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 DOI: 10.1177/1059840509358412

2010 26: 203 originally published online 11 January 2010The Journal of School NursingLisa Broussard and Rachel Myers

School Nurse Resilience: Experiences After Multiple Natural Disasters  

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Research Article

School Nurse Resilience: Experiences AfterMultiple Natural Disasters

Lisa Broussard, RN, DNS, CNE, and Rachel Myers, RN, MSN

This qualitative descriptive study explored the experiences of school nurses in coastal Louisiana, who were affected byHurricanes Gustav and Ike in 2008 and who had also been in the path of destruction caused by Hurricanes Katrinaand Rita in 2005. The purpose of the study was to describe the experiences of school nurses affected by repeatednatural disasters in relation to their professional practice. The researchers conducted interviews with five school nurses,using the constant comparative method of data analysis to analyze transcripts for recurrent themes. Findings revealeda common process of developing resilience among participants. As a result of their experiences, participants describedthe ability to recover and adapt in the face of adversity. Various factors affected this resilience, including preparedness,support from others, both personally and professionally, and commitment to the communities in which they live.

Keywords: resilience; disaster management; school nurse characteristics; qualitative research; natural disasters

INTRODUCTION

Previous research on Louisiana school nurses’experiences after Hurricanes Katrina and Rita in2005 revealed they experienced both personal andprofessional effects (Broussard, Myers, & Meaux,2008). From a practice standpoint, school nursesin the 2005 study reported challenges thatincluded increased workload, stress of dealingwith displaced children and families while facingtheir own personal losses, and providing care tochildren with no available medical records. Parti-cipants reported feelings of uncertainty, helpless-ness, and hopelessness. Three years after thesestorms, residents of south Louisiana were in vari-ous stages of recovery from the 2005 hurricanes.Some families were permanently displaced andwere rebuilding their lives as members of newcommunities. Many children in the affected areashad moved back into permanent school structuresonly within the past year, and some were still intemporary transitional school buildings as a

result of the storms of 2005. In September 2008,Hurricanes Gustav and Ike ravaged the GulfCoast within 2 weeks of each other. Winds fromHurricane Gustav as well as winds and massiveflooding from Hurricane Ike presented manyschools with the same devastation, and in somecases worse than had been experienced in 2005.

After Hurricanes Katrina and Rita, policieswere put into place in school systems specific to

Lisa Broussard, RN, DNS, CNE, is a principal investigator andassistant professor at the University of Louisiana at Lafayette,College of Nursing and Allied Health Professions.

Rachel Myers, RN, MSN, is an instructor at the University ofLouisiana at Lafayette, College of Nursing and Allied HealthProfessions.

Authors’ Note: This study was funded by a grant from Sigma ThetaTau, Delta Eta Chapter.

JOSN, Vol. 26 No. 3, June 2010 203-211DOI: 10.1177/1059840509358412# 2010 The Author(s)

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disaster preparedness. School nurses had neverbefore dealt with issues of this magnitude, includ-ing the rapid influx of children from other districtswith little or no health information, caring forchildren in transition with no access to health care,and working in physical environments that werenot conducive to health. After 2005, protocols fordealing with day-to-day professional school nursingpractice in the wake of hurricanes were developedand in 2008 were implemented as Gustav and Ikeagain hit Coastal Louisiana. To date, the experi-ences of the school nurses who have experienceddevastating hurricanes within such a short periodof each other have not yet been described. The pur-pose of this study was to make explicit the sharedmeanings of the experiences of Louisiana schoolnurses in coastal parishes, who had been affectedby both sets of hurricanes in relation to theirprofessional practice.

‘‘School nurses had never before dealt with issues ofthis magnitude, including the rapid influx of childrenfrom other districts with little or no health information,

caring for children in transition with no access tohealth care, and working in physical environments

that were not conducive to health.’’

