It’s 2:30 a.m. on a Sunday when the phone rings. “There have been two fatalities in Butts County,” says the disaster action team leader on the other end of the line. “We need a nurse to go to the site, and I understand you are on call.” Now wide awake, the nurse puts on a Red Cross Uniform and rushes to meet the other disaster team members, and the group continues to the disaster site. The nurse’s night of caring for the community suddenly begins.
In a hospital or other Nurses deal with disaster victims in a structured environment, but when disaster strikes a community, the rules, care, and strategy change. The nurse is no longer the staunch professional seemingly untouched by the mars of pain, death, and anguish from people with a last name and other identifying information. She is now among neighbors, acquaintances, friends, and sometimes family.
Nurses are called upon daily to apply skills, concepts, and theory to various situations. The core essence of the nursing profession mandates that they assist with basic physical, emotional, and spiritual human needs. Throughout their career they develop helping, trusting, and caring relationships with patients and families. Nurses are expected to create a healing environment for the physical and spiritual self, which respects human dignity. Nurses are empathetic to a family member who has suffered the loss of a loved one, and as they routinely perform their jobs, they work to instill faith, hope, and honor in others. During other times, they must step into the shoes of the other person in an authentic manner. Not only must they promote and accept both positive and negative feelings as they genuinely listen to another’s story, but they are called upon to use creative scientific problem-solving methods for caring decision making. They are required by their code of ethics to share teaching and learning that addresses the individual needs and comprehension styles. The tasks they perform will eventually open avenues of promise and change. The nurse has just used all 10 of Watson’s Caritas Processes.1
Following a disaster, the nurse on call and the Red Cross team enters the neighborhood, where it is apparent that a storm or possibly a tornado has hit. The streetlights are out, and trees and debris cover the area. The somber stillness is a quiet reminder of the destruction and tragedy that lay ahead. Some streets are blocked off for safety; power lines are down and the area is pitch black. As the emergency vehicle reaches the neighborhood, the nurse notices that the police and fire department are on the scene with makeshift emergency lighting. It is easy to identify which house has the fatalities because a huge oak tree has crushed one corner, leaving it unstable and uninhabitable.
As the team exits the vehicle, the fire department captain meets the team to inform them that the coroner has just removed the bodies of a 23-year-old male and his three-year-old son from the house. He points to the house where the surviving family, still in shock, anxiously waits for assistance. A lump enters the nurse’s throat, which she normally does not feel because she deals with death and dying regularly. The nurse is exhibiting one of the five components of Swanson’s Compassionate Care Program. She is in the knowing stage, which is “striving to understand an event as it has meaning to the life of another.”2 Although unaware at the time, most nurses demonstrate all five phases of the Compassionate Care model—knowing, being with, doing for, enabling, and maintaining belief—when assisting families who are dealing with a loss. While in the knowing stage, the nurse must carefully avoid assumptions and focus mainly on the one being cared for. Additionally, this is a period that the nurse must assess the situation and all options thoroughly. The nurse must use excellent communication skills to seek cues from the person being cared for.
The nurse and team of volunteers wade through a puddle of water and enter a damp, dimly lit house situated next to the destroyed house. Trying to focus in the hazily lit room, a young female suddenly appears and runs towards the nurse with tears streaming down her face. Aside from the immediate post-disaster needs of shelter and emotional support, the nurse knows the young lady will need help dealing with the aftermath of the disaster, especially the grieving and mourning process as she makes funeral arrangements for her only child and husband. The nurse must be emotionally present for the young lady, which is the second phase of the Compassionate Care Program—being with. It is during this time the nurse is emotionally available for the person suffering the loss. The nurse conveys reliability and can be free to share feelings without burdening the victim that has suffered the loss.3
The real-life scenario is an example of the need to employ Jean Watson’s 10 Caritas Processes to assist patients through mourning and grief after a significant loss has occurred. Though you can prepare for emergencies in general, crises and disasters are, of course, by their nature unexpected and unpredictable. When a family has experienced the loss of a home and personal items, whether by a fire, flood, tornado, or other natural disaster, they mourn the loss of the objects as well. Nurses must know how to assist families through the initial and subsequent stages of grief to a stage of acceptance where they can begin to move on to health and wellness. The support, acceptance, and gentle guidance that health care professionals give are very important to beginning the journey of caring after a tragedy. A caregiver’s knowledge and suggestions while allowing the affected family members to make their own decisions can help tremendously during difficult times.
