Enabling a Disaster-Resilient Workforce: Attending to Individual Stress and Collective Trauma

Experiences of Nurses Providing Care to Individuals in Earthquake-Affected Areas of Eastern Turkey: A Phenomenological Study

PURPOSE

The aim of this study is to examine the experiences of nurses who provide care to individuals in earthquake-affected areas of eastern Turkey.

DESIGN

A phenomenological design from qualitative research methods was utilized in this study.

METHODS

The study was conducted between May 29, 2023, and August 15, 2023, with 11 nurses working in the western region of Turkey's provinces through one-on-one semi-structured interviews. The interviews were conducted online and recorded on video. Content analysis was performed using the MAXQDA software package.

FINDINGS

Themes and sub-themes were identified from the expressions of nurses in line with research findings. Accordingly, 5 themes were determined for nurses providing care to individuals in the earthquake. zone: "challenges they face,""emotions they felt,""coping methods,""knowledge and skills"and "effects of earthquake".

CONCLUSION

The results obtained from this study demonstrated that nurses experienced difficulties due to environmental (hygiene, cold weather, shelter) and work-related (lack of coordination, psychosocial issues) conditions during the earthquake event. While providing care to individuals in earthquake-affected areas of eastern Turkey, nurses reported feelings of sadness, inadequacy, anxiety, and fear. They employed coping methods such as talking to family/friends, attempting not to dwell on thoughts, and turning to religious practices to manage these negative emotions. Nurses emphasized the necessity of having professional knowledge and crisis management skills to care for individuals during the earthquake period. In accordance with the findings of the research, it is recommended that nurses are provided with realistic training through simulations and drills in disaster management, as well as psychological support interventions.

Depression, anxiety, stress, and job performance among Turkish nurses in the early post-earthquake period

BACKGROUND

Individual and social concerns can negatively affect nurses' mental health during a large-scale earthquake's early stages, making it challenging to perform their professional responsibilities.

AIM

This cross-sectional correlational study aimed to examine the relationship between depression, anxiety, and stress levels Turkish nurses experienced during an earthquake's early period. The nurses participating in this study were not directly present in the earthquake-affected area.

METHODS

The study was conducted on 232 nurses between February 10 and 25, 2023. The data were collected using the Depression, Anxiety, Stress-21 Scale and the Job Performance Evaluation Form developed by the researchers through a literature review. These were used to investigate nurses' work motivation changes due to the earthquake. The study followed the STROBE checklist for cross-sectional studies.

RESULTS

The participants' depression levels were severe, anxiety levels were extremely severe, and stress levels were moderate following the earthquake. Nurses who felt exhausted experienced reduced energy levels toward their work and reported a decrease in their desire, effort, and work motivation to perform well. In addition, they had higher depression, anxiety, and stress scores (p < 0.005).

CONCLUSION

Psychological difficulties, including depression, anxiety, and stress experienced by nurses not directly present in an earthquake-affected area, reduced their professional efforts and motivation and negatively affected the patient care process. Further studies should focus on conducting comparative studies in different cultures affected by natural disasters on the longitudinal analysis of the impacts of nurses' psychological distress on their job performance.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing policymakers should be aware of the negative psychological effects experienced by nurses during the early post-earthquake period, even if they are not directly present in the earthquake-affected area. The study recommended that nurses should be provided with psychological support to deal with the negative effects of natural disasters and maintain job performance, including the nursing care process.

Exploring the competencies of Chinese critical care nurses in mobile medical teams based on the onion model: A qualitative study

BACKGROUND

With frequent conflicts, natural disasters, and public health emergencies globally, mobile medical teams (MMTs) are becoming increasingly critical. Importantly, the competency of critical care nurses in MMTs can substantially affect the effectiveness and quality of its rescue efforts. Yet, these nurses' competencies are not well understood.

AIM

This study examined the competencies of critical care nurses in MMTs using the Onion Model.

DESIGN

A qualitative descriptive method was used to describe the competencies of Chinese MMT critical care nurses.

