Unveiling the heart of disaster nursing: A qualitative study on motivations, challenges, and lessons from the devastating 2023 Turkey earthquakes

BACKGROUND

Turkey has faced a notable escalation in earthquake disasters in the last two decades. Despite initiating a health and disaster management system, nurses' pivotal roles and experiences in handling such crises have been disregarded.

AIM

This qualitative study analyzed nurses' experiences before, during, and after deployment in response to the 2023 Turkey earthquakes to enhance disaster-response efforts.

METHODS

This descriptive qualitative study was conducted between March and May 2023 using semistructured interviews with 15 nurses purposively  sampled among those who volunteered to work in the earthquake zone. The MIRACLE and COREQ guidelines were followed for reporting qualitative research.

FINDINGS

The analysis exposed five main themes for pre-tasking: moral obligation, motivation, insufficient experience, balancing responsibilities, and preparation challenges. The peri-task themes include responsibilities, skills, bravery and characteristics, workload management, teamwork, and outcomes. Post-tasking has three themes: competence assessment, career goals and aspirations, and support. Training and coping with anxiety and stress are common themes for all phases.

CONCLUSIONS

Disaster relief requires a comprehensive and coordinated response from healthcare organizations, government agencies, and support systems. Providing adequate training, ensuring safety protocols, offering mental health support, and fostering a fair and supportive work environment are crucial steps in mitigating the adverse effects on nurses and, by extension, the patient care process in earthquake-affected areas.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse training in disaster preparedness should cover various response methods and involve multiple disciplines. Managers can help by arranging drills, simulations, online courses, and workshops and promoting partnerships for improved collaboration. Psychological support should be included to address emotional challenges. Regularly updating response policies based on past experiences is crucial for preparedness and efficiency.

Experiences and psychosocial challenges of volunteer nurses in Turkey devastating earthquake zones: Lessons to be learnt for prevention of health system problems in disasters: A qualitative study

OBJECTIVE

This research aimed to investigate the experiences and psychosocial challenges encountered by volunteer nurses who provided care in the zones affected by the devastating earthquake that struck Turkey in 2023.

METHODS

This qualitative study involved semistructured, in-depth interviews with 15 volunteer nurses who were actively working in earthquake-affected regions. The study was conducted between June 2023 and July 2023. Participants were selected from diverse provinces (Hatay, Gaziantep, Adıyaman, Kahramanmaraş, and Malatya) affected by the earthquake, ensuring maximum variability. Individual online interviews were conducted using Google Meet, with data collection continuing until saturation was achieved. The study adhered to the COREQ checklist for reporting qualitative research.

RESULTS

Three main themes and eight subthemes were developed: (1) Management and Coordination (failure to meet basic needs, bureaucracy, duty, and authority issues, problems with supplies and equipment); (2) Professional Experiences (working conditions, education, perspective on the profession); and Psychosocial Problems and (3) Coping Methods (psychological problems, methods of coping with problems).

CONCLUSIONS

The study showed that volunteer nurses encountered management and organizational obstacles, were profoundly impacted by the disaster's psychosocial aspects, and often struggled with inadequacies in handling psychological challenges. Despite these challenges, the nurses reported a sense of competence in delivering care services. The insights derived from this study hold valuable lessons for future disaster response strategies. For this reason, it is recommended to plan the necessary training and initiatives to professionally strengthen the field of disaster nursing.

Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study

BACKGROUND

The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

METHODS

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

RESULTS

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

CONCLUSION

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

What Are the Best Practices for Nursing Care during an Earthquake? A Scoping Review

Among natural disasters, earthquakes have a considerable impact and are among the ten deadliest, with an extreme impact on the healthcare sector. This study aimed to analyze the best practices in nursing care for earthquake victims. An in-depth analysis was carried out by using a scoping review, a method used in accordance with the PRISMA-ScR recommendations, to identify best nursing practice in these circumstances based on searches of eight databases: MEDLINE via PubMed; Cochrane Library; Embase; VHL; PDQ-Evidence; Scopus; ProQuest; and Google Scholar. Twenty-one studies were selected. The nursing practices identified were grouped into two distinct dimensions, each subdivided into four subcategories: (i) care practices: (a) immediate care, (b) intermediate care, (c) psychosocial care, and (d) ethical care; (ii) care management and coordination practices, which cover (a) care coordination, (b) victim care network organization, (c) teamwork, and (d) training. By analyzing these nursing practices during care and relief operations for earthquake victims, this study identified the various actions carried out, the nursing skills to be developed, and the reinforcement of these advanced practices through the systematization of nurses' skills, in order to promote victims' rehabilitation, minimize their suffering, and improve their quality of life during and after an earthquake.

Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes

BACKGROUND

Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment.

AIM

This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission.

METHODS

Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research.

FINDINGS

The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission.

CONCLUSION

Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation.

NURSING AND HEALTH POLICY IMPLICATIONS

Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

Experiences of operating room nurses in disaster preparedness of a great disaster in Iran: a qualitative study

BACKGROUND

In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran.

METHODS

The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed.

RESULTS

The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations.

CONCLUSION

The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams.

Wildfires and Older Adults: A Scoping Review of Impacts, Risks, and Interventions

Climate change is leading to worsening disasters that disproportionately impact older adults. While research has begun to measure disparities, there is a gap in examining wildfire-specific disasters. To address this gap, this scoping review analyzed literature to explore the nexus of wildfires and older adults. We searched peer-reviewed literature using the following inclusion criteria: (1) published in a peer-reviewed journal; (2) available in English; (3) examines at least one topic related to wildfires; and (4) examines how criterion three relates to older adults in at least one way. Authors screened 261 titles and abstracts and 138 were reviewed in full, with 75 articles meeting inclusion criteria. Findings heavily focused on health impacts of wildfires on older adults, particularly of smoke exposure and air quality. While many articles mentioned a need for community-engaged responses that incorporate the needs of older adults, few addressed firsthand experiences of older adults. Other common topics included problems with evacuation, general health impacts, and Indigenous elders' fire knowledge. Further research is needed at the nexus of wildfires and older adults to highlight both vulnerabilities and needs as well as the unique experience and knowledge of older adults to inform wildfire response strategies and tactics.

End of life care during the COVID-19 pandemic: A qualitative study on the perspectives of nurses and nurse assistants

AIM

To explore nurses' and nurse assistants' experiences of providing end-of-life care during the COVID-19 pandemic in Austria, Germany and Northern Italy.

DESIGN

A qualitative explorative interview study.

METHOD

Data were collected between August and December 2020 and analysed using content analysis. Healthcare professionals (nurses (n = 30), nurse coordinators (n = 6) and nurse assistants (n = 5)) from hospitals (n = 32) and long-term care facilities (n = 9) in Austria, Germany and Northern Italy were interviewed for this study.

RESULTS

Five main categories were identified as follows: (i) end-of-life care involves love and duty, (ii) last wishes and dignity of the patient, (iii) communication with the family, (iv) organizational and religious aspects and (v) personal emotions. Results indicate that more training and guidelines are needed to prepare nurses and nurse assistants for end-of-life care during pandemics.

PUBLIC CONTRIBUTION

This research can help prepare nurses and nurse assistants for end-of-life care in pandemics and will be of value for improving the institutional and government health policies. Furthermore, it can be of value in preparing training for healthcare professionals patient-relatives.

"The usual challenges of work are all magnified": Australian paediatric health professionals' experiences during the COVID-19 pandemic

Background

The COVID-19 pandemic has significantly increased stress and strain on health professionals. With a focus on paediatric cardiac care, this study explored health professionals' concerns about COVID-19, perceptions of the impact of pandemic on healthcare, and experiences of psychological stress.

Methods

Paediatric health professionals working at a large quaternary hospital in Australia were invited to complete a survey between June 2020 and February 2021. Demographic factors, clinical role characteristics, and anxiety and depressive symptoms were assessed. Qualitative data on experiences and perceived effects of the pandemic on paediatric cardiac care were also collected.

