shelter at Nakhon Pathom Rajabhat University was based on a conviction to a holistic model of health care. This community-based health care service management is consistent with the mission of Nakhon Pathom Rajabhat University which aims to cooperate with the locality and the development of the identity of the Faculty of Nursing at Nakhon Pathom Rajabhat University requiring her to respond to emergency situations within society. Therefore, health care services are provided through a network of management systems focusing on the cultivation and integration of a volunteer spirit to enable students and lecturers of the Faculty of Nursing effectively providing health care for people in their area of responsibility.
Such concept was applied into practice by setting up two systems of health care services in line with the context of the shelters’ establishment as follows:
Providing services at the field hospital: The concept of this service was based on the principle of home care in association with the concept of hygiene, asepsis, quality service, referral of emergency cases, being enhanced by the health network management system in coordination with both internal and external networking organisations, as well as cultivating a volunteer spirit of nursing lecturers and students serving as health team members in proportion to patients. Providing services at the Shelter: This service emphasizes the home visit, dividing the target group into four sub-groups: healthy group, risk group, chronic disease group and the underprivileged group. Then, the concept of the database system is integrated with the home visit using the family folder for collecting data in order to acquire information that benefit planning, networking and integrated management of health care services (Fig. 1).
Figure 1Concept and principle of health care services management for the Nakhon Pathom Rajabhat University.
Structure of health care services for the Nakhon Pathom Rajabhat University
The structure of health care services is designed based on the location as follows first aid room and field hospital (Table 1).
Table 1The structure of health care services designed.
Main service
Core management
Detail
First aid room is designed in the form of the outpatient department and emergency department in combination with disease prevention and rehabilitation unit
Manpower management
It was determined to have 24 h manpower Nakhon Pathom Provincial Health Office was supplied additional manpower working period on 12–18 h Nursing students and lecturers of the Faculty of Nursing at Nakhon Pathom Rajabhat University were stand by for nursing care
Manpower for registered nurses
There were initially about 2–4 registered nurses for the morning shift and night shift The officer of the Tambon Health Promotion Hospital with a total of 1 person per shift The morning shift was available consisting by the first aid room of Nakhon Pathom Rajabhat University The night shift consisted of the shelter includes: Stage I: in the first time: one person per shift with the officer of Tambon Health Promotion Hospital and four nursing students Stage II: there were two registered nurses from the flooded hospitals such as Buddhamonthon Hospital on duty during the afternoon shift from 16.00 h to 20.00 h as replacement still maintaining 2–4 nursing students Stage III: most patients usually visited at night raising the figures to 30–40 cases per day. For this reason the night shift team had been revised to have two registered nurses available, removing the team members from Stage IV: Tambon Health Promotion Hospital. Nearing closing time for the shelter it had been revised to have one registered nurse from the Provincial Health Office on duty during the morning shift
Manpower for doctors–Doctors
Voluntary Doctors, Dr. Phanompan, who helped and provided medical services in the area for 3 weeks Doctors at the first aid room was revised in coordination with Nakhon Pathom Provincial Health Office by arranging doctors from Suan Phueng Hospital, Amphoe Suan Phueng, Ratchaburi Province and Chetsamian Hospital, Amphoe Chetsamian, Ratchaburi Province on a weekly rotation After 1 month, the decline in flood victims resulted in the revision of manpower for doctors by using the previous system consisting of doctors from Nakhon Pathom Hospital providing services every Monday–Friday from 13.00 h to 15.00 h
Services system management
The 24 h services were provided under the following scope: The primary medical care was provided by doctors for the flood victims, and specialised care was also given in case of availability by specialised doctors from the paediatric clinic, psychiatric clinic, and orthopaedic clinic The primary nursing care was provided by community nurse practitioners/registered nurses. Treatments included providing basic dressings, administering insulin injections, and other minor procedures such as administration of eye drops Vital signs checks were performed, blood pressure check were carried out Visiting flood victims with chronic diseases also occurred Giving advice on holistic health care including physical/mental/social/psychological health care, and environmental management was provided Referring flood victims with health problems to be treated at the hospital, etc.
