ADVANCE For NursesEditor’s note: This article first appeared in ADVANCE For Nurses. It is the second in a series of articles on disaster preparedness for bedside nurses. Missed the first entry? Get caught up here.

A disaster, whether natural or man-made, can cause chaos in any healthcare organization.

 Widespread power outages can add to the stress of dealing with the current patient load, new casualties and their families.

The nurse in the hospital setting needs to know the options for record keeping under these circumstances.

Record Keeping Following a Disaster

The Joint Commission requires disaster plans for healthcare facilities that address critical information systems and the data they house.

Mobile devices may offer some access to critical information, but nurses need to be familiar with their location range, as well as who is responsible for retrieving and evaluating these devices after patient safety is secured.

Nurses also need to be familiar with information system downtime procedures and where manual, printed forms can be obtained.

In the event that the hospital is given notice of an upcoming disaster, nurses can determine what critical information needs to be available in print form or on mobile devices to meet urgent patient needs. This may include a summary or medication record that stays with the patient or on the mobile devices that support ongoing access to information systems even if patients must be moved to another area.

Stress Management

During a disaster, nurses care for patients' physical injuries and have the interpersonal skills to provide psychological intervention. They can play an integral role in promoting normal recovery in situations where people are affected on many levels.

The more direct the patient's exposure to the disaster, the higher their risk will be for psychological trauma. The same applies to family members of the victims and the staff.

While the focus of care during a disaster event is on the injured, organizations can minimize the impact of a disaster on the nursing staff by utilizing a plan to reduce and intervene during high stress events.

An organization's stress management plan consists of four phases:

    1. Preparation and planning. The organization recognizes that a disaster may occur and is in an anticipation mindset for any type of disaster.
    2. Recognizing the threat. Receiving the warning is critical during this phase. Responses among those at risk for disaster may range from active planning and protective measures to denial of the threat. During the first two phases of the stress management plan, the level of stress on the organization and personnel is minimal because the true disaster has not yet occurred.
    3. Impact and rescue. This phase occurs immediately following the disaster and is the time of greatest damage and disorganization. Toward the end of this phase, the true impact of the situation is realized along with the reality of the outcome. Staff needs to be observed for increased fatigue and signs of stress. Stress responses occur when information enters the brain through the senses. These responses are emotional, cognitive and behavioral reactions that are influenced by developmental level and maturity, experiences and cultural background. Both staff and patients' family members experience these responses. Psychological and physical first-aid must begin. Most survivors, both staff and family members, experience normal stress reactions, but some may need immediate mental health intervention to manage feelings of panic, depress, anxiety or intense grief.
    4. Recovery. This phase begins two to three months post disaster with the hope of returning to a pre-disaster level of functioning. Individuals and communities try to bring their lives and activities back to normal during the recovery phase. Working with disaster survivors is stressful and crisis-provoking; the nurse is often simultaneously suffering from a disaster while caring for survivors and working amidst disaster impact. Nurses need to observe their own signs and symptoms and seek help from others. They are encouraged to periodically leave the immediate disaster scene and follow the rules established for workers, such as taking time to eat and sleep. No person can be the only one to assume responsibility.

Caring for Nurses

Once the recovery phase begins, survivors are receiving the needed physical and psychological care, which in most cases was initiated by the nurse.

But what happens to the nurses who helped care for the victims of the disaster?

Organizations need to assess the impact of the disaster on nurses who provided care. Post-traumatic stress syndrome can be identified in nurses who provide care during major disasters. Unfamiliar disasters are more likely to be psychologically disturbing, and those with sudden and unanticipated onsets are more stressful.

Nurses need to be assessed for and educated about signs and symptoms that indicate they may be experiencing difficulty coping.

Psychological First Aid

Nurses must also recognize the needs of caregivers, including themselves, and promote self-care. Psychological first aid is the key to stress management. Nurses and organizations need to promote feelings of safety by creating a calm and stable environment, providing reassurance for patients and caregivers.

Some caregivers may need to share their experience with others. As natural groups form, organizations need to support sharing that occurs spontaneously and allow nurses time to grieve losses and ventilate feelings. Interventions can aim to help people come to terms with the disaster, loss and other distressing events.

Organizations need to provide support, reinforce adaptive behaviors and help those suffering identify strengths. Communicating caring and empathy helps individuals cope during stress events.

Disasters evoke predictable emotional and cognitive responses in survivors. Organizations are responsible for having a plan for dealing these unexpected events, including how resources are allocated, addressing the physical and psychological health of those providing care and monitoring and supporting nurses and other healthcare professionals.

No one expects a disaster to strike, but being prepared to deal with the crisis and recovery allows the organization and the staff to function at optimal levels.

References for this article can be accessed here.

Charlene Romer is an adjunct instructor and Toni Hebda is a professor, both in the MSN Degree Program at Chamberlain College of Nursing.