REVIEW OF LITERATURE

In examining the effects of the hurricanes onschool nursing practice, the researchers used theconcept of resilience as a framework in describingstudy findings. Psychological resilience describesthe capacity to move on in a positive way fromnegative, traumatic, or stressful experiences(Tugade & Fredrickson, 2004). Psychologists havetaken the lead in exploring the concept of resili-ence and have focused most attention to this con-struct in relation to children and families(Coleman & Ganong, 2002; Luthar, Cicchetti,& Becker, 2000; Silerberg, 2001). Further studieshave examined the concept of resilience in rela-tion to potential trauma and disasters such asfloods, hurricanes, and the September 11, 2001,terrorist attacks (Maggio, 2006; Mancini &Bonanno, 2006; Walsh, 2002a).

Over the past 10 years, the concept of resiliencehas been increasingly described in the nursing lit-erature. Nurses have examined the concept ofresilience extensively in a variety of diverse areasincluding adolescent resilience (Ahern, 2006;Hunter & Chandler, 1999), in vulnerable popula-tions such as in battered women (Humphreys,2003), and as related to persons recovering frompsychiatric disabilities (Ridgway, 2001). Entirecommunities have been described as displayingcharacteristics of resilience (Kuling, 2000). Strate-gies for developing professional resilience in nur-sing students (Hodges, Keeley, & Grier, 2005),nurse managers (Judkins, Arris, & Keener,2005), operating room nurses (Giordano, 1997),and acute care nurses (Hodges, Keeley, & Troyan,2008) have also been explored.

Polk (1997) developed a middle range nursingtheory of resilience. Polk described resilience as‘‘the ability to transform disaster into a growthexperience and move forward’’ (1997, p. 5). In aconcept analysis of resilience, Gillespie, Cha-boyer, and Wallis (2007) identified the followingdefining attributes of the concept: self-efficacy,hope, and coping. The main consequences of resi-lience, which emerged were personal control, psy-chological adjustment, and personal growth.Findings from the analysis indicate that resilienceis not a fixed trait; rather, it is dynamic and may bedeveloped over time. Individuals who demon-strate persistence in the presence of adversity maybecome inured to such stressors and are more resi-lient. Increased exposure to stressful situationsmay well assist individuals to develop effectivecoping strategies and, as a consequence, adapt.McGee (2006) suggests that ‘‘resilience is notmerely the attitude of seeing the proverbial glassas ‘half-full,’ rather it is a dynamic life processwhereby the capacity for adaptation can mean thedifference between a full and happy life versus alife of despair and dysfunction’’ (p. 46).

Nurses bear witness to tragedy, suffering, andhuman distress as part of their daily lives and,because of the stressors associated with assistingothers to overcome adversity, resilience is identi-fied as essential for nurses in their everyday work(Tusaie & Dyer, 2004). Hodges et al. (2005) con-sider resilient nurses an essential element in anever-changing health care system. They challengenurse educators ‘‘to better prepare nurses for sus-tained professional resilience’’ (p. 548).

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Tugade and Fredrickson (2004) suggest thatthe ability to find positive meaning in adversesituations and to regulate negative emotionscontributes to the development of personal resili-ence. A literature review of personal resilience as astrategy for responding to workplace adversityrevealed that self-development strategies canbuild personal resilience in nurses (Jackson,Firtko, & Edenborough, 2007). Such strategiesinclude building positive and nurturing profes-sional relationships, maintaining positivity, devel-oping emotional insight, achieving life balanceand spirituality, and becoming more reflective.

Resilience offers a valuable framework forworking with diverse individuals and challengingsituations. However, few nursing researchers haveexamined the personal and professional resilienceof school nurses. Specifically, no literature isavailable on the concept of resilience of schoolnurses after natural disasters or repeated naturaldisasters. How resilience contributes to schoolnurses’ continued practice in hurricane-proneareas and their ability to experience personal andprofessional growth despite these environmentalstressors warrants investigation.

METHOD

A descriptive qualitative study was conductedto allow for rich descriptions of school nurses’hurricane-related experiences. This study pro-vided an understanding of school nurses’ experi-ences when dealing with the impact that therepeated natural disasters had on their school nur-sing practice. For this study, the researchers usedinterpretive hermeneutic phenomenology, whichis meant to attend to the meaning of everydayexperiences in participants’ own words. The goalof investigation was to discover common experi-ences and underlying situational meaning amongparticipants. The researchers articulated theseexperiences and their meanings clearly as patternsemerged. Hermeneutic inquiry describes an ana-lytical process wherein all data are comparedthroughout the data collection process to guidesubsequent processes until a clear understandingof the phenomenon occurs (Plager, 1994). Thisresearch methodology allowed for an explicitunderstanding of the meanings underlying partici-pants’ experiences of developing resilience after

these two sets of natural disasters. Approval forthe study was obtained from the InstitutionalReview Board of the University of Louisiana atLafayette.

