Australasian Emergency Nursing Journal (2013) 16, 116122

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/aenj

RESEARCH PAPER

Management of health care services for ood victims: The case of the shelter at Nakhon Pathom Rajabhat University Central Thailand
Hathaichanok Buajaroen, RN, PhD
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
Flood Relief Operations Center; Flood victims; Health care service systems

Summary Background: In Central Thailand basic health care services were affected by a natural disaster in the form of a ood 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 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 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, eld hospital. The core of management was to achieve integrated instruction started from nursing students were practiced skills as Health promotion and nursing techniques practicum.

Tel.: +66 34 261081; fax: +66 34 261075. E-mail address: hbuajalearn@gmail.com

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 without 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.

Introduction
In Central Thailand our health care system was severely affected by a ood 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.1 Patients who had chronic diseases needed follow up medication management. Accordingly they were moved to the ood shelter at Nakhon pathom Rajabhat University. The ood 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.2 Almost all of them had lost hope and were highly stressed suffering from mild depression and anxiety because of the ood since some of them already had for the second or third time to abandon a place they believed save before reaching the eld hospital.3 The Faculty of Nursing, Nakhon Pathom Rajabhat University urgently setup systems including a eld 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 ood 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 participation4 during OctoberDecember, 2010.

Data analysis
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 eld 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 benet planning, networking and integrated management of health care services (Fig. 1).

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 nonobservational 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 ood victims and the ood victims themselves at ood victims at Relief Operations Center, Nakhon Pathom Rajabhat University.

118

Table 1

The structure of health care services designed. Core management Manpower management Detail It was determined to have 24 h manpower Nakhon Pathom Provincial Health Ofce was supplied additional manpower working period on 1218 h Nursing students and lecturers of the Faculty of Nursing at Nakhon Pathom Rajabhat University were stand by for nursing care

Main service First aid room is designed in the form of the outpatient department and emergency department in combination with disease prevention and rehabilitation unit

Manpower for registered nurses

There were initially about 24 registered nurses for the morning shift and night shift The ofcer of the Tambon Health Promotion Hospital with a total of 1 person per shift The morning shift was available consisting by the rst aid room of Nakhon Pathom Rajabhat University The night shift consisted of the shelter includes: Stage I: in the rst time: one person per shift with the ofcer of Tambon Health Promotion Hospital and four nursing students Stage II: there were two registered nurses from the ooded hospitals such as Buddhamonthon Hospital on duty during the afternoon shift from 16.00 h to 20.00 h as replacement still maintaining 24 nursing students Stage III: most patients usually visited at night raising the gures to 3040 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 Ofce on duty during the morning shift Voluntary Doctors, Dr. Phanompan, who helped and provided medical services in the area for 3 weeks 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 The 24 h services were provided under the following scope: 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 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.

Manpower for doctorsDoctors

Services system management

H. Buajaroen

Management of health care services for ood victims

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 Ofce in support of medicine and 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 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 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 This was to place 2 registered nurses per shift from the ooded hospitals on duty for 12 h (7.0019.00 h) Registered nurses came from Huai Plu Hospital and Luangphopern Hospital who were on duty on even/odd day rotation

Referral system management

2. Field hospital served as the rehabilitation centre for dependent patients with chronic diseases

Manpower for registered nurses

Manpower for doctors Manpower for nursing students and lecturers from the Faculty of Nursing at Nakhon Pathom Rajabhat University

System management

This was to request doctors from the rst aid room to help follow-up patients and provide treatment once a day Initially there were about 68 volunteer nursing students on duty for 12 h, taking care of sick ood 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 rst 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 insufcient 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 (7.0015.00 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 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 Item

List of the budget estimation for health services management at the shelter at Nakhon Pathom Rajabhat University. Description Diapers, suction, suction catheters, suction catheter cleaners, urine catheters, oxygen Three meals per day for about 50 persons Estimated daily expense 2000 baht per day = 60,000 baht per month

1. Equipment for taking care of dependent patients 2. Food for patients, relatives, nurses, doctors, nursing students and lecturers, and volunteers 3. Equipment and medical supplies

5000 baht per day = 150,000 baht per month

4. Laundry 5. Infected waste disposal 6. Sterilisation 7. Nursing service cost 8. Personal supplies of patients and relatives 9. Vehicles for moving or referring patients to the hospital for seeing doctors, dialysis, and treatment 10. Medicine for chronic disease 11. Coordination

