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Disaster nursing: expecting the unexpected

14 Aug 2023

Six years ago, when RN Catherine Anne Brewer found out about the terrorist bombing at the Ariana Grande concert in England, she asked herself “What if that happened on my watch?” This question has inspired her to investigate the roles and experiences of rural and remote nurses who have responded to disasters, through her PhD with University of Newcastle.

At the time of that dis­as­ter, I was con­sid­ered a senior, work­ing in triage and resus­ci­ta­tion at the hos­pi­tal where I was work­ing,” says Catherine.

It got me think­ing, we have con­certs here. What if some­thing like that hap­pened on my watch? What would I be required to do? What can I expect?

I start­ed to read arti­cles about dis­as­ter pre­pared­ness and respons­es. And I realised that this was big­ger than me and the facil­i­ty I was work­ing in.”

Cather­ine is now half way through her PhD research to explore the expe­ri­ences of rur­al and remote nurs­es in Aus­tralia who have assist­ed in disasters.

Which was not simple. 

Rur­al and remote nurs­es in Aus­tralia are often involved in dis­as­ter response, fac­ing unique chal­lenges in their dai­ly prac­tice because of geo­graph­i­cal iso­la­tion and reduced resources,” says Catherine.

Art­siom P — stock​.adobe​.com.

But their expe­ri­ences have been large­ly unre­port­ed. I knew there had to be oth­er rur­al and remote nurs­es in Aus­tralia who would like access to local research to inform their practice.”

Cather­ine looked at thou­sands of arti­cles, from coun­tries like Brazil, Japan, Cana­da, the US and Thai­land. Not one arti­cle in Aus­tralia fit­ted the cri­te­ria. And so Cather­ine relied on over­seas mate­r­i­al for the first stage of her research, Expe­ri­ences of rur­al and remote nurs­es dur­ing and fol­low­ing dis­as­ters: a scop­ing review.

Matt Palmer — stock​.adobe​.com.

Eight over­seas arti­cles met the inclu­sion cri­te­ria for the review which iden­ti­fied four major themes: dis­as­ter roles, pre-dis­as­ter prepa­ra­tions, psy­cho­log­i­cal and emo­tion­al states, and com­mu­ni­ty involve­ment and relationships.

We learned about nurs­es’ ini­tial involve­ment, which was imme­di­ate­ly before the dis­as­ter,” Cathe­rien says.

They did things such as gath­er­ing essen­tial equip­ment and First Aid mate­ri­als; con­tact­ed oth­er indi­vid­u­als, inform­ing them of what was hap­pen­ing; checked out safe ground and evac­u­at­ed peo­ple, gen­er­al­ly prepar­ing for the impend­ing disaster.”

The arti­cles then described the psy­cho­log­i­cal and emo­tion­al states, the feel­ings of pow­er­less­less or unease when they couldn’t leave the hos­pi­tal, because the demand for their skills was too high, and con­cerns that they didn’t have the right or essen­tial equipment.

The arti­cles did show spe­cif­ic areas where the nurs­es, because they were in rur­al and remote areas, had exist­ing rela­tion­ships with the com­mu­ni­ty and, because of that, they felt able to step up,” says Catherine.

They felt they could assist the com­mu­ni­ty mem­bers because of those con­nec­tions. For exam­ple, they knew this per­son has high blood pres­sure,’ They’d met this per­son before and could facil­i­tate eas­i­er pre­scrip­tion of their med­ica­tion due to this inti­mate knowl­edge of the com­mu­ni­ty members’.”

Ser­hii — stock​.adobe​.com.

The scop­ing review showed that the nurs­es had exten­sive roles when respond­ing to the dis­as­ter. Assess­ing, triag­ing, pro­vid­ing treat­ment and psy­cho­log­i­cal sup­port, skills in net­work­ing and col­lab­o­rat­ing with oth­er health agen­cies; they were required to coor­di­nate peo­ple and to respond effectively.

What has been clear to me are the attrib­ut­es that nurs­es bring to their role in dis­as­ter sit­u­a­tions, attrib­ut­es that you don’t learn. They are innate,” says Catherine.

And what couldn’t be answered in the scop­ing review was how these attrib­ut­es are influ­enced by the rur­al and remote con­text in which these nurs­es are sit­u­at­ed and the rela­tion­ships they have with their com­mu­ni­ty. Is this some­thing that is spe­cif­ic to rur­al and remote nurses?”

Cather­ine recog­nised that fur­ther research is need­ed to bet­ter under­stand this phe­nom­e­na and to address knowl­edge gaps in exist­ing lit­er­a­ture, specif­i­cal­ly regard­ing Aus­tralia. She’s set out to fill those miss­ing spaces.

In the process, she has been inspired by the sto­ries from Aus­tralian nurs­es who have faced dis­as­ter in their work­ing lives, sto­ries that will become part of her thesis.

I’ve been over­whelmed by the sto­ries that these nurs­es have shared with me,” she says. Their com­mit­ment and ded­i­ca­tion to pro­vide care for the com­mu­ni­ty, some­times even being affect­ed by the dis­as­ter them­selves, help­ing out wher­ev­er and how­ev­er they can — they are just tru­ly amaz­ing clin­i­cians and human beings.”

In the next stage of her research, Cather­ine will analyse the respons­es from the nurs­es she has inter­viewed – to bet­ter under­stand and explain their expe­ri­ences in dis­as­ter sit­u­a­tions in rur­al and remote areas.

Ulti­mate­ly, her aim is to pro­vide Aus­tralia-spe­cif­ic infor­ma­tion and sup­port for nurs­es through­out the coun­try, should that what if” ques­tion ever become a real­i­ty for them.

Have you been involved in an inter­est­ing pro­gram or imple­ment­ed research that would ben­e­fit or inter­est the remote health work­force? We’d love to hear from you. Get in touch at communications@​crana.​org.​au