Background
Methods
Participants
Research design
Research procedures and analysis
Ethical considerations
Results
Characteristics of participants and their efforts after the disaster
Participant | Years of nursing practice at the disaster (years) | Sex | Operations at disaster and their transition |
---|---|---|---|
pI | 20 | Female | Provided healthcare services and played the administrative roles in the evacuation center where she evacuated just after the disaster |
pII | 10 | Female | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pIII | 5 | Man | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pIV | 19 | Female | Provided healthcare services and played the administrative roles in the evacuation center where she evacuated just after the disaster |
pV | 14 | Female | Worked as a volunteer at the evacuation center where she evacuated for a while, and then, formally assigned as a city employee for disaster relief |
pVI | 13 | Female | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pVII | 10 | Female | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pVIII | 10 | Female | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pIX | 9 | Female | Worked at the city hospital for a while, and then shifted to the evacuation centers |
pX | 19 | Female | Worked as a volunteer at the evacuation center where she evacuated for a while, and then, formally assigned as a city employee for disaster relief |
Category | Efforts |
---|---|
Healthcare for evacuees | Performing health checkup for the evacuees along with patrolling the evacuation centers with public health nurses and volunteer nurses |
Assessing oral conditions and teaching oral hygiene | |
Managing medications for evacuees | |
Screening the deep-vein thrombosis in the evacuees, and instructing them to use the compression stockings and perform the preventive exercises | |
Explanation of health counseling at secondary evacuation centers and home-visit health counseling | |
Hygiene management in evacuation centers | |
Assistance for medical care | Assistance for physician consultations |
Providing residents with information on the medical institutions | |
Coordination of a medical examination | |
Arrangement of healthcare services with other professionals | Assessing the level of care required for the evacuees |
Request healthcare services to the public health nurses | |
Arrangemeng of meetings with attending physicians, nurses, and clinical psychologists | |
Listing up the subjects who needed the physical or occupational therapies, and sharing their information with the medical staff | |
Livelihood support | Promoting exercise to prevent physical weakness |
Providing a place for children to release their stress and engage them in preschool lives | |
Assisting residents’ shopping trips | |
Working with evacuees with a history of mental illness | |
Administrative roles | Identification of the evacuees with the records in the city office |
Explaining the situation of the city to the residents with administrative staff | |
Responding to the applications for donations | |
Explain the disaster certification to residents | |
Organizing the documents for residents who have left the evacuation centers | |
Responding the phone calls from residents regarding administrative matters | |
Surveying residents who wish to return their home | |
Notifing itinerary for those who wish to return home | |
Sorting relief supplies | |
Explanation of the applications for the temporary housing | |
Survey of the citizens’ opinion | |
Response to inquiries from the mass media of television and newspapers | |
Preparing the venue for the city council members’ rounds, and attendance at their meetings |
Themes and the subthemes
RQ 1) Challenges in evacuation centers
Themes | Subthemes | Examples of codes |
---|---|---|
Experiences of not being recognized as an evacuee by residents | Experiences of being hurt by residents’ words | Residents lost their jobs due to the disaster. Because we were working, the residents told us, “I envy you.” We were the outlet for their frustration. (pIV) |
It was hard to hear residents say, “We can’t do our jobs because we lost our jobs.” (pI) | ||
I was most shocked when a resident cursed me, saying, “You’re on the government side.” (pVI) | ||
Residents were confronted with stress caused by the disaster, dissatisfaction with the shelters, and a desire to return home. (pII, III, IV, and IX) | ||
Sadness at not being reconized as an evacuee | They just saw me as a public servant and did not see me as a disaster victim. (pI, II, VI, and IX) | |
Conflicts between multiple positions | Conflicts between roles at home and thoughts as a nurse | During the evacuation, I had conflicts between roles as a mother, a nurse, and a city employee. (pIV) |
Conflicts between being a city employee and a nurse | Residents identified us as both a nurse and a city employee. (pI, VI, and IX) | |
Difficulties in performing tasks which they had never experienced before | Difficulties in working in a field different from clinical practice | My role at the evacuation centers was public health service. I felt tha my knowledge was insufficient because it was different from nursing care in a hospital. (pII, VIII, and IX) |
The difficulty in the first experience | I had never been involved in disaster relief before, and this was my first time working in an evacuation center.(pII, IV, V, and VIII) | |
It was my first time being affected by a major disaster and working in an evacuation center, so I was nervous the whole time. (pVI, and VII) | ||
Difficulties in making decisions when responding to the individual cases | While visiting a temporary housing complex, I found a resident collapsed inside. Since there was no standard of procedures for handling the situation, I was confused whether I should call an ambulance or not. My decision might cause messy conflict in the other evacuees. (pX) | |
Anxiety in working | Anxiety | We were also anxious about what would happen to us, and it was breaking our hearts. (pIV) |
Uncertainty in losing the goal | All I could think about was how I was going to spend my time and deal with it on a daily basis. (pVI) | |
It was all I could do to spend each day. (pV) |
“Residents lost their jobs due to the disaster. Because we were working, the residents told us that they envy us. We seemed to become the outlet for their frustration.” (pIV).
“They just saw me as a public servant and did not see me as a disaster victim.” (pVI).
“Residents were confronted with stress caused by the disaster, dissatisfaction with the shelters, and a desire to return home.” (pII).
“The residents just saw me as a public servant and did not see me as a disaster victim.” (pI).
“During the evacuation, I had conflicts between roles as a mother, a nurse, and a city employee.” (pIV).
“Residents identified us as both a nurse and a city employee.” (pIX).
