Beruflich Dokumente
Kultur Dokumente
RESEARCH PAPER
Faculty of Nursing, Nakhon Pathom Rajabhat University, 85 Moo 3 Maliaman Road, Maeng, Nakhon Pathom
73000, Thailand
Received 9 August 2012 ; received in revised form 18 April 2013; accepted 4 May 2013
KEYWORDS Summary
Flood Relief Background: In Central Thailand basic health care services were affected by a natural disaster
Operations Center; in the form of a ood situation. Flood Relief Operations Centers were established from the
Flood victims; crisis. Nakhon Pathom Rajabhat University and including the faculty of nursing volunteered to
Health care service care for those affected and assist in re-establishing a functioning health care system.
systems 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
ood 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 ood victims and the ood victims.
Data was collected during OctoberDecember, 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 eld hospital services. We had prepared a man-
agement 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, eld hospital. The core of man-
agement was to achieve integrated instruction started from nursing students were practiced
skills as Health promotion and nursing techniques practicum.
1574-6267/$ see front matter 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.aenj.2013.05.001
Management of health care services for ood victims 117
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 with-
out conditions, administrations concerned and volunteer nursing students instructors, University
Ofcer have sympathetic and charitable with ood victims and environment.
2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights
reserved.
Manpower for Voluntary Doctors, Dr. Phanompan, who helped and provided medical services in the area for 3 weeks
doctorsDoctors Doctors at the rst aid room was revised in coordination with Nakhon Pathom Provincial Health Ofce 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 ood victims resulted in the revision of manpower for doctors by using the previous system
consisting of doctors from Nakhon Pathom Hospital providing services every MondayFriday from 13.00 h to 15.00 h
Services system The 24 h services were provided under the following scope:
management The primary medical care was provided by doctors for the ood 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 ood victims with chronic diseases also occurred
H. Buajaroen
Giving advice on holistic health care including physical/mental/social/psychological health care, and environmental
management was provided
Referring ood victims with health problems to be treated at the hospital, etc.
Management of health care services for ood victims
System management for This was to coordinate with the network of the Pharmacy Department at Nakhon Pathom Hospital, the Social Medicine
medication, equipment, Department at Nakhon Pathom Hospital, and Nakhon Pathom Provincial Health Ofce in support of medicine and
and medical supplies medical supplies
During the early stage, it was necessary to use medicine and medical supplies from the rst 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 During the early stage, transportation services from the University were provided in case of follow-up visits at Nakhon
management 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
Ofce to the amount of 350 baht per trip leading to a more efcient referral system
However, due to unavailability of services during the change of shift at 7.009.00 h the survey on medical appointments
of ood victims was conducted in order to plan the referral time with the night shift rescue ofcers before 7.00 h
2. Field hospital served Manpower for registered This was to place 2 registered nurses per shift from the ooded hospitals on duty for 12 h (7.0019.00 h)
as the rehabilitation nurses Registered nurses came from Huai Plu Hospital and Luangphopern Hospital who were on duty on even/odd day rotation
centre for dependent
patients with chronic
diseases
Manpower for doctors This was to request doctors from the rst aid room to help follow-up patients and provide treatment once a day
Manpower for nursing Initially there were about 68 volunteer nursing students on duty for 12 h, taking care of sick ood victims every day
students and lecturers until 22.00 h. Then, these nursing students were required to stay overnight. In cases of emergency they had to call
from the Faculty of nurses at the rst aid room for assistance or referral to Nakhon Pathom Hospital
Nursing at Nakhon When the number of beds required by patients reached 28 the Faculty of Nursing realised an insufcient manpower
Pathom Rajabhat which was announced by the Dean of the Faculty at the beginning of the semester
University 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 (7.0015.00 h and 15.0021.00 h)
In addition, 78 nursing students were placed at shift work with 1 advisor at a total of 16 students and 2 advisors in 2
groups. After 21.3007.00 h 4 rst 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 eld
the eld hospital were categorised into:
Patients with chronic diseases requiring intensive care
Dependent ood victims
Dependent ood 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 ood victims and dependent ood
victims under the care of their relatives
119
120 H. Buajaroen
Figure 1 Concept and principle of health care services management for the Nakhon Pathom Rajabhat University.
Table 2 List of the budget estimation for health services management at the shelter at Nakhon Pathom Rajabhat University.
1. Equipment for taking Diapers, suction, suction catheters, suction catheter 2000 baht per day = 60,000 baht per month
care of dependent cleaners, urine catheters, oxygen
patients
2. Food for patients, Three meals per day for about 50 persons 5000 baht per day = 150,000 baht per month
relatives, nurses,
doctors, nursing
students and
lecturers, and
volunteers
3. Equipment and Dressing, NS for irrigation, cotton wool, alcohol, rst 3000 baht per day = 90,000 baht per month
medical supplies aid kit, plasters, cotton sticks, thermometers, kidney
trays, stethoscopes, wooden tongue depressors,
gloves, etc.
4. Laundry Bed sheets, patients clothing, rubber draw sheets 1000 baht per day = 30,000 baht per month
5. Infected waste Infected waste such as blood, lymph need to be 1000 baht per day = 30,000 baht per month
disposal disposed
6. Sterilisation Infected equipment needs to be sterilised 1000 baht per day = 30,000 baht per month
7. Nursing service cost Vital signs check, dressing, injection, capillary 1000 baht per day = 30,000 baht per month
puncture, suction, etc.
8. Personal supplies of Soaps, detergents, tooth pastes, tooth brushes, 2000 baht per day = 60,000 baht per month
patients and relatives shampoo, dish cleaners, talcum powder, combs, etc.
9. Vehicles for moving or 350 baht per time, about 48 times per day 2800 baht per day = 84,000 baht per month
referring patients to
the hospital for seeing
doctors, dialysis, and
treatment
10. Medicine for chronic Medicine for diabetes/hypertension, anti-biotic, 2000 baht per day = 60,000 baht per month
disease medicine for hyperlipidemia/heart disease/kidney
disease/orthopaedic disease/stroke, etc.
11. Coordination Coordination with related agencies by phone 1000 baht per day = 30,000 baht per month
Management of health care services for ood victims 121
Structure of health care services for the Nakhon prevention,6 Out Patient Department (OPD).3,7 Health care
Pathom Rajabhat University services systems for Flood Relief Operations Centers at
Nakhon Pathom Rajabhat University is different concept.
The structure of health care services is designed based on Because this centre is underpinned community based social
the location as follows rst aid room and eld hospital capacity and integrated capacity of Faculty of Nursing for
(Table 1). moveable to care during crisis situation. Especially, the
integration process came from with the involvement of the
Budgeting system management Dean and all lecturers through mutual thinking, planning,
According to the estimates of the budget for managing the implementation and evaluation. According to the manage-
eld hospital and the rst aid room at the shelter at Nakhon ment meeting at the Faculty of Nursing all the participants
Pathom Rajabhat University upon the establishment of the agreed that the instructions should enhance experiences
eld hospital on November 1, 2011, there were 30 patients, for students in managing the shelter, established health
incurring cost of caring in the amount of approximately promotion8 and the eld hospital, emphasising the activities
21,800 baht per day with a total of 654,000 baht per month held in accordance with the targeted objectives; adjusting
as outlined in Table 2. the target group, practice at a real location, designing
Above budget excludes utilities fee, location fee, and academic activities and conducting research guided by
service costs at the rst aid room. The eld hospital will lecturers operation resulting in research elds.
turn on ve air-conditioners at night (18.006.00 h) in alter-
nation. Limitations