Participants

Researchers initially identified those parishes insouth Louisiana, which had experienced theeffects of Hurricanes Katrina and/or Rita in2005, as well as Gustav and/or Ike in 2008. Con-tact information was provided by the LouisianaSchool Nurse Organization and members fromaffected parishes were contacted via e-mail andinvited to participate. Those interested wereinstructed to contact the principal investigator,and informed consent was then obtained.Arrangements were made for the conduct of per-sonal interviews at a time and location determinedby the participants.

Data Collection Method

Research data were collected by personal inter-views. Broad, open-ended questions were used toinitiate the discussion of the experiences of theschool nurses. Questions the researchers usedincluded (a) Tell us about your experiences afterthe hurricane(s) of 2005, and then after those in2008, (b) How were your experiences after the sec-ond set of hurricanes similar to or different fromthe first two? (c) How was your practice as a schoolnurse impacted by the hurricanes? (d) What areyour feelings in relation to the possibility of futurenatural disasters, and how they will impact yourschool nursing practice? Follow-up questions wereused when more information or clarity was needed.Interviews lasted approximately 1 hr and wereaudiotaped and professionally transcribed. Basedon preliminary findings, theoretical sampling wasconducted to provide further explication of themes.The principal investigator conducted all interviewsand the second researcher participated in three ofthe five interviews.

The constant comparative data analysis methodwas used, with data analyzed after each interview.This allowed for refinement of interview questionsto ensure deep exploration of emerging themes(Crist & Tanner, 2003). For example, the questionregarding the impact of the hurricanes on their

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professional practice was adjusted to reflectwhether any of their assigned schools had beenforced to close after any of the hurricanes. Reloca-tion to temporary structures had a major impacton their practice, and not all of the participantshad experienced this situation.

The researchers analyzed each transcript indivi-dually as well as together to gain an accurate pic-ture of the school nurses’ experiences after eachset of hurricanes. Data analysis resulted in theidentification of an overall process of developingresilience, as well as the explication of threephases that comprised the process. Credibility offindings was ensured through review of themesand subthemes with participants for accuracy, aswell as with knowledge of the existing literaturerelated to the concept of professional resilience(Lincoln & Guba, 1985).

FINDINGS

Resilience refers to the ability to recover quicklyor adjust to adversity (Hodges et al., 2008). One’scapacity for resilience allows for adaptation,balance, persistence, and growth in the face ofhardship. However, suffering and perseverance

are required in the struggle to work throughdifficulties as they emerge and to integrate experi-ences of crisis into one’s well-being (Wolin &Wolin, 1994). As interviews were conducted, itbecame apparent to the researchers that resiliencewas a key process in these school nurses after thehurricanes. Investigators uncovered three majorthemes, with accompanying subthemes, occurringin a sequential pattern (see Figure 1). The threemajor themes were (a) anticipating the disaster,(b) returning after the storm, and (c) making thedecision to stay.

Anticipating the Disaster

Hurricanes are the only major natural disasterthat can be predicted. Residents of the Gulf Coastare accustomed to paying particular attention toweather coverage from the beginning of June untilmid-October each year for the development oftropical storms, which often increase in intensityto hurricane-force winds. Hurricanes have alwaysbeen a reality for those living along the Gulf coast.Prior to 2005, only older people who had livedthrough Hurricanes Audrey (1957), Betsy(1965), and Camille (1969) had experienced the

Developing Resilience

Phase 2:Returning After the

Storm

Assessing the Damage:

Schools, Homes

Seeking and Providing Support

Phase 3:Making

Decision to Stay

Lessons Learned

Transgenerational, Cultural and Economic Ties

Phase 1:Anticipatingthe Disaster

DisasterPreparedness

Evacuation:School Children, Families, Elderly

Parents, Pets

Figure 1. Developing resilience.