System management for medication, equipment, and medical supplies
This was to coordinate with the network of the Pharmacy Department at Nakhon Pathom Hospital, the Social Medicine Department at Nakhon Pathom Hospital, and Nakhon Pathom Provincial Health Office in support of medicine and medical supplies During the early stage, it was necessary to use medicine and medical supplies from the first aid room of the University, as well as requesting donations from network drugstores in the Nakhon Pathom Province, people in the Nakhon Pathom market and the general public
Referral system management
During the early stage, transportation services from the University were provided in case of follow-up visits at Nakhon Pathom Hospital It was necessary to coordinate with Nakhon Pathom Tambon Local Administrative Organisation in arranging a 24 h rescue provided by vehicles being entitled to be reimbursed for their expenses by Nakhon Pathom Provincial Health Office to the amount of 350 baht per trip leading to a more efficient referral system However, due to unavailability of services during the change of shift at 7.00–9.00 h the survey on medical appointments of flood victims was conducted in order to plan the referral time with the night shift rescue officers before 7.00 h
2. Field hospital served as the rehabilitation centre for dependent patients with chronic diseases
Manpower for registered nurses
This was to place 2 registered nurses per shift from the flooded hospitals on duty for 12 h (7.00–19.00 h) Registered nurses came from Huai Plu Hospital and Luangphopern Hospital who were on duty on even/odd day rotation
Manpower for doctors–
This was to request doctors from the first aid room to help follow-up patients and provide treatment once a day
Manpower for nursing students and lecturers from the Faculty of Nursing at Nakhon Pathom Rajabhat University
Initially there were about 6–8 volunteer nursing students on duty for 12 h, taking care of sick flood victims every day until 22.00 h. Then, these nursing students were required to stay overnight. In cases of emergency they had to call nurses at the first aid room for assistance or referral to Nakhon Pathom Hospital When the number of beds required by patients reached 28 the Faculty of Nursing realised an insufficient manpower which was announced by the Dean of the Faculty at the beginning of the semester As a result of this manpower management was integrated into the nursing programme, requiring second year nursing students to practice nursing skills for 8 h per shift (7.00–15.00 h and 15.00–21.00 h) In addition, 7–8 nursing students were placed at shift work with 1 advisor at a total of 16 students and 2 advisors in 2 groups. After 21.30–07.00 h 4 first year nursing students were on duty for taking care of the patients
System management
There were two kinds of 24 h services: services for dependent patients, and day hospital services. Patients in the field the field hospital were categorised into: Patients with chronic diseases requiring intensive care Dependent flood victims Dependent flood victims under the care of their relatives. There were two nursing teams: A team of nurses providing care for patients with chronic diseases requiring intensive care A team of nursing lecturers and students voluntarily taking care of dependent flood victims and dependent flood victims under the care of their relatives
According to the estimates of the budget for managing the field hospital and the first aid room at the shelter at Nakhon Pathom Rajabhat University upon the establishment of the field hospital on November 1, 2011, there were 30 patients, incurring cost of caring in the amount of approximately 21,800 baht per day with a total of 654,000 baht per month as outlined in Table 2.
Table 2List of the budget estimation for health services management at the shelter at Nakhon Pathom Rajabhat University.
Item
Description
Estimated daily expense
1. Equipment for taking care of dependent patients
Above budget excludes utilities fee, location fee, and service costs at the first aid room. The field hospital will turn on five air-conditioners at night (18.00–6.00 h) in alternation.
Home visit
Home visit is a settle plan with man power, system management and develop innovation tool management as follows (see Table 3).
Table 3Home visit at the shelter at Nakhon Pathom Rajabhat University.
Main service
Core management
Details
Home visit
Manpower management
Four nursing lecturers Ten volunteers from first/second year nursing students Village health volunteers from Nakhon Pathom, cooperating in preparing the family folders for about 1 week 28 students enrolled in the health promotion programme and five nursing lecturers participated in the activity
System management
This was to provide continuous care having the family folders to facilitate each visit The fundamental health status of flood victims from 23 villages (about 400 persons) has been evaluated in the same way, recording their requirements and vital signs Specific visits were been provided for the flood victims with chronic diseases such as diabetes, hypertension, asthma, pregnant women, postpartum women, newborns, and sick children
Innovation: tool of management
“Map for patients visit at the shelter” was launched in order to acknowledge locations of patients, and utilised for disease surveillance Registered nurses did the daily nursing patrol at 20.00 h Team monitor home visit results from the family folder and to provide follow up visits in case of health problems including checking the map for chronic diseases cases Follow up enabled by nursing lecturers to plan nursing care with students in case required continuous care such as Fractures leg required to be treated at Nakhon Pathom Hospital Diabetes patients needing insulin injections Hypertension patients’ needs medication management and stress reduction Colon cancer patients needs follow up with doctor's cases regarding continuing care
The concept of the field hospital flood shelter victims has been subject to little research. This study contributes to our understood of flood victim relief in learning by doing which in the flood situation crisis. From integrated literatures review found filed hospital are emergency department,
Cooperation between Ministry of Public Health and Bangkok Metropolitan Administration in the Establishment of the Field Hospital at the Shelter. Bankok.
Health care services systems for Flood Relief Operations Centers at Nakhon Pathom Rajabhat University is different concept. Because this centre is underpinned community based social capacity and integrated capacity of Faculty of Nursing for moveable to care during crisis situation. Especially, the integration process came from with the involvement of the Dean and all lecturers through mutual thinking, planning, implementation and evaluation. According to the management meeting at the Faculty of Nursing all the participants agreed that the instructions should enhance experiences for students in managing the shelter, established health promotion
and the field hospital, emphasising the activities held in accordance with the targeted objectives; adjusting the target group, practice at a real location, designing academic activities and conducting research guided by lecturers operation resulting in research fields.
Limitations
There are limitations associated with timing, reliance on flood crisis situation that should be considered when interpreting the study results. This research was used within and without triangulation for creditability of research. The ethics of research use participants understood and verbal consent form before data collection.
Conclusions
The success factors for the health services management for flood victims at the shelter at Nakhon Pathom Rajabhat University included:
1)
Intention of the executive to provide assistance without limitations.
2)
Cooperation between lecturers by integrating their missions.
3)
Availability of the executive and lecturers through networking obviously contributed to the success of management.
Human research ethics approval
Approval was provided by the University Ethics Committee.
Provenance and conflicts of interest
None declared. This paper was not commissioned.
Funding
This paper was funded by Research and Development Institution, Nakhon Pathom Rajabhat University.
Acknowledgement
This research was generously funded by Nakhon Pathom Rajabhat University.
References
Board NEaSD
Inception report on disaster management and recovery: domestic and international case studies.
Cooperation between Ministry of Public Health and Bangkok Metropolitan Administration in the Establishment of the Field Hospital at the Shelter. Bankok.
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