The underlying factors affecting the ethical performance of health service providers when faced with disasters: a qualitative study
AbstractDisasters are sudden catastrophic events leading to decisions in health service provision that are not in compliance with the principles and frameworks used in normal circumstances. It is essential to develop guidelines in order to ensure the ethical performance of health service providers and to prevent and manage the adverse consequences. As the first step in guideline development, the present study investigated the underlying factors affecting the ethical performance of health service providers in disasters.This was a qualitative research based on grounded theory, and was conducted through unstructured in-depth interviews with various health service providers including paramedics, physicians and crisis zone managers who had some experiences in a number of domestic and foreign disasters. The collected data were analyzed using conventional content analysis.The underlying factors extracted from the 24 interviews were divided into structural and mediatory factors. The structural factors covered the nature of the disaster, the type of social interactions, and lack of a unity management; the mediatory factors were connected to the emotional atmosphere governing the field, the behavior of the local people, the locals’ economic status, the locals’ trust in the authorities, and the safety of the crisis zone.We can look into more effective, continuous and dynamic relationships between the components of the process of ethical performance. It is evident, however, that the underlying factors have more effective roles than the other components. According to our findings, the role of the underlying, structural and mediatory factors are more of a threat than an opportunity in disasters.
2. Anonymous. The Human cost of natural disasters 2015, a global perspective.http://cred.be/sites/default/files/The_Human_Cost_of_Natural_Disasters_CRED.pdf (Accessed on 2017).
3. Khankeh H, Mohammadi R, Ahmadi F. Health care services at time of natural disasters: a qualitative study. Iranian Journal of Nursing. 2007; 20(51):85-96.
4. Rios CL, Redlener M, Cioe E, et al. Addressing the need, ethical decision making in disasters, who comes first. Journal of US-China Medical Science. 2015; 12: 20-6.
5. Kiani M, Fadavi M, Khankeh H, Borhani F. Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents inIran: a qualitative study. Med Health Care Philos. 2017; 20(3): 343-51.
6. Grimaldi ME. Ethical decisions in times of disaster: choices healthcare workers must make. J Trauma Nurs. 2007; 14(3):
7. Wynia MK. Ethics and public health emergencies: rationing vaccines. Am J Bioeth. 2006; 6(6):4-7.
8. Holt RG. Making difficult ethical decisions in patient care during natural disasters and other mass casualty events. Otolaryngol Head Neck Surg. 2008; 139(2):181-6.
9. Corbin J, Strauss A. Basics of Qualitative Research. USA: Sage Publication; 2008.
10. Larkin GL. Unwitting partners in death, the ethics of teamwork in disaster management. Virtual Mentor. 2010; 12(6): 495-501.
11. Thompson C. Making ethical decisions during disasters. Nurs N Z. 2006; 12(11): 30.
12. O’Laughlin DT, Hick J. Ethical issues in resource triage. Respir Care. 2008; 53(2):190-200.
13. Montan KL, Örtenwall P, Lennquist S. Assessment of the accuracy of the medical response to major incidents (MRMI) course for interactive training of the response to major incidents and disaster. Am J Disaster Med. 2015; 10(2): 93-107.
14. Karadag CO, Hakan AK. Ethical dilemmas in disaster medicine. IRCMJ. 2012; 14(10): 602-12.
15. Chaffee MW. Making the decision to report to work in a disaster: Nurses may have conflicting obligations. Am J Nurs. 2006; 106(9): 54-7.
16. Fothergill A, Peek L. Poverty and disasters in the United States: a review of recent sociological findings. Natural Hazards.2004; 32(1): 89-110.
17. Sobelson RK, Wigington CJ, Harp V, Bronson BB. A whole community approach to emergency management: strategies and best practices of seven community programs. J Emerg Manag. 2015; 13(4): 349-57.
18. Bergeron WP. Considering cultural in evacuation planning and consequence. J Emerg Manag. 2015; 13(2): 87-92.