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 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.

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
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.
Introduction
In Central Thailand our health care system was severely
affected by a ood crisis situation, which reached the high-
est 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 Uni-
versity 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 knowl-
edge of concept, lesson learned, process of management
for health care service system among ood victims at Relief
Operations Center, Nakhon Pathom Rajabhat University.
Materials and methods
Study design
This study used a qualitative research design. We employed
a mixed methods approach involving in-depth inter-
views, focus group, observational participation and non-
observational 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.
117
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 manage-
ment, 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 consis-
tent with the mission of Nakhon Pathom Rajabhat University
which aims to cooperate with the locality and the develop-
ment 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 vol-
unteer 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).
 118
Table 1 The structure of health care services designed.

Main service Core management Detail

First aid room is Manpower management It was determined to have 24 h manpower

designed in the form Nakhon Pathom Provincial Health Ofce was supplied additional manpower working period on 1218 h
of the outpatient Nursing students and lecturers of the Faculty of Nursing at Nakhon Pathom Rajabhat University were stand by for
department and nursing care
emergency
department in
combination with
disease prevention
and rehabilitation unit
Manpower for registered There were initially about 24 registered nurses for the morning shift and night shift
nurses 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

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.

Item Description Estimated daily expense

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

Table 3 Home visit at the shelter at Nakhon Pathom Rajabhat University.

Main service Core Details

management

Home visit Manpower Four nursing lecturers

management 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
System This was to provide continuous care having the family folders to facilitate each visit
management 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
Innovation: Map for patients visit at the shelter was launched in order to acknowledge locations of
tool of patients, and utilised for disease surveillance
management 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 alter-
nation.
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 manage-
ment 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

Home visit There are limitations associated with timing, reliance on

Home visit is a settle plan with man power, system manage-
ment and develop innovation tool management as follows
(see Table 3).
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
ood crisis situation that should be considered when inter-
preting 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.
Conclusions
The success factors for the health services management for
ood victims at the shelter at Nakhon Pathom Rajabhat Uni-
versity included:
122
1) Intention of the executive to provide assistance without
limitations.
2) Cooperation between lecturers by integrating their mis-
sions.
3) Availability of the executive and lecturers through
networking obviously contributed to the success of man-
agement.
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 Insti-
tution, Nakhon Pathom Rajabhat University.
Acknowledgement
This research was generously funded by Nakhon Pathom
Rajabhat University.
H. Buajaroen
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