In this study, the experience of nurses regarding the challenges faced by providing care to earthquake victims has examined. After Semi-structured interviews and data collection, the analysis yielded five categories. The organizational and managerial difficulties were the main extracted categories. According to the participants, different organizations like the ministry of health, the Red Crescent, and other relief organizations were in charge of providing services to care-seekers. These organizations worked independently and had no coordination.
Pouraghaei et al. studied the Azerbaijan earthquake in 2012 and highlighted the lack of coordination among organizations as one of the main challenges [16]. Another study by Li et al. on the Sichuan earthquake in China, they pointed to the lack of collaboration among disaster relief teams and insufficient leadership. [17].One of the challenges of the modern age is the necessity of an integrated system to face the disaster.
The human resources challenge was another extracted category in this study. The participants highlighted issues like lack of welfare facilities for caregivers like accommodation facilities, nutrition, bathrooms, and negligence of the mental health of nurses. Other studies have reported similar concerns in nurses like personal safety, adequate food, water, and accommodations [18, 19]. Hugelius et al. noted that providing psychological support was one of the main elements in nursing services in the face of disasters [20]. Also, Salmani et al. In their study noted that volunteers' potential problems and their physical and mental status would meet during and after disasters. [21]. The participant mentioned ineffective call and distribution of relief forces in the regions hit by the earthquake, lack of uniform, and their concerns about the safety of their families. Studies on the Sichuan earthquake in China and the Bam earthquake have highlighted poor human resource organization as well [17, 18]. Although health and treatment personnel were present in the region, they were not known to officials and clients in the early days. In the Bam and Azerbaijan earthquakes, some of the volunteers did not have uniforms and ID cards [16, 18]. Providing dress to distinguish the health providers and the ranking is fundamental to handle the disaster.
Despite the valuable role of nurses in the earthquake region, they and their families received no mental, financial, and emotional support. Similar problems have reported in other studies [9, 16, 22]. Nursing Organizations can take steps in this regard by providing protection and support for nurses and their families during disasters as incentives for nurses. Such services solve the concerns in nurses and improve their capability to provide health services.
Another main category was infrastructural challenges. The participants had experienced several challenges in this field. Ardalan et al. reported that due to communicational problems and the demolition of three health centers and 89 local clinics failed to play a more practical role during the first phase of reaction to the Azerbaijan earthquake [23]. Infrastructure disruption after disasters has mentioned in several studies as a serious challenge [24, 25].
Another extracted challenge was about the education system. Many of the participants acknowledged the lack of skills and knowledge for providing health care in disaster and the absence of a comprehensive education program in this regard. A systematic review in 2017 showed that nurses were not ready to work during a crisis; most of the reviewed studies were from Asian countries [26]. Like many other countries, crisis nursing education would not develop in Iran, so nurses do not have the knowledge and skill to work in disasters due to lack of education [12]. Empowerment of nurses and the improvement of their awareness can be a significant step to provide timely and proper services to victims during disasters. Theoretical and practical educations should be a part of the nursing program to improve the performance of nurses during emergencies.
Another category based on the experiences of nurses was moral challenges. Some of the participants mentioned situations full of ethical issues and that they had no education in this regard and morality in providing care to the victims while nurses being at risk, were discussed. These findings are consistent with other studies on nurses who helped earthquake victims and faced with moral challenges [9, 11, 27]. Studies have shown that a lack of resources and hard situations create moral challenges like whether or not washing equipment with drinking water is the right thing to do. Similarly, nurses in our study also reported such practices as using one forceps for multiple injuries [8, 28]. Moral preparedness of nurses who are the front line of providing care services during disaster neglected and they suffer the consequences of different professional and moral challenges afterward [9].