Nursing Care in Disaster Management
What Is Disaster
Norris et al. (2002) defined a disaster as a sudden event that has the potential to terrify, horrify, or engender substantial losses for many people simultaneously. Disasters are classified by the nature of the event, ie, natural, technological, and deliberate acts of mass violence (terrorism), and/or by the impact of exposure, ie, "dose response."
Natural disasters are geophysical forces (eg, earthquakes) or weather forces (eg, hurricanes, tornadoes). Technological disasters are frequently attributed to human negligence and error and include collapse of structures, environmental catastrophes, and failures of public transportation equipment.
Traumatic events are relevant to nursing science and practice for several reasons. First, these events are more common and have more pervasive impacts than previously thought. Norris (1992) in a survey of residents in four Southeastern cities showed a lifetime exposure rate of 69%.
Those surveyed had experienced at least one
traumatic event. Tragic death, robbery, and serious motor vehicle injuries were
the three most frequently reported. The impacts of disasters on individuals and
communities are multidimensional and immense, and adaptation to loss is of long
rather than short duration (Murphy, 2001; Norris et al.).
Research findings (Hall, Norwood, Ursano , Fallerton , & Levinson, 2002; Murphy. 2001; Norris et al., 2002) resulting from all types of traumatic events suggests five major domains of human responses following exposure sure to one of these events:
(a) Specific pay chaological problems include shock, terror. guilt, horror, irritability, anxiety, hostility, post-traumatic stress disorder (PTSD), and depression.
(b) Cognitive responses include: inability to concentrate, confusion, self-blame, intrusive thoughts (flashbacks) about the experience, decreased sense of self-efficacy, fear of losing additional control over life events, and fear of reoccurrence of the event.
(c) Biological responses include sleep disturbance (insomnia, nightmares), exaggerated startle response, and indicators of stress and immune disorders. Behavioral responses include avoidance, social withdrawal, interpersonal stress (decreased intimacy and lowered trust in others) and substance abuse.
(d) Resource losses include losses of income, social support, time for non-effect activities, social embeddedness, optimism, self-efficacy. and perceived control.
(e) Collective responses. Neighborhood and community response studies are rare with assessments generally taking three approaches: P
articipants have been asked to report community conditions, individual level responses have been aggregated, and archival data have been used to illustrate loss and responses to loss, for example, changes in liquor sales in a given neighborhood or community ( Bromet , Parkinson , Schulberg , & Gondek , 1982; Gleser , Green, & Winget , 1981; Norris et al.).
Individual And Collective Outcomes
Norris et al. (2002) summarized both the individual and collective outcomes obtained from 160 disaster samples from 29 countries. All three types of disaster, natural, technological, and mass violence events, were examined and analyzed for effect size.
The magnitude of severity of negative consequences for the individual level response samples reviewed by Norris et al. was rated by level of impairment: minimal-11%, moderate-51%, severe-21%, and very severe-18%. When the data were assessed by type of event, victims of terrorist attacks (as opposed to natural and technological events) suffered the most severe consequences.
Norris et al. reported that women and youths were more severely affected than men and older adults. Rescue and recovery workers were reportedly the most resilient. Examples of US disasters rated as "high impact" by Norris et al. were the Buffalo Creek dam collapse (1972), the Exxon Valdez oil spill (1989), Hurricane Andrew (1992), and the Oklahoma City bombing (1995).
Findings emerging from World Trade Center study samples, ie, Manhattan and
nearby areas, showed incidence of symptoms of stress ranging from 20% to 40%,
suggesting a high disaster impact (Galea et al., 2002; Schuster et al., 2001) .
Study of Disaster and Their Outcomes
Disasters and their outcomes are difficult to study. There are several reasons for this and some cannot be overcome. First, "pre-event" data are rarely available. It may be that mental disorders are overestimated in some post disaster samples.
Second, study reports vary widely in their methods. Norris et al. (2002) noted that 68% of the samples in their data set provided single, one-time data frequently by telephone.
Initial, post event data collections ranged from immediately after an event up to 7 years later, making the determination of immediate impact difficult to estimate.
Most longitudinal
studies have not collected follow-up data for more than a year, leaving
long-term outcomes unknown. Thus, study design variability poses a threat to
generalizability of findings.
Suggestions for Disaster Study
Four suggestions for the study of disasters are to: increase the number of community and family studies, examine the roles of protective factors and lost resources, develop and test evidence based interventions, and increase nurse researcher involvement.
Research is needed in regard to factors that prevent or impede negative consequences, eg, the roles of social networks and the efficiency of relief agencies. Collective responses interact with individual responses, making outcome measurement a challenge.
The measurement and documentation of post trauma responses has improved over time, but there is a lack of understanding in regard to how to reduce high levels of PTSD.
Beaton and Murphy (2002) have made some initial recommendations in regard to the timing of psychosocial interventions following terrorist events. Finally, nurses provide post disaster emergency services and follow-up treatment, and some have assisted in study data collection, but only a few have been study investigators.
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