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The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as “first receivers” during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored.
Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique.
Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4) appropriate mechanisms to enable two-way communication between employees and their families under conditions of quarantine or long work hours.
Social and organizational supports are critical to help buffer the effects of stress for nurses and assist them in managing difficult role conflicts during infectious disease outbreaks. These supports are necessary to improve response capacity for bio-disasters.
Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units.
The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness.
Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts 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 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.
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.
There is always a temptation to shrink from the difficult task of grounding identifying assumptions in empirical and theoretical knowledge and to select them instead on grounds of statistical convenience or simplicity. This is a temptation that is worth resisting if we wish to arrive at a real understanding of the phenomena we are studying. In this as in other decisions associated with our statistical methods, it is a snare and a delusion to seek out ‘automatic’ techniques that can be applied without careful consideration or that are neutral with respect to the substance of our theories. It is not enough to learn the etiquette book. The reason (or lack of reason) for its rules must be understood as well.
Herbert A. Simon (1979)
STATISTICS AND THE ANALYSIS OF SURVEY MATERIAL
It may be useful to begin with a small amount of history. This chapter derives from a series of seminars held in London to stimulate discussion of research issues in social psychiatry and was deliberately couched in somewhat provocative terms (hence its title). In a longer view it relates to a certain lingering skepticism about the usefulness of complex multivariate statistics – at least on the part of the first two of us. To be provocative: in our own field of social psychiatry we know of no important findings whose dissemination required such statistics; we suspect that most discoveries have not owed their origin to such statistics, and the statistics may at times actually have prevented important insights.
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