“My role at the evacuation centers was public health service. I felt that my knowledge was insufficient because it was different from nursing care in a hospital.” (pVIII).
“It was my first time to be affected by a major disaster and to work in an evacuation center, so I was nervous the whole time.” (pVII).
“While visiting a temporary housing complex, I found a resident collapsed inside. Since there was no standard of procedures for handling the situation, I was confused about whether I should call an ambulance or not. My decision might cause messy conflict in the other evacuees.” (pX).
“We were also anxious about what would happen to us, and it was breaking our hearts.” (pI).
“All I could think about was how I was going to spend my time and deal with it on a daily basis.” (pVI).
“It was all I could do to spend each day.” (pV).
RQ2) Motivations to continue the disaster relief efforts in the evacuation centers
Themes | Subthemes | Examples of codes |
---|---|---|
Carrying out the role of a nurse | Rewarding | I thought that I did help improve the evacuees’ health conditions by providing nursing care. (pI and III) |
Providing healthcare services that met the needs of evacuees | In order to alleviate residents’ concerns as much as possible, all we can do was to listen to them in an accommodating manner (pIII, IV, and VII) | |
Evacuees just needed their listeners. (pI, II, V, VI, and X) | ||
Acceptance by residents | Build a trusting relationship with residents | I was very happy when someone said, “I can talk to you easily because you are a nurse from my hometown and I can understand your dialect. (pI and IV) |
Reduce residents’ anxiety | Some residents said, “Because we are from the same hometown, we can talk to each other and feel at ease.” (pII) | |
Strengths of human connections | Strengths of having a family together | My family members were with me, so I felt a little reassured (pI) |
Strength of being with friends | I was helped by the staff who were working together (pII) | |
I felt more comfortable when I worked my teammates than when I was alone (pIII and IV) | ||
The support of people in the shelter community | I have many good memories, such as festivals at evacuation centers (pII, VII, and VIII) | |
Evacuees did not mind the radiation accident. They accepted us and were kind and concerned about us (pI and III) | ||
I evacuated to the area that suffered by the Chuetsu Earthquake in 2007. The residents were kind enough to say to us, “You are also victims of the earthquake, so please try to take care of yourselves emotionally”. (pIII and VII) |
“I thought that I did help improving the evacuees’ health condition by providing the nursing care.” (pIII).
“In order to alleviate residents’ concerns as much as possible, all we can do was to listen to them in an accommodating manner.” (pIV).
“Evacuees just needed to their listeners.” (pX).
“I was very happy when someone said that they can talk to me easily because I am a nurse from their hometown and they can understand my dialect.” (pI).
“Some residents said, because we are from the same hometown, we can talk to each other and feel at ease.” (pII).
“My family members were with me, so I felt a little reassured” (pI).
“I felt more comfortable when I worked my teammates than when I was alone.” (pIV).
“Evacuees did not mind the radiation accident. They accepted us and were kind and concerned about us” (pIII).
“I evacuated to the area suffered by the Chuetsu Earthquake in 2007. They were kind enough to say to us, “You are also victims of the earthquake, so please try to take care of yourselves emotionally”.” (pVII).
RQ3) Gains from experience at the evacuation centers
Themes | Subthemes | Examples of codes |
---|---|---|
Increased awareness of disasters | Opportunity for disaster nursing | I got a certificate as a member of the disaster medical assistance team (DMAT) after the earthquake (pIII and IV) |
After the earthquake, I registered as a nurse specializing in disaster relief (pVIII) | ||
I always want to help someone with difficulties (pIV and IX) | ||
I want to be a person who can do the same thing as the people in the evacuation centers who supported us. (pI and III) | ||
Preparation for disaster | I think about how I can help when disaster strikes my location (pIV and V) | |
I always make sure that my family is prepared for any disaster, and I make use of the lessons I learned from that time, such as being out of water. (pVI and IX) | ||
Need to pass on experience | I participated in disaster relief after the Kumamoto earthquake, and I definitely made use of my experience in 2011. (pIV) | |
I hope we can pass on our experiences to others. We have no choice but to make use of the lessons we have learned(pIIIVI) | ||
Change to a positive attitude | I am here now because of my various experiences (pVII and VIII) | |
I started to think positively (pV) | ||
Despite difficulties, this experience turned out to be a blessing in disguise (pIII and IV) | ||
Growth as a nurse | Renewed awareness of responsibility as a nurse | The feeling that the work must be done responsibly. (pV, VI, and IX) |
Reaffirming that a public health effort is an object of nursing | I thought that the target audience for nursing was not only people in hospitals but also all residents when considered from the perspective of health. (pVI) | |
It has changed my feelings about my job and about being allowed to do nursing. (pII and III) | ||
It broadened my perspective as a nurse (pIV and V) | ||
Changes in relationships with people | What has changed since the disaster is that I have more interaction with people in the community. (pVI and X) | |
I felt the importance of communication again. (pIII) |
“After the earthquake, I registered as a nurse specialized for disaster relief” (pVIII).
“I always make sure that my family is prepared for any disasters, and I make use of the lessons I learned from the disaster in 2011, such as not running out of water.” (pIX).
“I hope that we can pass our experiences to other nurses. We have no choice but to make use of the lessons we have learned” (pVI).
“I am here now because of my various experiences.” (pVII).
“The feeling that the work must be done responsibly.” (pV).
“I thought that the target for nursing care was not only patients in medical institutions but also all residents when I considered from the view of public health.” (pVI).
“My feelings about my job have changed as an appreciation for working as a nurse.” (pII).
“What has changed since the disaster is that I have more interaction with people in the community.” (pX).