As the nurse allows the young, distraught wife to embrace her and sob on her shoulder, she has just put into action the first of Watson’s 10 Caritas Processes—Embrace altruistic values and practice loving kindness with self and others.1 Afterwards, the journey of caring for the community proceeds using Watson’s theory and the five components of compassionate caring that Swanson describes.2 Dr. Watson’s nursing theory has been adopted by several magnet hospitals, including the Atlanta VA Medical Center, because it exemplifies the essence of the nursing profession and is the epitome of the VA mission, “to care for him who shall have borne the battle, and for his widow, and his orphan.”4
Last year, 2011, produced an unusually large number of natural disasters. Almost every state suffered some sort of catastrophe. According to an article by MSNBC, “the United States has experienced 98 natural disaster events, which left $27 billion in economic losses, more than double the 10-year average of $11.8 billion.”5 FEMA declared 84 disasters in the United States from January through September 2011.6 The disasters touched every profession, every socioeconomic status, and every culture. Nurses who normally treat patients in a sterile protected environment found themselves caring for people in shelters or at the disaster site.
The events began with the winter snow and ice storms that plagued states that usually do not see any cold weather. Interstates became impassible for days and neighborhoods were without heat and lights for weeks. During early spring, the snow melted and again disaster struck as flooding inundated once quiet, serene neighborhoods. The floods wiped out bridges, sweeping away homes and entire communities. Just when citizens began to breathe a sigh of relief, the spring brought destructive tornadoes and windstorms, taking lives and destroying the fragments that the floods had left behind. Coupled with the coastal arrival of the residual from tsunamis in other countries, everyone wondered what could happen next. Then an earthquake shook the eastern United States, so intense it cracked the foundation of the Washington Monument on the National Mall.
Nurses have always been a cornerstone for the provision of services by the American Red Cross. More than 20,000 nurses continue to be involved in paid and volunteer capacities at all levels and in all service areas.7
The Red Cross team at the disaster site in this scenario interviews the young lady to ascertain her immediate needs. They learn the family has no insurance—nothing to cover the destroyed house or even funeral expenses for the deceased husband and child. Not only does this situation require the nurse to assist with physical, emotional, and spiritual human needs such as temporary shelter, food, and clothing, but she must also step briefly into the shoes of the other person in an authentic and empathetic manner as she learns what happened.
The young widow tearfully tells the story of what happened. She describes the thunder and lightning as the storm ravaged the neighborhood. The father decided to check on the son in the next room who had been awakened by the thunder. Just as he lifted the two year old to comfort him, the oak tree crashed through the roof, crushing them both. The young widow begins to cry again and the nurse hugs her to her shoulder, allowing her to sob and holding back her own tears as the rest of the Red Cross team sits quietly.
The nurse realizes that the process of recovery will be long and difficult for the survivor, but with her training, dedication, and sensitivity, she assists the widow with the immediate needs. The nurse provides Red Cross funds for temporary housing, meals for several days, and partial payment of both funerals. The nurse has many conversations with the young lady as she assists with the early stages of grief and mourning.
Nursing theories, compassionate care programs, and caring processes can be put to use when a disaster strikes the community. Disasters happen all too often and the nurses must be prepared to assist the client on the caring journey to the road of recovery and healing. Nursing does not stop when the shift ends, it continues as long as needed as the nurse seeks to specifically maintain the last portion of the Nightingale pledge...“with loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.8