“You Came to Not Normal Land”: Nurses' Experience of the Environment of Disaster: A Phenomenological Investigation

Previous research suggests US nurses are unprepared for disaster, and suffer from adverse psychosocial outcomes following their disaster response. Current disaster preparedness focuses on providing hospital-centric trauma and acute care in fully resourced Western conditions, and does not include the environmental realities of the disaster setting. This study utilized an existential phenomenological approach to explore the meaning of the nurse’s experience of the disaster environment. Eleven nurses with broad disaster expertise and training levels participated in this research. The essence of their disaster experiences can be summed up by the central theme of “You came to not normal land.” Four global themes that describe this “not normal land” were “All the resources was gone”; “You prepare, you prepare, and you are unprepared”; “It can be done; it’s just different”; and “Stuff that sticks with you.”

The environment of disaster was both “not normal” and challenging owing to the many simultaneous breakdowns in healthcare supportive systems. Nurses were surprised and unprepared for the environmental conditions surrounding them. Reductions in systems (i.e. water, power), structures, staff, and supplies were coupled with lack of familiarity with alternative care sites, unaccustomed patient populations, the prevailing need for public health and fundamental nursing, and the isolated nature of disaster environments. Policies and regulations that “normally” guide nurses’ actions were disregarded in the immediacy of providing care when the usual social framework no longer existed. Nurses continue to relive the disaster setting’s sights, sounds, smells, and stories of the people they encountered. A strong sense of pride, duty, and willingness to respond again prevailed in these nurses.

Nurses can be prepared for the likely conditions of reduced resources and damaged infrastructure following disaster by including the contextual setting of disaster nursing in disaster education, practice, training, and policy. Suggestions for further research include determining the relevance of current disaster training to the nurses’ actual disaster experience; determining what non-clinical knowledge or skills or training disaster nurses think would be useful; and identifying and measuring the contribution of environmental factors to disaster nurses’ stress.