1. Nurses’ Beliefs about a Bioterrorism Event: Fear of Abandonment Carol O’Boyle PhD, RN Cheryl Robertson, PhD, RN Molly Secor-Turner BS, RN School of Nursing, University of Minnesota

2. Background  In a large-scale public health emergency (PHE), there will be multiple patient admissions to healthcare facilities  Nurses may be exposed to infectious agents  A PHE may produce fear, anxiety, stress, and confusion in the hospital setting

3. Purpose  Identify beliefs and attitudes of nurses regarding PHE

4. The Research Question  What are the beliefs, concerns, and feelings of nurses expected to work in clinical settings during a PHE?

5. Methods  Qualitative descriptive approach with 9 focus group meetings  Sessions were audiotaped, then data was analyzed  Categories and themes were identified

6. Sample  Purposive sample  33 registered nurses working in critical care, emergency, and medical/surgical units in hospitals  3 metropolitan hospitals designated as bioterrorism-receiving sites in 2003.

7. Procedure  Researcher moderated discussions using a core set of questions  Discussions were audiotaped

8.  Questions: –What is the likelihood that you will be asked or expected to work during a bioterrorism (BT) event? –What do you think working during a BT event will be like? –What do you think of the preparations that have been made by the hospital for a BT event? –If you had to make a list of your concerns about working during a BT event, what would be the top 3 concerns? Procedure

9. Procedures  Questions: –In your opinion what equipment or procedures planned to be used during a BT event will be effective or helpful? –In your opinion, what equipment or procedures planned to be used during a BT will be a problem? –If you could make changes to the BT procedures, what would you recommend or suggest?

10. Themes 1.Expectation of chaos in an environment without adequate information and resources 2.Loss of safe clinical environment for nurses and patients 3.Loss of freedom 4.Limited institutional commitment

11. Chaos Themes Fear of Abandonment Unsafe Environment Loss of Freedom Limited Institutional Commitment

12. Chaos  Disorganized, overwhelming situation  Lack of leadership, direction  Unclear chain of command, who will direct?  Lack of clarity re: role, responsibilities  Unprepared organization, how to cope, function  Lack of knowledge, lack of accessible information

14. Unsafe Environment  Self-protection – personal risk of disease  Insufficient amount of personal protective equipment( PPE) for nurses  PPE taken, stolen by others  Inadequate supplies for patients (e.g. rooms, ventilators)  Danger: risk of transmission to loved ones

16. Loss of Freedom  Unable to leave hospital, no relief, expected to work  Inadequate staff (no shows, staff leaving)  Contract with patient, contract with hospital?

17. Limited Institutional Commitment  Hospital’s obligation to nurse?  Will hospital honor contract with nurses, provide care and support them if injured or diseased?  Who will be in the clinical environment with them?

19. Limitations of the Study  Small number of participants from one metropolitan area  Additional studies needed to validate findings with larger sample of nurses from various geographic areas

20. Summary  Belief that the work environment could not withstand the stress of such an enormous event  Belief that they would be on their own in the situation without institutional support  Belief that social norms restraining aggressive behavior may be diminished

21. Summary  Few organizations have assessed caregivers’ needs and fears about working during a PHE  Need for psychological resources to facilitate coping in high stress situations