Results

228 health professionals (152 nurses, 37 medical doctors, 22 allied and mental health professionals, 17 medical research and administrative staff) participated in the survey (54.4% response rate, 85% women). Half the sample (52.2%) endorsed 'moderate' to 'extreme' worry about COVID-19 and 38% of participants perceived healthcare services as adversely impacted by the pandemic to a 'great' or 'very great' extent. Almost one in five health professionals reported anxiety (18%) and 11% reported depressive symptoms indicative of a need for clinical intervention. Six themes were identified in the qualitative data: (1) Concern about the consequences of visitor restrictions and disrupted patient services, (2) Intensified strain on healthcare workers, (3) Feelings of fear and loss, (4) Social isolation and disconnection, (5) Adapting to change, and (6) Gratitude.

Conclusion

Timely, tailored policies, supports, and interventions are needed to address health professionals' mental health needs during and beyond the pandemic, to minimize the far-reaching impact of situational stressors.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study

INTRODUCTION

The COVID-19 pandemic had an unprecedented effect on those living and working in care-homes for older people, as residents were particularly vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID-19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages.

OBJECTIVE

To explore RNs' experiences of working in older people's care-homes during the COVID-19 pandemic.

DESIGN

Qualitative interview study.

SETTING

Care-homes for older people in England and Scotland, UK.

METHODS

Recruitment via direct contact with care-homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care-home, and location. Data collected through one-to-one online interviews using topic guide developed collaboratively with care-home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes.

RESULTS

Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March-June 2021; majority aged 46-55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care-home staff and working together to cope with the crisis.

CONCLUSION

Care-home nurses felt unprepared for managing the COVID-19 pandemic, many experienced moral distress. Supporting care-home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care-home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care-home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders.

CLINICAL RELEVANCE

The COVID-19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long-term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges distinct from their hospital-based nursing peers and non-nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms.

Frontline nurses' experiences of working in a COVID-19 ward-A qualitative study

Aim

To explore how nurses experienced working in a newly organized COVID‐19 ward with high‐risk patients during a new and unknown pandemic.

Design

A qualitative explorative study using a phenomenological‐hermeneutic approach.

Methods

Semi‐structured individual telephone interviews were conducted in June–July 2020 with 23 nurses working in COVID‐19 wards from three regional hospitals in Denmark. The nurses had been transferred from other departments at their hospital to the newly organized COVID‐19 wards. Data analysis was influenced by Paul Ricoeur's theory of narrative and interpretation, including three analytical levels: naïve reading, structural analysis and critical interpretation and discussion.

Results

During the structural analysis four themes were generated: (a) Challenging and uncertain situation, but also a positive experience (b) Professional and personal development (c) Lack of nurses' rights during a pandemic (d) Reward in itself or a desire for financial reward.

A systematic mapping review of factors associated with willingness to work under emergency condition

INTRODUCTION

An effective response to an emergency situation relies on health care workers' preparedness. The main purpose of this study was to provide a comprehensive overview of relevant studies regarding the willingness to work in emergency and disaster situations, describe and classify the most important challenges and solutions, identifying knowledge gaps in the literature which could inform future research.

METHODS

In this Systematic Mapping Review required information was searched from PubMed, Scopus, the web of science, Embase databases, and Google scholar search engine in the period 2000-2020. Data were analyzed using a content framework analysis.

RESULTS

From 2902 article search results, 26 articles met the inclusion criteria. The studies varied in terms of aim, study design, and detail of reporting. The results showed that nearly three-quarters of studies were conducted in high and middle-income countries. Most of the studies were published in 2020 due to the COVID-19 pandemic. Also, the most common types of crises reported in the included studies were emerging and re-emerging infectious diseases. The results show that most of the problems were in the dimension of mental and psychological issues, personnel health concerns, and management relationship with personnel.

CONCLUSION

This mapping review illustrated a big picture of health workers' resilience in disaster conditions. This review presents an overview of different kinds of strategies that address the challenges. One of the most important challenges in health workforce retention is poor communication between managers and staff. Being away from family, which leads to mental fatigue, puts staff in moral dilemmas. Attracting adequate health professionals, especially volunteers and regulating the shifts of health personnel in crisis time will largely prevent burnout.