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massive destruction associated with a Category5 hurricane. When Katrina and Rita devastatedcoastal Louisiana in 2005, perceptions of thestrength and force of hurricane winds and floodingchanged for all. Preparation for hurricanes hadalways been carried out, but having personallyexperienced or witnessed the devastation thatcould occur caused disaster preparedness to takeon a new meaning.

Participants in the study verbalized that due tothe first set of hurricanes, and the increasedawareness of the need for formal disaster plans,preparing for the hurricanes of 2008 was muchmore efficient. Important lessons were learnedafter 2005, including the need for improved secur-ing of student health records and equipment usedfor mass screenings and specialized nursing inter-ventions. Much more emphasis was placed oncomputerized documentation after 2005, becausecaring for displaced children with no healthrecords was a major obstacle for school nurses inparishes that received evacuees. Online, state-wide immunization records, student healthrecords, and individualized health plans (IHPs)are now easily accessible via computer in mostschool districts. According to one participant:

I think that we were better prepared and shut down theschools, making sure we had our records together, youknow. It helped so much having everybody on the stateimmunization system, because we were able to drawoff of that and get their immunizations up-to-date.The thing that worried me most after Rita was the teta-nus. A lot of our children were stepping on nails whilethey were cleaning up after the hurricane, and we hadno idea if they were up-to-date on their shots. Now wecan just pull them up and give them a booster if theyneed one.

Evacuation of communities was a major con-cern. For participants, assisting families of theirstudents was an issue, as well as evacuating theirown families, which often included elderly parentsand pets. After the hurricanes of 2005, the schoolnurses felt that improvements had been made interms of availability of shelters for those withoutresources, as well as a better system of communi-cation for those in shelters. One participant wasfrom Cameron Parish, an area in which entirecommunities had been wiped out by Rita and thenagain by Ike. These towns lie directly on the coast,

with students able to see the Gulf of Mexico fromthe front of their school building. Complete, man-datory evacuations occur with each hurricane, andaccording to the school nurse, most have familiesin areas of higher elevation or arrangements withchurch groups for accommodations duringstorms. For the families of special needs childrenin rural Terrebone Parish, arrangements weremade for provision of services in areas not affectedby the storms. Due to the repeated hurricanesexperienced by residents of south Louisiana, thespecial education school nurse in the study statedthat most of these families were prepared ahead oftime and able to cope with their child’s specialneeds during the storm.

Returning After the Storm

The duration of the evacuation depended onthe severity of damage to the community. Onenurse voiced concern over the fact that they werenot allowed to return to their communities forsome time after the storm, which causes anxietyover being able to return and commence withclean up of their homes. Assessing the damageto homes and schools was done quite quickly. Oneof the participants spoke passionately aboutschools that had never been rebuilt after Hurri-cane Rita. These were small, community schoolsthat had limited enrollment prior to the storm.Due to the financial implications of rebuildingthese schools after they had been destroyed by theflooding caused by Hurricane Rita, the decisionwas made not to rebuild them. The school nursestated:

I guess they kept the school open before the stormbecause it was such a part of the community. It hadalways been there, and they loved their school. Afterthe storm, some people left that community and therejust weren’t enough there to rebuild the school. It’s atouchy subject for a lot of those people still living there.But it just wasn’t economically feasible for the parish.But it’s sad. My husband is from there, went to schoolthere. It was a good school. It’s sad . . . .

All of the participants talked about being able toreturn to their schools and communities with sup-port from others. Support came from manysources, including nongovernmental organizations

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such as Habitat for Humanity, National Alliance onMental Illness, church groups, and employee assis-tance programs. All school nurses identified theschool community, including other school nurses,staff, school counselors, and administration, as majorsources of support. According to one participant:

Our national school nurse organization, NASN,helped us out a lot, too. They gave us money to getsupplies and stuff. Also, many departments, youknow, our counselors, principals, assistant principals,curriculum instructors, they were all there to help. Oursuperintendent said all we needed to do was ask. Ourcommunity really came together, too. Our NAMIgroup here in our city was there for us and for ourchildren with mental health problems. We were ableto refer the parents of the children that needed mentalhealth services too. And we had lots of other non-profitorganizations that helped us, our school kids, andtheir families.

