Aim: This study assessed the prevalence of compassion fatigue, compassion satisfaction and burnout among expatriate Ebola aid workers roughly 1 year after they returned from deployment. It also investigated methods by which care providers managed stress in the field and when they returned to their homes.
Methods: A convenience sample of medical care providers who were solicited by non-governmental organizations that deployed practitioners to work in the Ebola response were asked to complete an online Professional Quality of Life (ProQOL 5) scale. Of those respondents, one-third consented to sit for a key informant interview to validate the findings and explore aspects of stress management. Responses were calculated for the whole sample and then differentiated into groups based on professional role and years of professional experience. MANOVA and independent samples t-tests were administered. An inductive thematic analysis, which included open and axial coding, was applied to the interview data.
Results: Fifty-eight participants completed the scale; of those, 20 participants were interviewed. There were no significant differences between the interview and non-interview group ProQOL 5 scores. The whole sample scored in the lowest 25% quartile with regards to compassion satisfaction, but scored in the 50% quartile with regards to compassion fatigue and burnout. Within the sample, physicians scored significantly lower than the other groups with regards to compassion fatigue (p=0.05, 95% CI −0.03 to 8.56). Providers with 1–5 years of experience scored significantly higher on the burnout scale compared to standard quartiles presented by ProQOL (p=0.031, 95% CI −10.47 to −0.51). Six themes arose from the qualitative analysis that supported the ProQOL findings: Changes on return, Camaraderie, Satisfaction—self and others, Dissatisfaction—organizational, Seeking organizational support and Extreme situations.
Conclusions: The qualitative data from this study validated the ProQOL 5 findings that expatriate providers who worked in the Ebola response did not experience high levels of compassion fatigue and burnout 1 year after deployment. These results suggest post-traumatic growth among the study sample. Post-traumatic growth refers to one’s ability to recognize and embody positive changes in one’s life after witnessing or experiencing trauma. One would posit that providers with lower levels of compassion fatigue and burnout post Ebola may be exhibiting post-traumatic growth which, through its positive response to traumatic events, may decrease the likelihood of burnout. Providers with fewer years of professional experience were most at risk for high burnout scores, and physicians, as compared to the other professional groups, had lower scores of compassion fatigue. Providers described strong senses of community and camaraderie, coupled with the use of narrative methods as tools that helped them manage the stresses of caring for Ebola patients. It is likely that collegial support, despite witnessing excess death and working in the face of organizational dysfunction, buffered these providers against compassion fatigue and burnout.
Aim: Post-traumatic growth suggests that experiencing difficult situations can lead to growth if meaning is given to the experience. Public health nurses who experienced the Great East Japan Earthquake of 2011 through their health activities reflected on that event, and our study investigated how they negotiated feelings of conflict and suffering and made sense or meaning of their work during this disaster.
Methods: Narrative interviews with seven public health nurses who experienced the earthquake and who provided health activities for more than 1 year afterwards were conducted. Post-traumatic growth was defined as giving meaning to their experiences and finding new ways of thinking. Data for each case were categorized by similarities, and themes were named for each case; data from all cases were then integrated.
Results: Three broad concepts emerged with 13 sub-themes: ‘self-understanding’ (three sub-themes; e.g., ‘positive self-perception’ and ‘acceptance of emotions such as pain and loss’), ‘ways of thinking about relationships with others’ (six sub-themes; e.g., ‘feeling of solidarity with colleagues’ and ‘trust in related organizations’), and ‘beliefs and values about public health nurses as an occupation’ (four sub-themes; e.g., ‘having a long-term responsibility to the community’ and ‘need for a sense of mission and resolution to protect residents’ lives and health’).
Conclusions: Public health nurses’ giving meaning through reflection enabled them to understand their actions and responses to circumstances beyond their control during their service after the earthquake. In post-disaster health care, reflecting on how nurses responded in disaster situations may be valuable to both personal and professional growth.
Aim: This paper examines the humanitarian crisis in Aleppo, Syria, during its civil war in 2016.
