Perinatal Nursing in Uncertain Times: The Katrina Effect

Perinatal Nursing in Uncertain Times: Rebounding from Hurricane Katrina

Background: When Hurricane Katrina made landfall on August 29^th 2005 in the Greater New Orleans area, maternity nurses were staffing ten different hospitals to provide obstetrical and neonatal care. It was unknown how well nurses in obstetrical and neonatal specialties were able to cope with the unpredictable stressors and to care for their patients under unexpected, life-threatening conditions. Little was known about the immediate and long term effects of this event on the personal and professional lives of the nurses involved.

Purpose: To describe and make explicit the nurses’ shared meanings of their lived experience providing nursing care in obstetrical and newborn settings during the disaster of Hurricane Katrina and coping with the aftermath.

Aims:

1.      To describe safety issues and concerns related to emergency preparedness in perinatal nursing settings that will inform health care and professional organizations in how to better prepare specialty nurses for disaster-care experiences.

2.         To describe the personal and professional needs of perinatal nurses subsequent to working in a disaster experience.

Methods: van Manen’s interpretative phenomenology was used to guide the study. Sixteen nurses were interviewed 9-18 months after the disaster. The semi-structured, interviews were taped and transcribed. An audit trail was maintained and data was analyzed by the researchers, guided by van Manen’s method of hermeneutic reflection and thematic analysis. Member-checking with a sample of participants and peer debriefing with an external obstetrical nurse with qualitative research experience was used to further substantiate credibility.

Results: An exhaustive description of themes described the nurses’ experiences and the shared meanings. Themes included: Duty to care; Conflict in duty; Chaos after the storm: Uncertain outcome; Evacuation: Routes through uncertainty, hopelessness, abandonment, and/or fear; Strength to endure; Grief: A loss of relationships, identity, and place; Anger; Feeling you are in the right place again.

Conclusions: Although faced with obstacles and personal losses, the nurses maintained a sense of duty and creative care-taking during the immediate disaster, characteristic of expert nurses. They felt they fulfilled the social contract to care; but experienced feelings that institutions of society failed to adequately assist them or adequately support them after the experience. The nurses voiced difficulty readjusting to work environments post-Katrina and used a variety of mostly self-imposed coping strategies. The prolonged stress and lack of perceived support voiced by the participants should serve to inform health care and professional organizations in how to better prepare specialty nurses for disaster-care situations and assist nurses cope afterwards with the effects of working and living through a major disaster.

This study was funded by a grant from the New Orleans District Nurses Association (NODNA).