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How nurses responded to the challenges of post-quake Christchurch was the focus of a research project by the Joint Centre for Disaster Research. Nursing Review reports on centre researcher ZOE MOUNSEY’s presentation to the recent People in Disasters conference, where she shared insights on nurses’ coping mechanisms.

 

Nurses were more interested in looking after their patients than in looking after themselves in post-quake Christchurch, a research project has found.

Researcher Zoe Mounsey says this was a common finding when the Joint Centre for Disaster Research analysed its indepth interviews of 11 nurses working in acute hospitals, community care and aged residential care during and after the Christchurch earthquakes.

She says the nurses were very ready to talk about the psychological support and self-care advice they gave to patients and clients.

“But one of the things we found, compared with the GPs we interviewed, was that while nurses knew the science of self-care, they didn’t do it,” says Mounsey. “They didn’t practice what they preached.”

Some nurses joked that their idea of self-care “was a bottle of wine and a bar of chocolate”.

“But they also said, ‘I know I should be exercising, I know I should be [taking] time out and I knew I should be doing these other things’ but they very much had this [sense that their] duty of care was to look after people, and they, themselves, were secondary. And that came across very clearly.”

Mounsey addressed the People in Disasters conference, held in Christchurch recently to mark the fifth anniversary of the 22 February 2011 quake, on some of the nurse findings from the joint Massey University and GNS Science research centre project, which also included post-quake interviews with GPs and mental health professionals.

Much of the post-disaster research of health professionals looks at the ‘blue light’ response in the immediate aftermath of a disaster and doesn’t look at the longer-term impact, says Mounsey. The centres’ research interviews were held around three years after the quake series began and found that the nurses were still facing ongoing effects of the quakes on their workplace, workloads and personal lives; with many reporting increased workloads and more stressed clients and then returning home after frustrating commutes to face housing and insurance issues.

Reluctance to accept help

Despite the interviews being held several years down the track, Mounsey says some of the nurses said it was the first time they had really sat down and talked to somebody about what had happened on 22 February and in the years since.

“What we found was that the interview itself was a therapeutic process in its own right,” says Mounsey. She sees this as a clear lesson on how organisations can support staff by giving them an opportunity to debrief or reflect on their experiences.

Nurses who worked for the District Health Boards could name a number of post-quake support services available to them including onsite counsellors and EQC advice but those who worked for smaller organisations, like in the residential aged care sector, reported struggling to get the out-of-town head office to understand the difficulties they were working under or the emotional impact on staff. 

“There was a sense of inequality and inequity about the kind of support services people got depending on their organisation.”

But even when support services were available, Mounsey says researchers found that with both the nurses and other health professional interviews there was “a real reluctance to seek out and accept help”.

“There was a real sense, particularly from the nurses, that they are the ones who look after people so they shouldn’t need looking after themselves.” The nurses had reported using distraction techniques, such as focusing on others and keeping busy, to avoid dealing with their own emotions.

Others talked about not wanting to ask for help as it felt like admitting a weakness.

But two nurses explicitly acknowledged they had been or were at risk of burnout and others talked about compassion fatigue, lack of energy, and increased illness.

Mounsey says this may mean organisations need to be proactive in offering help and support to nurses rather than waiting for nurses to come to them.

In the early days most nurses reported that the key source of support was peer support; being able to talk to colleagues not only about the impact of the quakes on their workplace and workload but also what was happening at home. Participants said the best way their organisation supported them was allowing space for this to happen, whether it be morning teas or barbecues where people could get together informally and talk about their experiences.

Though one participant said eventually they had to “step away” from emotionally supporting other nursing colleagues as they hadn’t “too much more to give”.

Another finding Mounsey says they found very interesting was that half of the cohort had changed roles or reduced their working hours. Some were due to changes to services but a “significant proportion” reported the change was due to emotional stress and reducing their hours or changing to a role they saw as less intense.

Nurses do need support

She concluded that a “clear and clean” message from the research was that nurses did need support post-disaster to help manage their work and personal lives. This could include recognising workload issues and whether organisations post-disaster were “trying to do too much with too little”.

Mounsey says there was also no ‘one-size-fits-all’ answer but support needed to be not only in the first months after a disaster but extend for several years and to recognise the “barriers that healthcare professionals” have in accepting and getting support.

“Also perhaps being more proactive about how they model self-care behaviour and showing everybody that it is all right to take time off and all right to have a life outside work.” ✚