Methods: Historical methodology was used to analyze primary sources such as records from aid agencies and aid workers and secondary sources on humanitarianism and “new wars.”
Results: Many United Nations and international non-government organizational missions have been involved in Syria. The White Helmets and Médecins Sans Frontières (Doctors Without Borders), in particular, illustrate the frustration and challenges that responders to the “new wars” experience.
Conclusion: As nurses work in politically charged environments such as war, they face new challenges that demand new responses. We call for nurses to engage in the needed dialogue over the use of force that intersects with humanitarian work.
Aim: This paper examines the Chi-Chi earthquake that struck central Taiwan (Republic of China) on September 21, 1999.
Methods: Framed within a geopolitical examination, historical methodology utilized primary sources of relief agency reports, US Agency for International Development Fact Sheets, news analyses, and nurses’ voices.
Results: Although the international community and government provided for physical needs, many of the earthquake survivors relied on the compassion and innovation of local hospital nurses, fellow citizens, and religious communities. For the nurses, the authority that being nurses gave them, their innovation, and self-reliance propelled them into duty.
Conclusion: Although Taiwan received an outpouring of international aid, the disaster proved grim. The rugged geography and geopolitical strains complicated the effectiveness of international aid as it arrived hours after the earthquake. The “921” earthquake has significantly affected Taiwan’s national psyche.
Aim: This paper examines the interplay of geopolitical and humanitarian responses to the 2015 earthquake in Nepal, a devastating 7.9-magnitude earthquake that resulted in nearly 9,000 deaths and 22,000 injuries.
Methods: Historical methodology used primary sources from the World Health Organization, USAID, and the voices of nurses who responded on the ground. Secondary sources included disaster nursing and international relations literature.
Results: Much of the disaster response involved local Nepali people who worked to take care of their own. Nurses and other aid workers from various countries also treated patients and distributed sufficient food and supplies.
Conclusions: Tensions over nation-state boundaries affected the response, but in the end, relief was a joint effort, with international, national, and local organizations teaming up to provide health care.
Aim: On January 12, 2010, Haiti experienced a 7.0 magnitude earthquake that shook the country to its core and toppled its fragile foundation. This paper examines the international response within the framework of geopolitical alignments.
Methods: Historical methodology examined primary sources of news stories, voices on the ground, and international relief agency reports, with secondary sources on disaster nursing and humanitarianism.
Results: The emergent relief that followed the powerful disaster of January 2010 proved to be both beneficial and harmful to the people needing assistance. While donations and help came from all over the world, United Nations troops’ unsanitary practices contributed to a cholera outbreak.
Conclusions: Disasters provide opportunities not only for humanitarian aid but also for countries to broaden their political reach beyond their own borders. Disasters make the balancing acts for power and influence among nations even more challenging.
Aim: This study aimed to describe the experiences of a unique cohort of students and United States Cadet Nurse Corps cadets at the University of Cincinnati College of Nursing and Health between 1943 and 1946. How the experiences fostered resilience in the students to provide nursing service during World War II is also discussed.
Methods: Historical research methods to include oral histories of seven graduates and archival research were used. Both primary and secondary data sources informed the broader historical context.
Results: The one-time, 3-year accelerated nursing degree program created unique experiences for the students. Two themes, lack of cadet status recognition and lack of knowledge regarding faculty concerns, were identified. The lack of these factors shed light on what was present for this cohort that fostered resilience in the students to provide nursing service during the war. The cohort experienced a strong sense of community and confidence instilled by a supportive faculty within a rigorous yet, predictable and structured program.
Conclusions: Findings can be used to assist faculty in preparing today’s student nurses for disaster nursing. To foster resilience, students’ disaster nursing experiences need to be organized and structured, and involve a supportive faculty. Nursing programs can provide these experiences to students through disaster simulation or authentic, organized disaster relief when available. Positive relationships with faculty and peers also build a sense of community that expands from one’s program cohort to the broader nursing and societal community.
