When terror is routine: how Israeli nurses cope with multi-casualty terror

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments.