One of the factors that made evacuation shelter activities difficult was the stress of working in an evacuation shelter while being a disaster victim. Nurses that experienced the earthquake, tsunami, and fear of radiation exposure in the same area were also city employees directly involved with the affected residents. The initial confusion surrounding the earthquake may have triggered conflicting feelings about the staff’s double role as relief workers and victims of the earthquake. In this context, the words of blame from the residents may have caused emotional distress among the nurses.
Previous studies have reported on the experience of first responders feeling hurt by the words of residents affected by the Great East Japan Earthquake.7,12−14 The condemnation of public officials by residents is among the characteristics of the Fukushima NPP accident. Residents may blame first responders, including nurses, seeing them as representatives of the government that may have been negligent in disaster prevention. Much has been reported about the need for aid worker support during disasters.10,15−18 Disaster response should include physical and mental health support for the victims as well as for first responders.
During evacuation shelter activities, the nurses have reported difficulties associated with performing “health activities” rather than “clinical activities”; these challenges were associated with the lack of experience in health activities. In disaster response, hospital nurses provide emergency treatment and medical care, while community nurses provide disease prevention interventions. A mismatch between expectations and competencies, and the requirements of a situation may create a sense of helplessness.19 Clinical nurses may benefit from the experience of community practice in preparation for disaster response; these opportunities may be provided by medical facilities that offer follow-up visits to discharged patients and home nursing services. This approach may help expand nurse competencies and reduce the stress associated with emergency response.
In this study, a factor that helped nurses fulfill their disaster response tasks was their willingness to do this work. Nurses tend to have high emotional intelligence and empathy, which they demonstrate in their job.20 In evacuation centers, listening to the residents is part of mental healthcare that is required; providing this type of support to disaster victims can provide nurses with job satisfaction, which increases the levels of positive self-evaluation.21 Confidence in one’s own role and competencies may help nurses continue their activities at evacuation centers.
Community and clinical nurses practice in different contexts and their relationships to target populations are different although both groups have nursing responsibilities toward local residents. Clinical nurses may care for residents in home and care home settings. Clinical and community nurses should collaborate to better understand each other’s roles, which may help support disaster response where both groups are involved.22
The nurses reported that support from residents and fellow staff helped their work. Encouragement from residents, expressed as warm words, helped the nurses feel accepted by the residents. Previous studies have shown that public appreciation of first responders helps them fulfill their duties, leading to recovery.23,24 The present findings are consistent with those of previous studies.
Trauma-informed care helps trauma victims.25,26 The present study participants were able to accurately recognize traumatic events, including resident hostility, and discuss among each other the thoughts and feelings these events triggered, accounting for their mood fluctuations. This approach may have helped the nurses persevere and attend to their responsibilities. Disaster relief workers experience stress and trauma, and should be equipped with coping strategies that may be used in disaster response.
The nurses reported gaining professional insight and growth in disaster preparedness. Disaster response places a high burden on first responders that operate under the conditions of stress and chaos, which may also give them a sense of mission. First responders provide emotional support to disaster victims, which may cause stress; these circumstances create challenges that may be an opportunity for growth. Previous studies have shown that post-traumatic growth may help first responders positively view their experience of providing disaster relief.9,27,28 The present findings are consistent with those of previous studies. The nurses who overcame the hardship of the Great East Japan Earthquake grew as professionals, which may help them maintain staff motivation and morale in response to future disasters.
This study has some limitations, which should be considered when interpreting its findings. First, the interviews were conducted 9 years after the disaster, and some of the subjects failed to remember the disaster at the time of the interviews; therefore, the present findings may be subject to recall bias. In addition, this study did not include all employees of the Minamisoma Municipal General Hospital that were engaged in disaster response. In particular, nurses that retired during or after participating in the evacuation shelter support activities were not included, potentially reducing the generalizability of the present findings.