The lived experience of nursing in the emergency department during a disaster

Author: Karen Hammad

Hammad, Karen, 2017 The lived experience of nursing in the emergency department during a disaster, Flinders University, School of Nursing & Midwifery

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When a disaster has impacted a community hospitals play an integral role in the healthcare response as a place where people go to seek refuge and treatment. This places the emergency department (ED) at the frontline of the hospital response and emergency nurses as first responders triaging, treating and managing the care of people affected by a disaster. While there is a plethora of literature written about the healthcare response to disasters, there is a relatively small amount about the role and experiences of nurses working in the ED. At present, many of the publications that inform what we know about nursing in the ED during a disaster are narrative accounts describing the ED response to an event. Furthermore, the few studies that describe the lived experience of nurses working in the ED during a disaster are written about singular events thus making this study unique because it explores the collective experience of nursing in the ED during a disaster across a variety of different disaster events and from the perspectives of nurses in different geographical contexts.

Grounded in the tradition of hermeneutic phenomenology, with a methodological approach informed by van Manen’s insights the aim of this study is to generate meaning and understanding in the experience of working as a nurse in the ED during a disaster. Nurses from different countries around the world participated in interviews about the phenomenon of working as a nurse in the ED during a disaster. The findings of the study emerge through thematic analysis and guided reflection as two different perspectives on nurses’ experience with the phenomenon. The first perspective of the findings is presented as a discussion of five distinct Moments of Disaster Response; notification, waiting, patient arrival, caring for patients and reflection. The second perspective of the findings explores five existential themes common to everyone’s lifeworlds; relationality (lived body), corporeality (lived self), spatiality (lived self), temporality (lived time) and materiality (lived things). Both perspectives are considered together to uncover the meaning that is embedded within the experience of nursing in the ED during a disaster.

Two key findings emerge from this research. Firstly that emergency nurses are motivated to participate in disaster response by altruistic endeavours. Nurses want to support their ED colleagues and help the people affected by disaster, and in doing so overlook their own needs. The second finding of this research highlights that disaster response presents a unique set of challenges that make it different from the everyday experience of working in the ED. Challenges associated with disaster response include changes to the ED space, caring for unfamiliar patient presentations, a feeling of being overwhelmed and an emotional impact. This thesis contributes to an enhanced understanding of the experience and meaning of working as a nurse in the ED during a disaster response. This knowledge may better inform preparedness activities and future research direction in this area.

Keywords: disaster, nurse, emergency nurse, emergency department, terror attack, CBRN, van Manen, hermeneutic phenomenology, interpretative phenomenology

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Nursing & Midwifery
Supervisor: Professor Paul Arbon