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Nurses Not Immune to Stress from Disaster


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By Jennifer Thew, RN
Originally appeared in Health Leaders Media.

As communities hit by Hurricanes Harvey and Irma begin the long path to recovery, it's important to remember disasters leave more in their wake than physical damage to homes and property. They also leave marks on victims' psyches.

That includes nurses.

"When both personal life and professional life are impacted by an adverse event, as occurred in Superstorm Sandy, stress can exponentially increase. The responsibilities associated with the profession of nursing add additional demands that increase the risk for role conflict when a disaster occurs," says Victoria H. Raveis, PhD.

Raveis is research professor and director of the Psychosocial Research Unit on Health, Aging and the Community at NYU College of Dentistry.

She, along with colleagues at NYU Rory Meyers College of Nursing and NYU Dentistry, recently published two reports in the Journal of Nursing Scholarship that offer insights on emergency preparedness, recovery, and resilience.

The reports were centered on nurses working at NYU Langone Health's main hospital during Superstorm Sandy in 2012. Key themes that emerged were communication—both improving channels and its importance in connecting nurses with others during a crisis—and social support.

Preparedness Training Needed

To understand how nurses at NYU Langone were impacted before, during, and after the storm, the researchers conducted interviews and surveys with 16 nurses who participated in the mid-storm evacuation of more than 300 patients at NYU Langone's 725-bed Tisch Hospital due to high water levels.

Raveis and her team explored nurses' experiences in disasters, assessed their challenges and resources for carrying out responsibilities, and uncovered some lessons.

After the interviews, an online survey was sent to all RNs assigned to inpatient units at NYU Langone on the day of the storm. The researchers received 528 anonymous responses, including responses from 173 nurses who were part of the evacuation.

While some nurses had had disaster training and experience, and a few of them reported feeling prepared during the storm and the resulting evacuation, many working the night of the storm lacked prior hands-on experience or deep knowledge of emergency preparedness.

This lack of comfort with emergency preparedness is not uncommon says Eric Alberts, corporate manager, emergency preparedness at Orlando Health.

"I've been going across the United States speaking about the PULSE [nightlclub mass shooting] incident and, unfortunately, we're finding a lot of hospitals don't have an emergency plan," he says.

"Or if they do they don't practice it. And if they do practice it, they're not really practicing it. They're just doing a flu shot campaign and calling it an exercise."

Alberts recommends that hospital and health system leaders do a thorough evaluation of their disaster readiness.

"Really look at your processes and your people and see what is available during emergencies. Emergency preparedness and healthcare looks and feels different everywhere you go," he says. "And then from that, look at what resources and people are able to help those individuals have a good, efficient, and effective plan."

The NYU researchers also call for more education and planning for future disasters and recommend FEMA's all hazards approach to disaster planning.

Personal Concerns Present

Communication was a challenge during Superstorm Sandy when access to electronic medical records, email, and phone communication was unavailable because of power loss.

RNs reported unlocking medication carts in anticipation of the power outage and handwriting medical summaries for patients being evacuated to other hospitals. Of the nurses surveyed, 72% reported their primary mode of communication was talking face-to-face and 24% used personal cell phones.

Researchers also found that nurses had personal concerns during the storm, worrying about their families' welfare and personal loss.

While many arranged for extended stays at the hospital before the storm, they reported they felt uncertain about leaving their families and later had trouble contacting loved ones.

The survey found 25% nurses had property damage or loss and 22% needed to relocate after the storm. Some respondents reported psychological problems after the storm including disturbing thoughts (5%) and difficulty sleeping (4%).

Social support from coworkers, hospital leadership, and loved ones was cited as an important resource in helping them through the stressfulness of the disaster.

"Our research also shows that maintaining good communication with peers and hospital leaders after the hurricane helped the nursing staff feel more connected and less stressed," said Christine T. Kovner, RN, PhD, the Mathey Mezey Professor of Geriatric Nursing at NYU Meyers.