Nurses’ Beliefs Nurses’ Beliefs about a about a

Bioterrorism Event: Bioterrorism Event: Fear of Fear of

AbandonmentAbandonmentCarol O’Boyle PhD, RNCarol O’Boyle PhD, RNCheryl Robertson, PhD, RNCheryl Robertson, PhD, RNMolly Secor-Turner BS, RNMolly Secor-Turner BS, RN

School of Nursing,School of Nursing,University of MinnesotaUniversity of Minnesota

BackgroundBackground In a large-scale public health emergency In a large-scale public health emergency

(PHE), there will be multiple patient (PHE), there will be multiple patient admissions to healthcare facilitiesadmissions to healthcare facilities

Nurses may be exposed to infectious Nurses may be exposed to infectious agentsagents

A PHE may produce fear, anxiety, A PHE may produce fear, anxiety, stress, and confusion in the hospital stress, and confusion in the hospital settingsetting

PurposePurpose

Identify beliefs and attitudes of Identify beliefs and attitudes of nurses regarding PHEnurses regarding PHE

The Research The Research QuestionQuestion

What are the beliefs, concerns, What are the beliefs, concerns, and feelings of nurses expected and feelings of nurses expected to work in clinical settings to work in clinical settings during a PHE?during a PHE?

MethodsMethods

Qualitative descriptive approach Qualitative descriptive approach with 9 focus group meetingswith 9 focus group meetings

Sessions were audiotaped, then Sessions were audiotaped, then data was analyzed data was analyzed

Categories and themes were Categories and themes were identifiedidentified

SampleSample Purposive samplePurposive sample 33 registered nurses working in critical 33 registered nurses working in critical

care, emergency, and medical/surgical care, emergency, and medical/surgical units in hospitalsunits in hospitals

3 metropolitan hospitals designated as 3 metropolitan hospitals designated as bioterrorism-receiving sites in 2003.bioterrorism-receiving sites in 2003.

ProcedureProcedure

Researcher moderated Researcher moderated discussions using a core set discussions using a core set of questionsof questions

Discussions were audiotapedDiscussions were audiotaped

Questions:Questions:

– What is the likelihood that you will be asked or What is the likelihood that you will be asked or expected to work during a bioterrorism (BT) event?expected to work during a bioterrorism (BT) event?

– What do you think working during a BT event will What do you think working during a BT event will be like?be like?

– What do you think of the preparations that have What do you think of the preparations that have been made by the hospital for a BT event?been made by the hospital for a BT event?

– If you had to make a list of your concerns about If you had to make a list of your concerns about working during a BT event, what would be the top working during a BT event, what would be the top 3 concerns?3 concerns?

ProcedureProcedure

ProceduresProcedures Questions:Questions:

– In your opinion what equipment or In your opinion what equipment or procedures planned to be used during a BT procedures planned to be used during a BT event will be effective or helpful?event will be effective or helpful?

– In your opinion, what equipment or In your opinion, what equipment or procedures planned to be used during a BT procedures planned to be used during a BT will be a problem?will be a problem?

– If you could make changes to the BT If you could make changes to the BT procedures, what would you recommend or procedures, what would you recommend or suggest?suggest?

ThemesThemes

1.1. Expectation of chaos in an Expectation of chaos in an environment without adequate environment without adequate information and resourcesinformation and resources

2.2. Loss of safe clinical environment Loss of safe clinical environment for nurses and patientsfor nurses and patients

3.3. Loss of freedomLoss of freedom

4.4. Limited institutional commitmentLimited institutional commitment

Chaos

ThemesThemes

Fear of Abandonment

Unsafe Environment

Loss of Freedom

Limited Institutional Commitment

ChaosChaos Disorganized, overwhelming situationDisorganized, overwhelming situation Lack of leadership, directionLack of leadership, direction Unclear chain of command, who will Unclear chain of command, who will

direct?direct? Lack of clarity re: role, responsibilitiesLack of clarity re: role, responsibilities Unprepared organization, how to cope, Unprepared organization, how to cope,

functionfunction Lack of knowledge, lack of accessible Lack of knowledge, lack of accessible

informationinformation

Unsafe EnvironmentUnsafe Environment Self-protection – personal risk of Self-protection – personal risk of

diseasedisease Insufficient amount of personal Insufficient amount of personal

protective equipment( PPE) for protective equipment( PPE) for nursesnurses

PPE taken, stolen by othersPPE taken, stolen by others Inadequate supplies for patients Inadequate supplies for patients

(e.g. rooms, ventilators)(e.g. rooms, ventilators) Danger: risk of transmission to Danger: risk of transmission to

loved onesloved ones

Loss of FreedomLoss of Freedom

Unable to leave hospital, no Unable to leave hospital, no relief, expected to workrelief, expected to work

Inadequate staff (no shows, Inadequate staff (no shows, staff leaving)staff leaving)

Contract with patient, Contract with patient, contract with hospital?contract with hospital?

Limited Institutional Limited Institutional CommitmentCommitment

Hospital’s obligation to nurse?Hospital’s obligation to nurse? Will hospital honor contract with Will hospital honor contract with

nurses, provide care and support nurses, provide care and support them if injured or diseased?them if injured or diseased?

Who will be in the clinical Who will be in the clinical environment with them?environment with them?

Limitations of the StudyLimitations of the Study Small number of participants Small number of participants

from one metropolitan areafrom one metropolitan area Additional studies needed to Additional studies needed to

validate findings with larger validate findings with larger sample of nurses from sample of nurses from various geographic areasvarious geographic areas

SummarySummary

Belief that the work environment Belief that the work environment could not withstand the stress of could not withstand the stress of such an enormous eventsuch an enormous event

Belief that they would be on their Belief that they would be on their own in the situation without own in the situation without institutional supportinstitutional support

Belief that social norms restraining Belief that social norms restraining aggressive behavior may be aggressive behavior may be diminisheddiminished

SummarySummary

Few organizations have Few organizations have assessed caregivers’ needs and assessed caregivers’ needs and fears about working during a fears about working during a PHEPHE

Need for psychological Need for psychological resources to facilitate coping in resources to facilitate coping in high stress situationshigh stress situations