Yuli Zang

Development of hospital disaster resilience: conceptual framework and potential measurement

Objective Despite ‘hospital resilience’ gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. Methods Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included ‘resilience and framework or model’ or ‘evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety’. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities. Result A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included. Discussion and conclusion Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.

The applicability of WHODAS 2.0 in adolescents in China

AIMS AND OBJECTIVES This study was designed to examine the applicability of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in adolescents in China for internal consistency and factorial validity. BACKGROUND The conceptualisation of impairments, activity limitation and participation restriction as disability underpins WHODAS 2.0. Available evidence is mainly about the use of WHODAS 2.0 in adults with little attention to adolescents. DESIGN Survey design. METHODS A total 314 adolescent inpatients were recruited using a purposive sampling strategy and self-measured with a range of scales related to puberty development, family function, 36-item WHODAS 2.0, extended version of Strength and Difficulties Questionnaire (Ext-SDQ). The same amount of junior high school student data was randomly selected to facilitate the model invariance examination through confirmatory factor analysis with the assistance of amos 19 and spss 19. RESULTS Adolescents (mean, 14.07; SD, 2.866) varied greatly in demography, health conditions, body mass index, puberty development, family function, disability and difficulties as well as prosocial status. After the removal of the item on sexual activity, the internal consistency for the 35-item WHODAS is satisfactory, overall and dimensional. The six-factor WHODAS model was found to be a good model fit, moderately correlated with the overall difficulty measured by the 20-item four-factor SDQ, with the ability to differentiate the group of adolescent inpatients and junior high school students. CONCLUSION The 35-item WHODAS is useful with adolescents with satisfactory internal reliability and factorial validity. RELEVANCE TO CLINICAL PRACTICE This study supports the use of 35-item WHODAS in adolescents with or without health conditions in school and hospital settings, which paves the way for a better understanding about and health service delivery to adolescents during the transition from childhood to adulthood.

Validation of a Framework for Measuring Hospital Disaster Resilience Using Factor Analysis

Hospital disaster resilience can be defined as “the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one.” This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.

2010–2011 Queensland floods: Using Haddon's Matrix to define and categorise public safety strategies

The 2010–2011 Queensland floods resulted in the most deaths from a single flood event in Australia since 1916. This article analyses the information on these deaths for comparison with those from previous floods in modern Australia in an attempt to identify factors that have contributed to those deaths. Haddons Matrix, originally designed for prevention of road trauma, offers a framework for understanding the interplay between contributing factors and helps facilitate a clearer understanding of the varied strategies required to ensure peoples safety for particular flood types.

Promoting urinary continence with older people: key issues for nurses.

Urinary incontinence is one of the most common and distressing of the conditions experienced by older people. It is not just associated with physical and cognitive frailty but also features significantly in the fit community living population. Urinary incontinence is known to be hidden and under-reported. Yet the needs of older people across the globe in relation to urinary incontinence will increase with the changing demography. Palliative strategies to contain urinary incontinence predominate in practice, although the reasons for this are not fully understood. Conservative approaches including lifestyle adjustments and behavioural therapies form the mainstay of active continence promotion but their routine use by nurses working with older people seems to be minimal. Promoting continence with older people is an area of practice long overdue for significant and sustainable practice development.

Development of key indicators of hospital resilience: a modified Delphi study

Objectives Hospital resilience is an emerging concept, which can be defined as ‘a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining its critical health care functions, and then recover to its original state or adapt to a new one’. Our aim was to develop a comprehensive framework of key indicators of hospital resilience. Methods A panel of 33 Chinese experts was invited to participate in a three-round, modified Delphi study to develop a set of potential measures previously derived from a literature review. In the first round, these potential measures were modified to cover the comprehensive domains of hospital resilience. The importance of proposed measures was scored by experts on a five-point Likert scale. Subsequently, the experts reconsidered their voting in light of the previous aggregated results. Agreement on measures was defined as at least 70% of the responders agreeing or strongly agreeing to the inclusion of a measure. Results A large proportion of preliminary measures (89.5%) were identified as having good potential for assessing hospital resilience. These measures were categorized into eight domains, 17 subdomains, and 43 indicators. The highest rated indicators (mean score) were: equipment for on-site rescue (4.7), plan initiation (4.6), equipment for referral of patients with complex care needs (4.5), the plan execution (4.4), medication management strategies (4.4), emergency medical treatment conditions (4.4), disaster committee (4.4), stock types and quantities for essential medications (4.4), surge capacity of emergency beds (4.4), and mass-casualty triage protocols (4.4). Conclusions This framework identifies a comprehensive set of indicators of hospital resilience. It can be used for hospital assessment, as well as informing priority practices to address future disasters better.

Progress and challenges of disaster health management in China: a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Effectiveness of audiovisual interventions on stress responses in adolescents with ENT surgery in hospital: randomized controlled trial protocol.

AIM To investigate the circadian pattern of cortisol secretion and other stress indictors in association with audiovisual stimuli in adolescents having otorhinolaryngological surgery in hospital. BACKGROUND Hospitalization for surgery is a major stressful life event for adolescents causing negative consequences, including anxiety. Recent studies suggest that entertaining and educational interventions might be effective at reducing such adversities, but little is known about the pattern of these responses and effects. DESIGN Randomized controlled trial. METHODS Adolescents with otorhinolaryngological surgery in hospital without any contraindictions for salivary cortisol enzyme immunoassays will be recruited and randomly allocated to experimental, placebo and control. Stress indicators will be collected regularly for 5 days. Standard audiovisual interventions will be displayed for experimental and placebo groups including a simultaneous video-recording of facial and behavioural changes on the second afternoon postadmission and stress indicators will be collected pre- and three times with 20-minute interval postintervention. Follow-up will be conducted to evaluate the longer term effects at 2 weeks, 1-month and 3 months postadmission, respectively. Descriptive and comparative analyses of stress indicators will be performed to examine group differences. Competitive funding was obtained from the Independent Innovation Foundation of Shandong University for interdisciplinary research in 2012. DISCUSSION This study will help identify timeslots for interventions for integrating strength-building into stress response reduction in adolescents hospitalized for surgery.

Commentary on Chen WT & Han M (2010) Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive individuals: a cross-sectional survey. Journal of Clinical Nursing 19, 3227–3234

This letter discusses a cross-sectional survey of the knowledge attitudes and perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive patients. The survey explores the barriers challenges and difficulties for nurses to develop positive attitudes and practice towards people living with HIV (PLHIV). The author states that policy-level efforts have to be made to facilitate positive changes to nurses attitudes towards PLHIV especially AIDS patients by securing their legal economical medical and social rights.