METHODS

From April to May 2022, a convenience sample of 18 participants (14 critical care nurses and 4 surgeons) from 10 MMTs was recruited for semi-structured interviews. Deductive and inductive coding methods were combined for content analysis.

RESULTS

In total, 29 competencies were identified, which were grouped into four major domains using the Onion Model. From the outer to inner layers, these domains were knowledge and skills, professional abilities, professional quality, and personal traits. Several novel competencies emerged, including field medical equipment operation skills, on-site hazard identification and safety prevention skills, triage knowledge, and field survival skills.

CONCLUSIONS

Using the Onion Model, this study furthers the understanding of the competency of critical care nurses in MMTs, especially by revealing the novel competencies. Further, the results can be used to recruit, evaluate, and train critical care nurses for MMTs.

RELEVANCE TO CLINICAL PRACTICE

Understanding MMT critical care nurses' competencies can help managers plan and provide relevant training and education before deployment, which can improve nurses' performance, and especially reduce the mortalities and disabilities from trauma.

Disaster Nursing Competency of Intensive Care Nurses in Jinan, China: A Multicenter Cross-Sectional Study

BACKGROUND

Patients in disaster areas require the most urgent assistance. In recent large-scale natural disasters, intensive care nurses have served as an important reserve component of disaster response teams. In disaster nursing, ability and attitude directly affect the quality and effectiveness of disaster rescues. However, few studies have examined the disaster nursing competency of intensive care nurses in China.

PURPOSE

This study was designed to describe the current status of disaster nursing competency among intensive care nurses, analyze the related factors affecting the disaster response effectiveness, and evaluate the values of disaster nursing continuing education and training in cultivating professional personnel with disaster emergency rescue competence.

METHODS

This cross-sectional study was conducted at six tertiary general government hospitals in Jinan, Shandong Province, China. A convenience sampling method was adopted, and the Wenjuanxing website was used to compile the network questionnaire, which participants completed via a WeChat group. Descriptive, correlation, and regression analyses were performed using SPSS software.

RESULTS

The participants in this study included 285 registered intensive care nurses employed at six hospitals in Jinan. Most were female (77.9%), and the mean age was 29.9 years. The mean total disaster nursing ability score was 122.98 (SD = 31.70), and the average scores for each item ranged from 2.78 to 3.70. The incident command system item earned the highest mean score (3.70, SD = 1.22), followed by triage (3.24, SD = 0.93). The biological preparedness item earned the lowest mean score (2.78, SD = 1.04). Being male, being < 30 years old, having an understanding of disaster nursing, having previously participated in disaster emergency simulation drills or training, and having a higher self-evaluation of rescue competence were all associated with higher disaster-nursing knowledge scores. Multiple linear regression analyses indicated that understanding of disaster nursing and experience participating in disaster emergency rescue drills or training had the most significant influence on the disaster nursing emergency knowledge score, followed by positive self-evaluation of disaster nursing ability and demand for training.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings of this study indicate that the participants had a moderate disaster-nursing competency and that this competency may be improved through disaster-related continuing education and training. The cognitive attitude of disaster nursing was found to correlate positively with self-efficacy. Simulated emergency drills may effectively improve the disaster nursing competency of critical care nurses. The findings emphasize that experiences other than direct clinical practice such as specialized simulated emergency drills and training as well as willingness for such training are stronger factors for identifying and developing overall disaster nursing competency.

Chemical, Biological, Radiological, or Nuclear Response in Queensland Emergency Services: A Multisite Study

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

Factors affecting nurses' ability to provide effective care in a disaster response: a review