For some participants, providing support tofamilies in need while dealing with personal issuesof their own, including stresses of experiencedpersonal loss due to the storm, was a challenge.According to the participants, this was a majorissue after the hurricanes of 2005; in 2008, theyfelt that they were better prepared to deal withpersonal issues while helping school children andtheir families in need at the same time.

Making the Decision to Stay

All five of the participants still live in the samecommunities as they did prior to 2005, workingin schools with children who also live in thesehurricane-prone areas. Interviews with theseschool nurses revealed an overwhelming sense ofcommitment to their communities, with a senseof preparation for future storms. After Katrinaand Rita in 2005, many school nurses were unsurewhether they could cope with the effects ofanother hurricane (Broussard et al., 2008). Inter-estingly, these participants felt very strongly thatafter surviving both the storms of 2005 and thoseof 2008, they had learned many important lessonsand although they prayed that they would bespared further devastating storms, felt like theywould be able to adapt regardless of what thefuture brought. According to one participant:

Oh yes, for us, Katrina was a big learning experience.And even though none of us thought it would happenagain so soon, we felt like we were ready, and we prettymuch were, as much as you can be. With notifyingpeople and getting prepared and stuff, I think thatwe did the best that we could. And we will be readyif it happens again. We learned that we can handleit. You just do what you gotta do.

There also was a sense among three of the par-ticipants that help from government agencies,especially Federal Emergency ManagementAgency (FEMA), was not to be relied on. Thestrong sense of community instilled a sense ofpride and commitment to the rebuilding of theschools, homes, churches, and other buildings inthe community. One nurse stated:

I just think that as a community we need to make surethat we take care of ourselves, because we can’t bedependent on the outside. So we need to be preparedas a community to take care of ourselves. And we are.We saw this especially after Ike.

The participants discussed reasons that resi-dents of Louisiana continue to live along the Gulfcoast, a question asked often by people from otherareas of the state and the United States. Theschool nurses, as members of these communities,referred to emotional, familial, and economic tiesto this region. In some cases, generations of fam-ilies have lived in these communities, and theywould never call anywhere else home. One nurseconveyed her personal situation:

It’s a matter of do we want to live here? It’s a lot ofsoul-searching, and a hard decision to make. We aresinking a lot of money into a house that hopefully willbe able to stand the next storm. But we live on theproperty that we love, and it’s home. I think my chil-dren will go away to college, but I’m sure that they willcome back here to live. It’s their home too. My hus-band’s parents were here during Hurricane Audreyand lost a lot of their friends, and some of their rela-tives. But they stayed, and so will we.

Each of the participants referred to a sense ofdoing what needed to be done. They referred todealing with the situation brought on by the hurri-canes in a matter-of-fact manner. Statements such

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as ‘‘You are going to deal with what you have todeal with,’’ ‘‘We learned our lessons from Katrina,and we just keep going,’’ and ‘‘We prepare ourschools and our homes, and do the best that wecan’’ portray a sense of adaptation to the stressesand impacts of hurricanes and how they resolvethemselves to deal with these natural disastersrepeatedly. One nurse spoke to the need to be ableto put aside one’s own needs and focus on othersduring and after the storm:

When you are going through it, you don’t have time tostop and feel sorry for yourself and say, oh my God,how am I going to get through this. You just do it. Youtake one moment at a time and do what you can atthat moment.

The development of this sense of resilience as aresult of dealing with these two sets of devastatinghurricanes and experiencing personal and profes-sional effects was apparent in the interviews of allof these school nurses. None voiced any desire torelocate or change jobs as a result of the hurri-canes. The predictability of the storms, the disas-ter plans in place in the event of the storms, thesupport that they receive during and after thestorms, and their commitment to their commu-nities and their schools foster this resilience andenable them to remain a vital part of the lives oftheir children in the school setting.

‘‘The predictability of the storms, the disaster plans inplace in the event of the storms, the support that theyreceive during and after the storms, and their com-

mitment to their communities and their schools fosterthis resilience and enable them to remain a vital part

of the lives of their children in the school setting.’’