Aim: Nurses are healthcare personnel who play an important role in disaster management in all phases of a disaster. However, research findings have pointed out that there is a lack of necessary preparedness for disasters as well as development of nursing competencies. This research aimed at investigating the effects of an interactive teaching method on nursing students’ learning achievement and nursing competencies of prevention and mitigation, preparedness, and response based on the framework of disaster nursing competencies of the International Council of Nurses.
Methods: Based on the International Council of Nurses’ framework of disaster nursing competencies and interactive teaching method, this course was designed and implemented with third-year nursing students at the Thai Red Cross College of Nursing who were enrolled in an emergency and disaster nursing course. The experimental group and control group were asked to complete the learning achievement test and the perceived competencies of prevention and mitigation, preparedness, and response questionnaires. Data was analyzed using an independent-sample t-test and a paired-sample t-test.
Results: The mean achievement score of the experimental group was statistically significantly higher than that of the controlled group (p < 0.05). The mean scores of nursing competencies of prevention and mitigation, preparedness, and response of the subjects in the experimental group were statistically significantly higher than those of the subjects in the control group (p < 0.001).
Conclusion: It is noteworthy that theoretical teaching via an integrative teaching method can enhance students’ achievement, perceived competencies and motivation to learn about nursing actions in response to disasters.
Aim: This study aims to structure the process of cognitive evaluation of stress in disaster relief nurses, focusing on long-term adjustment or maladjustment.
Methods: A self-administered questionnaire was completed by 535 disaster relief nurses from Japanese prefectures outside the impact zone of the Great East Japan Earthquake. The study was based on the theory of stress and divided into three stages: cognitive evaluation of stress, secondary evaluation of emotional changes and re-evaluation of individual adjustment or maladjustment. External impact factors were established for each stage. A checklist for disaster relief workers and the Impact of Event Scale-Revised were employed. A structural equation model with observed variables was used.
Results: The endogenous variable relationships of the structural model comprised: (a) cognitive evaluation of stress and emotional changes; and (b) negative emotions and long-term inability to cope. External impact factors were as follows: for cognitive evaluation of stress, gender (female), marital status (married), timing of disaster relief activities (within 2 weeks of the disaster), nature of the activities (work at evacuation sites), and individual adjustment behaviors (focusing on the problem); for negative emotions, assessment of others’ intentions and adjustment behaviors during work (laughing and joking); for long-term maladjustment, inappropriate assessments of one’s own behavior and individual adjustment behaviors (focusing on emotion). The structural model showed discrepancies due to gender.
Conclusions: The cognitive evaluation process of disaster relief nurses’ stress could be structured according to stress theory. Furthermore, the study revealed differences in the structural model by gender.
Aim: This study aimed to identify the experiences and feelings of difficulty during international humanitarian aid of Japanese relief workers based on the length of the mission.
Methods: This cross-sectional study was conducted from August through December 2015. Participants were 167 Japanese healthcare workers who participated in an overseas disaster relief mission and were asked to complete a self-administered questionnaire. Feelings of difficulty during the international humanitarian aid were assessed using the Humanitarian Aid Difficulty Scale. Scores on this instrument were evaluated based on mission duration using analysis of covariance with adjustment for sociodemographic status and disaster relief-related status.
Results: Of the instrument’s five subscales, the highest score for all mission duration was for “Culture and Custom”. Higher “Culture and Custom” scores and “Cooperation” scores were associated with longer mission duration (p trend: 0.02 and 0.004, respectively). Additionally, the “Infrastructure” score for a medium mission duration was higher than that for a long mission duration (p = 0.001), and the “Cooperation” score for a long mission duration was higher than for a short mission duration (p = 0.02).
Conclusions: The mission duration may be independently associated with an increase or decrease in the negative experiences of Japanese relief workers at an overseas disaster site. Results suggest that it is necessary for Japanese relief workers, who participate in international aid, to further enrich their cross-cultural understanding through education. Moreover, relief organizations should provide comprehensive support that addresses difficulty-related feelings depending on the mission duration.