Disasters cause death, trauma, and psychological distress. Comprising the largest number of healthcare workers, nurses play a crucial role in reducing the impact of a disaster. The objective of this review is to identify the factors that influence nurses’ ability during a disaster emergency response to provide adequate care. This research was conducted by doing a literature search from the Pro-Quest and Science-Direct databases using the PRISMA-ScR to screen the articles. The final results included 13 articles. An analysis was performed to identify themes in line with the purpose of the review. All factors affecting nurses’ ability to respond to a disaster situation were classified into three themes: 1) factors increasing nurses’ ability, 2) barriers to delivering effective nursing care, and 3) support needed to maintain the nurses’ ability. During an emergency situation due to a disaster, adequate knowledge and skill to save lives, treat injuries, manage stress and coordinate between teams are the basic competencies needed for optimal care. Nurses’ clinical experience or previous disaster experience and training could increase nurses’ adaptability in disaster conditions. Support from nurses’ workplace and proper implementation of disaster management policy enhance nurses’ services and prevent barrier under disaster condition. The results emphasize that future training should aim for improving nurses’ knowledge and skills, including the knowledge of nurses’ family to protect themselves and deal with disasters. Such knowledge increased family preparedness, which is an important factor to enhance nurses’ willingness to work following a disaster.

Clinical Nurse Specialist Expands to Crisis Management Role During COVID-19 Pandemic

PURPOSE

Emergence of the COVID-19 crisis into the healthcare system challenged existing roles and shifted organizational priorities and staff responsibilities. Operating within the spheres of impact, clinical nurse specialists (CNSs) adapted to the needs of the organization and expanded their responsibilities to provide crisis leadership.

DESCRIPTION OF PROJECT

The CNSs used advanced practice nursing skills and leadership to implement hospital rounds, identify issues, make decisions, collaborate with stakeholders, disseminate new and emerging information, and evaluate processes in an ongoing pandemic. Using the health crisis management framework, the CNSs demonstrated authentic leadership throughout the prevention, preparedness, response, recovery, and rehabilitation phases.

OUTCOME

Data analysis of CNS handoff and meeting communications generated these areas of focus involving the CNSs: (1) clinical practice, (2) supplies, (3) workflows, and (4) people.

CONCLUSION

The CNS played a vital role in the planning, training, and evaluation of crisis preparation. New and emerging infectious diseases may continue to confront the healthcare system. Thus, healthcare systems need to remain prepared for public health threats. In the crisis leadership role, the CNS helped the transition to learn and relearn practices. As authentic leaders, CNSs instilled calmness, confidence, trust, and resiliency to the staff during the COVID-19 pandemic.

A Concept Analysis on Disaster Resilience in Rescue Workers: The Psychological Perspective

OBJECTIVE

The term disaster resilience has not been well defined. The purpose of this article is to scrutinize the concept of disaster resilience in rescue workers.

METHODS

A systematic search was conducted of the PsychInfo, PubMed, ISI Web of Science, MEDLINE, CINAHL, Embase, and Scopus databases using the key terms. The framework from Walker and Avant was used to analyze the concept of disaster resilience.

RESULTS

A total of 26 papers was included in this analysis. The attributes of disaster resilience have been identified from the literature as including personality, perceived control, self-efficacy, coping strategies, and social support. The antecedents of disaster resilience are disastrous events and preparedness for disaster. The consequences of disaster resilience are psychological well-being, posttraumatic growth, and enhanced work engagement.

CONCLUSION

This concept analysis presents a definition of the concept of disaster resilience that could contribute to the development of a standardized screening or assessment tool and tailored training programs to strengthen disaster resilience among those who are willing to be deployed to engage in disaster rescue work and those who have been involved in such work.

Providing targeted psychological support to frontline nurses involved in the management of COVID-19: An action research

Aim

To develop and implement a targeted psychological support scheme for frontline nurses involved in the management of coronavirus disease 2019 (COVID‐19).

Background

Nurses play a vital role in managing the ongoing COVID‐19 pandemic, while confronting enormous challenges and psychological problems.

Methods

Action research design was adopted to develop and provide a targeted psychological support scheme to 1,496 frontline nurses. Data regarding nurses’ feedback were collected from WeChat group chat, letters and comments on theme lectures. Subsequently, qualitative content analysis was conducted using MAXQDA.

Results

A targeted psychological support scheme was formed via three action cycles according to nurses’ needs. Frontline nurses received psychological assistance from a research team, which offered (1) a sense of belonging, (2) a sense of professional value and pride, and (3) a sense of being protected and confident.

