Nurses’ Beliefs about a Bioterrorism Event: Fear of Abandonment

1. Nurses’ Beliefs about a Bioterrorism Event: Fear of Abandonment Carol O’Boyle PhD, RN Cheryl Robertson, PhD, RN Molly Secor-Turner BS, RN School of Nursing, University of Minnesota

2. Background • In a large-scale public health emergency (PHE), there will be multiple patient admissions to healthcare facilities • Nurses may be exposed to infectious agents • A PHE may produce fear, anxiety, stress, and confusion in the hospital setting

3. Purpose • Identify beliefs and attitudes of nurses regarding PHE

4. The Research Question • What are the beliefs, concerns, and feelings of nurses expected to work in clinical settings during a PHE?

5. Methods • Qualitative descriptive approach with 9 focus group meetings • Sessions were audiotaped, then data was analyzed • Categories and themes were identified

6. Sample • Purposive sample • 33 registered nurses working in critical care, emergency, and medical/surgical units in hospitals • 3 metropolitan hospitals designated as bioterrorism-receiving sites in 2003.

7. Procedure • Researcher moderated discussions using a core set of questions • Discussions were audiotaped

8. Procedure • Questions: • What is the likelihood that you will be asked or expected to work during a bioterrorism (BT) event? • What do you think working during a BT event will be like? • What do you think of the preparations that have been made by the hospital for a BT event? • If you had to make a list of your concerns about working during a BT event, what would be the top 3 concerns?

9. Procedures • Questions: • In your opinion what equipment or procedures planned to be used during a BT event will be effective or helpful? • In your opinion, what equipment or procedures planned to be used during a BT will be a problem? • If you could make changes to the BT procedures, what would you recommend or suggest?

10. Themes • Expectation of chaos in an environment without adequate information and resources • Loss of safe clinical environment for nurses and patients • Loss of freedom • Limited institutional commitment

11. Themes Chaos Unsafe Environment Fear of Abandonment Loss of Freedom Limited Institutional Commitment

12. Chaos • Disorganized, overwhelming situation • Lack of leadership, direction • Unclear chain of command, who will direct? • Lack of clarity re: role, responsibilities • Unprepared organization, how to cope, function • Lack of knowledge, lack of accessible information

14. Unsafe Environment • Self-protection – personal risk of disease • Insufficient amount of personal protective equipment( PPE) for nurses • PPE taken, stolen by others • Inadequate supplies for patients (e.g. rooms, ventilators) • Danger: risk of transmission to loved ones

16. Loss of Freedom • Unable to leave hospital, no relief, expected to work • Inadequate staff (no shows, staff leaving) • Contract with patient, contract with hospital?

17. Limited Institutional Commitment • Hospital’s obligation to nurse? • Will hospital honor contract with nurses, provide care and support them if injured or diseased? • Who will be in the clinical environment with them?

19. Limitations of the Study • Small number of participants from one metropolitan area • Additional studies needed to validate findings with larger sample of nurses from various geographic areas

20. Summary • Belief that the work environment could not withstand the stress of such an enormous event • Belief that they would be on their own in the situation without institutional support • Belief that social norms restraining aggressive behavior may be diminished

21. Summary • Few organizations have assessed caregivers’ needs and fears about working during a PHE • Need for psychological resources to facilitate coping in high stress situations