FUKUSHIMA Lives on the Line

103chap.IIFukushima Medical University Record of Activities [Notes and Messages]FUKUSHIMA: Lives on the Linediscussed how to exchange information, contact methods, and the next steps. We then decided on measures to be taken by the nursing department. Outpatient care took the same form as the previous day; outpatient consultations with appointments beyond normal hours took place in the outpatient orthopedic surgery area (green-tagged patient area). The day after the earthquake, also a weekend, there was no major confusion in the outpatient area.With the water shortage, we had to limit the amount of water we used, and thus, also regulated the number of outpatients and visitors. We made the main entrance the only entrance into the building, and the exit was a different location. By doing so, patients could move in one direction, and we could measure their radiation levels. Outpatient nurses also worked on decontamination of those exposed to radiation, and oversaw the temporary childcare center that the employees could avail. Each person in charge had a personal handy phone system by which they could be contacted.On March 13, the following Monday, we started to adjust staffing in coordination with the outpatient system. We decided to have day-shift nurses (including assistant nurses) in charge of support work, preparing for outpatients and organizing and conducting emergency care. We also placed two nurses in charge of radiation screening and two in charge of decontamination. Outpatient care changes with the demands of a particular day. Thus, I adopted the role of a head nurse and responded to needs with adjustments in staffing.On March 14, we conducted entryway triage, with nurses and administrative staff standing at the entrance of the hospital grounds stopping cars as they came in. The staff explained to them that we were limiting outpatient consultations and visitors and decided whether an examination was necessary. The nurse in charge of triage decided whether the patient had an emergency situation, and if so, they were given an outpatient examination. Moreover, we explained to non-emergency patients with appointments that if they brought their medical records or a doctor’s prescription from their last visit to the hospital pharmacy, they would receive medication as part of the disaster relief program. The radiation technologists also measured the radiation of patients from the nuclear evacuation zone, but none of them needed decontamination. We also had many telephonic inquiries about insulin and stoma care products, with one nurse responding to each query. On March 15, the entryway triage became crowded, requiring us to increase the number of nurses. We also had an increase in the number of patients who were temporarily evacuating the disaster area; thus, outpatient nurses could enter the hospital wards to help with meals and to change the position of bedridden patients. The nurses, it seemed, were becoming irked with the lack of clear patient data and complaints and accusations about the acts of other staff members. It was believed that the lack of water or electricity at home and the difficulty in securing food may have also been factors. At these times, I said to them, “Our outpatient care system is changing and we don’t know what type of patients will come in next. It was wonderful that amid such situations, outpatient nurses worked quite well on a night shift after a long interval.” or “Everybody in the hospital is giving their best with the work that they can do, so let’s recognize this in each other and overcome the situation!”On March 16, given the dwindling gas supply, the staff requested to change the outpatient care system from three to two shifts. Because the entryway triage was as busy as always, we increased the number of nurses in charge from two to four. By March 18, one week after the earthquake, night-time outpatients had reduced in number; thus, we combined the surgery and internal medicine into one examination area. We also scaled down the number of students and medical professional staff who we had for support. From the 19th, we began preparations to reopen the outpatient area, and on the 22nd, 12 days after the earthquake, outpatient internal medicine areas returned to their normal state. We continued to limit outpatient surgeries, and asked the staff who had relentlessly worked until then to go on vacation. On the 24th, outpatient surgery returned to its normal state, we did away with limits on visitation and stopped entryway triage.(3) Looking Back on Our WorkThis is an outpatient nursing director’s record of the two weeks after the earthquake.I learned that in times of emergency, head nurses often must make independent decisions. It is important to make case-by-case determinations without the aid of a manual. I deeply realized how important it is to educate head nurses on how to improve their day-to-day decision-making skills.A wide array of skills was demanded of outpatient nurses with this disaster, and our nursing system underwent changes. I learned that as long as there is a head nurse who can give clear directions, most nurses will promptly follow-up. I believe the experience of our nursing staff was also a factor, and that the quality of outpatient nursing will only increase if the head nurse believes in the nurses’ strengths and supports them to act based on their thoughts.Activity Records of the Fukushima Medical University Hospital