Conclusion

The researchers successfully provided targeted psychological support to nurses, and nurses were motivated and became more confident when their needs were addressed.

Implications for Nursing Management

Nurses have various types of psychological needs, which could be addressed by targeted support. It is suggested that nurse managers should identify nurses’ needs in real time and provide appropriate support through multidisciplinary collaboration to improve their confidence and enhance their resilience.

Relationships between disaster nursing competence, anticipatory disaster stress and motivation for disaster engagement

Nurses are the largest group of healthcare providers and are often the first line responders to a disaster event. Nurses' disaster competence, motivation for disaster engagement, and factors that impact their motivation to respond to disaster events need to be understood. The purposes of the study were to determine the predictive relationships between Taiwanese nurses' disaster competence, anticipatory disaster stress, and motivation for disaster engagement. A cross-sectional design was used to analyze data collected between August 2017 and December 2017 from eight hospitals in southern Taiwan. Ninety participants who met the recruitment criteria completed and returned questionnaires with an 88.24% response rate. Data collection involved administering the Disaster Nursing Competence Questionnaire, Anticipatory Disaster Stress Questionnaire, and the Motivation of Disaster Engagement Questionnaire. The results indicated that anticipatory disaster stress was positively correlated with disaster competence and motivation for disaster engagement. Disaster competence and willingness to join a hospital disaster rescue predicts an individuals' motivation for disaster engagement. The results of the study add to the understanding of factors that correlate with nurses' motivation to participate in disaster events. By understanding these factors, the government and healthcare administrators can design disaster education plans and other strategies to improve Taiwanese nurses' motivation to engage in disaster events.

Grit: The Essential Trait of Nurses During a Disaster

Natural and man-made disasters have increased dramatically over time, requiring healthcare systems to develop and sustain emergency preparedness plans. Nurse leaders and frontline clinical nurses are often the first and long-term responders during these traumatic events. Emergency preparedness requires nurses exceed expectations beyond the daily level of performance in caring for patients in the presence of obstacles. A disaster creates additional burdens on nurses psychosocially due to work and home demands. Despite this adversity, nurses are able to work under harsh conditions and make critical clinical decisions. This commitment is often described as being resilient. A deeper reason why nurses perform during disasters is that they possess the personality trait known as grit. Grit motivates them to endure challenges and be successful over time. The critical attributes of grit are passion and perseverance. Cultivating grit among nurse leaders and clinical nurses is essential to sustaining interest in emergency preparedness and ensuring the needs of patients and caregivers are met when a disaster occurs.

Nurses' psychological trauma: "They leave me lying awake at night"

OBJECTIVE

To describe nurses' personal and professional psychological trauma.

METHODS

A content analysis of 372 responses surrounding personal and professional trauma was performed.

RESULTS

Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care.

CONCLUSION

Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.

The case for a paradigm shift: from global to planetary nursing

The purpose of this paper is to propose a paradigm shift from "global nursing" toward "planetary nursing" to more effectively engage worldwide health initiatives, such as the United Nations 2030 Agenda for Sustainable Development. Such a shift expands the understanding of "health" from a phenomenon focused solely on humanity toward one of interdependent animal, environment, and overall planetary well-being, recalibrating the future roles and responsibilities of nursing accordingly. While there is limited data that discusses nursing-focused contributions to planetary health, the advancement of planetary nursing has been the focus of scholarly dialogue. Knowledge regarding the planet's systems, species, ecosystems, and myriad environmental dimensions must be integrated throughout nursing education to be translated to practice and social justice initiatives. As the profession deepens collaborations with international policymakers, nurses will become integral to advancing planetary health through social justice and health equity efforts. Nursing research must evolve to contribute to the goal of planetary health for the next generation and beyond. Ultimately, these authors call for a shift toward One Mind-One Health-One Planet to move the disciplinary stance from one of "global nursing" to a more expansive view of "planetary nursing" in alignment with initiatives to promote and sustain planetary health.