Sağlık Profesyonellerinin Afet Triajı Yapabilme ve Etik Karar Verebilme Düzeyleri: İzmir İli Örneği

Amaç: Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Fakültesi Acil Yardım ve Afet Yönetimi Bölümü, İstiklal Yerleşkesi 15030 Burdur, TürkiyeMateryal-Metot: Veri toplama aracı olarak anket formu kullanılmıştır. Hazırlanan anket formları çalışmanın yapıldığı ildeki 112 Acil Sağlık İstasyonları çalışanları, UMKE ekibi ve AKS-110 ekibinden toplam 215 sağlık profesyoneline uygulanmıştır. Böylelikle sağlık profesyonellerinin afet triajı yapabilme yeterlilikleri ve ikilem halinde etik karar verebilme düzeyleri değerlendirilmiş ve değişkenler ile arasındaki ilişkiler belirlenmiştir.Bulgular: Araştırma sonucunda katılımcıların %51,2’sinin afet triajı etik bilgi düzeylerinin yetersiz olduğu tespit edilmiştir. Katılımcıların afet triajı etik bilgi düzeyi arttıkça etik karar verme eğilimlerinin de arttığı gözlenmiştir. Katılımcılar, afet triajında ölüm kararı verme, CPR uygulama ve kıt kaynakların paylaştırılması konusunda etik ikilemde kalmışlardır.Sonuç: Öncelikli olarak afet öncesi hazırlık döneminde afet triajına yönelik eğitimlerin arttırılması ve sağlık profesyonellerinin mesleki eğitimlerinde almış oldukları etik derslerine afet triajının etik boyutunun da dâhil edilmesi önerilmektedir. Sağlık profesyonellerinin etik düşünebilme ve etik karar verebilme yetenekleri yapılan tatbikatlar, simülasyonlar ve masa üstü egzersizlerle geliştirilmelidir. Hazırlanacak bu uygulamalı eğitimlerde etik ikilemin yaşanabileceği afet senaryoları yer almalıdır.

Healthcare Professionals’ Levels of Disaster Triage and Ethical Decision Making: İzmir Province Samples

Objective: This study aimed to examine whether the qualities healthcare professionals in Izmir related to disaster triage were adequate and whether these qualities influence their capacity to make ethical decisions. Material-Method: The researcher used a questionnaire form for data collection. The survey was completed by 215 healthcare professional working in Emergency-Medical Stations, National Medical Rescue Teams and Search-Rescue-Health Teams in Izmir. Through this method, their ability to carry disaster triage and make ethical decisions in conflictual situations is measured in relation to different variables. Results: According to results, it was determined that 51.2% of the participants had inadequate knowledge level of ethical principles of disaster triage. Their knowledge level of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to make ethical decisions also increased. Also, they stayed in ethical dilemmas that perform cardio-pulmonary resuscitation, manage limited resources and make decisions to die. Conclusions: So results of this study suggest that more training on disaster triage should be provided on the areas of the pre-impact phase of disaster. In addition, ethical dimension of disaster triage should be included in the syllabi of the ethics classes in the vocational training for healthcare professionals. Drill, simulations, and board exercises can be used to improve ethical decision making abilities of healthcare professionals. Disaster scenarios where ethical dilemmas are faced should be prepared for such applied training programs.