DISCUSSION

According to Walsh (2002), resilience theoryrefers to a dynamic process experienced by indi-viduals whereby they face challenges and developcoping mechanisms that allow them to overcomethese challenges. Findings from this study indi-cate that the school nurses developed skills afterthe hurricanes of 2005 that allowed them to cope

with the second set of hurricanes in 2008.Resources from their families, communities, andcolleagues contributed to their ability to overcomeobstacles, a characteristic supported by Echter-ling, Presbury, and McKee (2005).

The literature refers to the role of protective fac-tors in fostering a sense of resilience after trau-matic events (Spaccarelli & Kim, 1995;Tummala-Narra, 2007). These include a sense ofcultural identity, as well as family support. Beinga part of the Cajun culture of south Louisiana,with strong family ties and community connec-tions, was one of the factors that contributed tothe participants’ sense of resilience. The majorityof those residing in the coastal parishes of Louisi-ana was born there and has generational ties to thecommunities in which they live. Research fromresidents of New Orleans after Katrina focusingon resilience also identified transgenerational fac-tors, as well as historical and cultural influences(Hsu, Davies, & Hansen, 2004). This supports thefindings of the current study in explaining theschool nurses’ decision to stay when confrontedwith the possibility of future devastation fromhurricanes.

For participants in the study, resilience in rela-tion to the uncertainty and stress presented bythese natural disasters is a way of life. Nurses inmany professional settings work with individualsand communities whose daily lives are affectedby extreme adversity (Tusaie & Dyer, 2004). Afterthe hurricanes of 2008, school nurses in southLouisiana were able to rebound and carry on, witha sense of determination and strength of spirit toprovide care for others, while dealing with per-sonal adversity. They were able to conceptualizethe trauma associated with the hurricanes as anopportunity for growth, cultivating a sense of resi-lience that resulted in the development of survivalskills for future disasters.

Fine (1991) conceptualized resilience as a two-stage process. The first stage entails the directionof energy to minimize the impact of the stress andstressor. In the second stage, reorganizationoccurs whereby a new reality is faced andaccepted. This process was supported in the cur-rent study. Before, during, and immediately afterthe hurricane, the school nurses dealt with themost pressing concerns, focusing on security ofrecords, dissemination of information to studentsand families, and reentry into the school setting.

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This was followed by the realization that they hadsurvived the storms and that they had the abilityand resources needed to continue in the face offurther adversity.

Previous research supports the sense of resili-ence noted in this study, with these school nursesnot only surviving adverse conditions but alsoachieving positive outcomes as evidenced by theirrecognition of support from family, friends,community leaders, and colleagues in the schoolsystem and also by their confidence in their abilityto adapt to extreme environmental stressors.

Limitations of the study include the small sam-ple size. It should be noted, however, that a schoolnurse from each parish that suffered a significantimpact from both sets of hurricanes participated.

IMPLICATIONS FOR PRACTICE

This study provided an insight into schoolnurses’ experiences after repeated natural disas-ters. It is important to note the effectiveness of thelessons learned after the storms of 2005. Manyschool nurses spent countless hours on DisasterPlanning Committees in the wake of HurricanesKatrina and Rita. The input of school nurses see-mingly had a positive effect on schools’ abilitiesto prepare for future hurricanes, as well as toadapt to the effects of these storms on students,faculty, and staff. The National Association ofSchool Nurses describes the role of the schoolnurse in disaster preparedness in terms of mitiga-tion, planning, response, and recovery (NationalAssociation of School Nurses, 2006). By continu-ing to serve as an active member of Disaster Pre-paredness Planning Committees, the schoolnurse can assure that the needs of children inschool are met. In terms of developing resilience,ongoing support and identification of mentalhealth needs of the entire school community canmaximize the ability to recover, recognizing thepotential for growth even during difficult times.

For future studies, school nurse researchers canfocus on resilience in relation to other natural dis-asters as well communicable disease outbreaks.Pandemic flu has the potential to drastically affectschool nursing practice, and their predictability islimited. By understanding the basic elements ofresilience, school nurses can work to put into place

protective factors that will maximize their adapta-tion to a variety of environmental stressors.

‘‘By understanding the basic elements of resilience,school nurses can work to put into place protectivefactors that will maximize their adaptation to a

variety of environmental stressors.’’

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