Dressing, NS for irrigation, cotton wool, alcohol, rst aid kit, plasters, cotton sticks, thermometers, kidney trays, stethoscopes, wooden tongue depressors, gloves, etc. Bed sheets, patients clothing, rubber draw sheets Infected waste such as blood, lymph need to be disposed Infected equipment needs to be sterilised Vital signs check, dressing, injection, capillary puncture, suction, etc. Soaps, detergents, tooth pastes, tooth brushes, shampoo, dish cleaners, talcum powder, combs, etc. 350 baht per time, about 48 times per day

3000 baht per day = 90,000 baht per month

1000 baht per day = 30,000 baht per month 1000 baht per day = 30,000 baht per month 1000 baht per day = 30,000 baht per month 1000 baht per day = 30,000 baht per month 2000 baht per day = 60,000 baht per month 2800 baht per day = 84,000 baht per month

Medicine for diabetes/hypertension, anti-biotic, medicine for hyperlipidemia/heart disease/kidney disease/orthopaedic disease/stroke, etc. Coordination with related agencies by phone

2000 baht per day = 60,000 baht per month

1000 baht per day = 30,000 baht per month

Management of health care services for ood victims

Table 3 Home visit at the shelter at Nakhon Pathom Rajabhat University. Core management Manpower management Details

121

Main service Home visit

System management

Innovation: tool of management

Four nursing lecturers Ten volunteers from rst/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 ve nursing lecturers participated in the activity This was to provide continuous care having the family folders to facilitate each visit The fundamental health status of ood victims from 23 villages (about 400 persons) has been evaluated in the same way, recording their requirements and vital signs Specic visits were been provided for the ood victims with chronic diseases such as diabetes, hypertension, asthma, pregnant women, postpartum women, newborns, and sick children 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 doctors cases regarding continuing care

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 rst aid room and eld hospital (Table 1). Budgeting system management According to the estimates of the budget for managing the eld hospital and the rst aid room at the shelter at Nakhon Pathom Rajabhat University upon the establishment of the eld 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. Above budget excludes utilities fee, location fee, and service costs at the rst aid room. The eld hospital will turn on ve air-conditioners at night (18.006.00 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).

prevention,6 Out Patient Department (OPD).3,7 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 promotion8 and the eld 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 elds.

Limitations
There are limitations associated with timing, reliance on ood 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.

Discussion
The concept of the eld hospital ood shelter victims has been subject to little research. This study contributes to our understood of ood victim relief in learning by doing which in the ood situation crisis. From integrated literatures review found led hospital are emergency department,5 inuenza

Conclusions
The success factors for the health services management for ood victims at the shelter at Nakhon Pathom Rajabhat University included:

122 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.

H. Buajaroen

References
1. Board NEaSD. Inception report on disaster management and recovery: domestic and international case studies. Bangkok: Petchrung Press; 2011. 2. Nilapan S. Field hospital model providing assistance for difculties. Matichon Newspaper; 2011. Available from: http://www.matichon.co.th/news detail.php?newsid 3. Management CfD. Flood information; 2011. Available from: http://www.k4ood.net 4. Strauss HLCJ. Basics of qualitative research: techniques and procedures for developing groundeal theory. Thousand Oaks: Sage; 1998. 5. Health MoP. Cooperation between Ministry of Public Health and Bangkok Metropolitan Administration in the Establishment of the Field Hospital at the Shelter. Bankok; 2011. Available from: http://www.manager.co.th/Home/ViewNews.aspx?NewsID= 9540000138231 6. Mitigation DoDPa. Manual on the shelter management; 2011 http://www.disaster.go.th/dpm/ood/news/book/book immigrantion%20center.pdf 7. Committee KM. Lesson on the establishment of the shelter for ood victims at Suansaranrom Hospital. Surat Thani: Suansaranrom Hospital; 2011. 8. Thanomsat K, Chowsilpa N. Health promoting behaviors among voluntary working staff at the shelter for ood victims, Nakhon Pathom Rajabhat University. Nakhon Pathom: Nakhon Pathom Rajabhut University; 2011.

Human research ethics approval

Approval was provided by the University Ethics Committee.

Provenance and conicts 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.