NurseClick

by Matt Luther FACN

Disaster nursing: Are you really prepared and have you asked the right questions? (PART 1) provided an overview of disasters and the role of nursing, Part 2 below introduces international perspectives on preparedness for disaster nursing. Let us know what you think in the comments.

Projecting into the international disaster response space, Hammad et al (2017), in their research “Moments of Disaster Response in the Emergency Department”, focused on the experience of multinational emergency nurses in a disaster response, exploring the impact of variables such as geographical regions and disaster types, on the nurse’s involvement. Understandably these variables, in conjunction with the elements of unpredictability, unfamiliarity, urgency, uncertainty and potentially threatening environments, can significantly impact a health care professional’s ability to perform their duty in a deployed disaster response situation. In no fault of their own, some responders have willingly deployed in response to a disaster only to find themselves unable to comprehend concepts confronting them such as the enormity of the situation, limitations in their ability to impact the situation, as well as personal limitations, having to return early, potentially impacted in ways their never imagined.

Elizabeth Battles (2007), a Registered Nurse from Louisiana, United States, in her pilot study “An Exploration of Post-traumatic Stress Disorder in Emergency Nurses Following Hurricane Katrina”, looked at the impact the chaos during and after the storm had on emergency nurses involved. While infrequently addressed in association with disaster preparedness, nor contemplated by many potential responders, psychological stressors of disasters themselves, as well as the response to a disaster, can lead to injuries such as post-traumatic stress disorder as well as physical injuries. Battles found that a significant percentage of the nurses involved reported post-traumatic stress disorder (PTSD) symptoms. Further research into the true rate of psychological injury experienced by disaster responders is needed to better understand the phenomena and thus strategies that may be useful in minimising the risk, though potential responders need to add this risk into their informed choice decision making around volunteering.

Chung and Davies (2016) extended the concept of personal psychological stressors impacting responders, looking at both the physical and emotional impact of caring for traumatised survivors of the Canterbury earthquakes, New Zealand, noting the discrete and distinct entities of compassion fatigue and burnout, having a combined impact. While compassion fatigue can be moderated and compassion rebuilt, burnout can have a prolonged impact on a health care professional’s career. While many nurses may consider themselves educationally prepared, it is difficult and in some circumstances impossible, for some health care providers, to fully prepare themselves for all facets of a disaster response. The capacity of individuals to cope evolves over time as nurses grow and their circumstances change, as does their family and social circumstances. Thus each potential deployment should be consider by the health care provider independently at that point in time.

It is not uncommon for nurses to volunteer to respond to a disaster/emergency, which is not surprising, considering the service nature of the role itself, embodying the selflessness and devotion of the image of Florence Nightingale. Preparedness, as discussed, is an underestimated, complex, missing or incomplete link in a robust sustainable model of disaster nursing. Responders generally have not truly comprehended the enormity of what they are volunteering for, as the allure of the opportunity largely take primacy. How many nurses, in the course of considering volunteering to respond to a disaster, assess whether they are: willing to be away from their family/loved ones potentially for an indeterminate period of time, work for periods without a defined end point, live in very close confines with a small group of people, have limited opportunities for hygiene, potentially be physically or psychologically injured or become ill due to local infectious diseases, have significantly altered access to communications (generally no social media access), access only a limited diet, go to the toilet in a plastic bag or partake in camp maintenance (such as burning off faeces)?  Other aspects to consider include whether they are able to apply levels of care appropriate for the population they are supporting, for example not intubating a child knowing they are terminal, as there is no capacity for ongoing intensive care level services. Some individuals are not able to manage such situations when immersed and have to return prematurely, potentially impacting the greater response capability. Preparedness is a very personal and complex state.

Dainty et al (2017) examined the perceived readiness amongst health care professionals within a tertiary care centre in Toronto, Ontario, addressing a common issue in disaster response the perceived fallacy of “readiness” to respond to disastrous situations. The eloquent statement of Dainty et al, “ubiquitous banality [pervasive normality] of personal health risk as an expected, acceptable feature of everyday life at work for ED [emergency department] staff”, while noting a desensitising, does not transcribe to preparedness. Disasters/emergency crises, by definition, are not everyday life – no matter what the operational tempo.