PDF

___

1. Bostick NA, Subbarao I, Burkle FM, Hsu, EB, Armstrong JH, James JJ. Disaster triage systems for large-scale catastrophic events. Disaster Medicine and Public Health Preparedness 2008; 2(1): 35-39.
2. Lanoix R, Wiener DE, Zayas VD. Concepts in disaster triage in the wake of the world trade center terrorist attack. Advanced Emergency Nursing Journal 2002; 24 (2): 60-71.
3. Rådestad M, Lennquist MK, Rüter A, Castrén M, Svensson L, Gryth D, Fossum B. Attitudes towards and experience of the use of triage tags in major ıncidents: a mixed method study. Prehospital And Disaster Medicine 2016; 31(4): 1-10.
4. Geale SK. The ethics of disaster management. Disaster Prevention And Management: An International Journal 2012; 21(4): 445 – 462.
5. Ranse J, Zeitz K. Disaster Triage. International Disaster Nursing. Cambridge University Press, 2010, p. 57-79
6. T O’Laughlin D, Hick JL. Ethical ıssues in resource triage. Respiratory Care 2008; 53(2): 190-200.
7. Tännsjö T. Ethical aspects of triage in mass casualty. Current Opinion in Anesthesiology 2007; 20(2): 143-146.
8. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press, 2001, p. 12-20.
9. Good L. Ethical decision making in disaster triage. Journal of Emergency Nursing. 2008; 34(2): 112-115.
10. Carter R. Special Considerations in Disaster Zones. Emergency Medical Services: Clinical Practice And Systems Oversight, Second Edition,USA: Wiley, 2015, p. 283-287.
11. Özdemir A. Yöntem Biliminde İleri Araştırma Yöntemleri ve Uygulamalar. İstanbul, Beta Yayıncılık, 2010; p.122.
12. Kaya Z, Kaya ON. Öğretmen eğitiminde vignette tekniği ve uygulamaları. Eğitim ve Bilim Dergisi 2013; 38(168): 129-142.
13. Daniel M. Bedside resource stewardship in disasters: a provider’s dilemma practicing in an ethical gap. The Journal Of Clinical Ethics. 2012; 23(4): 331-335.
14. Goodman A, Black L. The challenge of allocating scarce medical resourc-es during a disaster in a low income country: a case study from the 2010 haitian earthquake. Palliat Med Hosp Care Open J. 2015; 1(1): 24-29.
15. Rios CL, Redlener M, Cioe E, Roblin PM, Kohlhoff S, Rinnert S, ... & Arquilla B. Addressing The Need, Ethical decision making in disasters, who comes first?. Journal Of US-China Medical Science 2015; (12): 20-26.
16. Ekşi A. Kitlesel Olaylarda Hastane Öncesi Acil Sağlık Hizmetleri Yönetimi. İzmir, KitapAna, 2015.
17. Howard PK, Foley AL. Disaster triage-are you ready?. Journal of Emergency Nursing. 2014; 40(5): 515-517.
18. Koziel JR, Meckler G, Brown L, Acker D, Torino M, Walsh B, Cicero MX. Barriers to pediatric disaster triage: a qualitative ınvestigation. Prehospital Emergency Care. 2015; 19(2): 279-286.
19. Cicero MX, Overly F, Brown L, Yarzebski J, Walsh B, Shabanova V, ...Cone DC. Comparing the accuracy of three pediatric disaster triage strategies: a simulation-based ınvestigation. Disaster Medicine And Public Health Preparedness. 2016; 10 (02): 253-260.
20. Sevimli S, Dursun R, Karadas S. Health professionals of emergency service: evaluation of triage and ethical values in disaster medicine. Journal of Academic Emergency Medicine 2015; 14(3): 107-112).
21. Reeves, D. Emergency Responders’ Perspetives on Ethics of Triage. (Unpublished Master Dissertation). Arkansas, Graduate Colloge of Arkansas Tech University, 2015.
22. Wagner JM, Dahnke MD. Nursing ethics and disaster triage: applying utilitarian ethical theory. Journal Of Emergency Nursing. 2015; 41(4): 300-306.
23. Schultz CH, Koenig KL. Disaster Preparedness. Rosen’s Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences, 2013; pp: 2457- 2468. http://www.slremeducation.org/wp-content/uploads/2015/02/Chapter-193.-Disaster-Preparedness.pdf, 17.06.2016.
24. Mace SE, Mayer TA. Triage. Pediatric Emergency Medicine. Saunders Elsevier. 2008; 1087-1096. https://books.google.com.tr/books?id=4XcatTO8dVUC, 05.01.2016.
25. Lanoix R, Wiener DE, Zayas VD. Concepts in disaster triage in the wake of the world trade center terrorist attack. Advanced Emergency Nursing Journal 2002; 24 (2):60-71.
26. Pesik N, Keim, ME, Iserson KV. Terrorism and the ethics of emergency medical care. Annals of Emergency Medicine 2001; 37(6): 642-646.
27. Pou AM. Ethical and legal challenges in disaster medicine: are you ready?. Southern Medical Journal 2013; 106 (1): 27-30.
28. Gül Ş, Duru-Aşiret G, Bayrak-Kahraman B, Devrez N, Örnek-Büken N. Etik dersi alan ve almayan hemşirelik öğrencilerinin etik karar verebilme düzeylerinin incelenmesi. Hemşirelikte Araştırma Geliştirme Dergisi 2013; 15(1): 23-31.