The World Association for Disaster and Emergency Medicine provide a clear direction in regards to disaster nursing in that, nurses as frontline health professionals, must have an understanding of the situations they may face before, during and after a disaster and they must develop the skills and strategies to provide effective and immediate care. A perception of preparedness may bear little correlation to effective performance as a disaster responder, thus equal importance must be placed on both the individual professional’s preparation and resilience, as well as their competence.

While only subtle differences in wording, the response, “I’m ready” versus “I’ll go if you need me” from health care professionals reflecting on disaster response preparedness, captures the variable between youthful naivety and eagerness, against perhaps a more gnarled and scarred position of considered dedication and experience.

Considering the complex unpredictable nature of disasters, combined with the intricacy of human behaviour and capacity, perhaps only the lived experience can prepare the responder for a reality that cannot be adequately described, prepared for or anticipated.

References

Battles, E.D., 2007. An exploration of post-traumatic stress disorder in emergency nurses following Hurricane Katrina. Journal of Emergency Nursing, 33(4), pp.314-318.

Chung, J. and Davies, N., 2016. A review of compassion fatigue of nurses during and after the Canterbury earthquakes. Australasian Journal of Disaster and Trauma Studies, 20, pp.69-80.

Dainty, K., Seaton, M., McGowan, M. and Gray, S.H., 2017. P042: Are we ready for a gunman in the emergency department? A qualitative study of staff perceptions of personal health risks, workplace safety, and individual and institutional readiness to respond to “code silver”. Canadian Journal of Emergency Medicine, 19(S1), pp.S92-S92.

Hammad, K., Arbon, P., Gebbie, K. and Hutton, A., 2017. Moments of Disaster Response in the Emergency Department. Prehospital and Disaster Medicine, 32(S1), pp.S147-S147.

Keim, M.E., 2008. Building human resilience: the role of public health preparedness and response as an adaptation to climate change. American journal of preventive medicine, 35(5), pp.508-516.

Nilsson, J., Johansson, E., Carlsson, M., Florin, J., Leksell, J., Lepp, M., Lindholm, C., Nordström, G., Theander, K., Wilde-Larsson, B. and Gardulf, A., 2016. Disaster nursing: Self-reported competence of nursing students and registered nurses, with focus on their readiness to manage violence, serious events and disasters. Nurse education in practice, 17, pp.102-108.

Ranse, J., Arbon, P., Cusack, L. and Shaban, R.Z., 2017. Australian Civilian Hospital Nurses’ Lived Experience of the Out-of-Hospital Environment following a Disaster: A Lived-Space Perspective. Prehospital and Disaster Medicine, 32(S1), pp.S146-S147.

Ranse, J. and Lenson, S., 2012. Beyond a clinical role: nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009. Australasian Emergency Nursing Journal, 15(3), pp.156-163.

Ranse, J., Lenson, S. and Aimers, B., 2010. Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting. Collegian, 17(4), pp.153-159.

Shipman, S.J., Stanton, M.P., Tomlinson, S., Olivet, L., Graves, A., McKnight, D. and Speck, P.M., 2016. Qualitative analysis of the lived experience of first-time nurse responders in disaster. The Journal of Continuing Education in Nursing, 47(2), pp.61-71.

The Sphere Project, 2017. Humanitarian Charter and Minimum Standards in Humanitarian Response. http://www.sphereproject.org/. Accessed 13NOV17.

Van Hoving, D.J., Wallis, L.A., Docrat, F. and De Vries, S., 2010. Haiti disaster tourism—a medical shame. Prehospital and disaster medicine, 25(3), pp.201-202.

World Association for Disaster and Emergency Medicine (WADEM), 2017. World Association for Disaster and Emergency Medicine. https://wadem.org/. Accessed 13NOV17.

World Health Organisation (WHO), 2017. Disasters and emergencies. http://www.who.int/surgery/challenges/esc_disasters_emergencies/en/. Accessed 08NOV17.

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