Anxiety and Stress in Live Disaster Exercises

Nurses play critical roles in disaster response, often preparing through simulated exercises. According to The NLN Jeffries Simulation Theory, simulations can lead to anxiety in participants that affects learning. The objective of this research was to measure and describe anxiety and stress levels of participants in a live disaster-training exercise.

A quasiexperimental/descriptive design using quantitative methods (amylase, cortisol levels) and qualitative methods (survey, focus groups) was used with a convenience sample of senior nursing students taking part in a disaster exercise. Participants completed self-reports of anxiety before and after the exercise using the State-Trait Anxiety Inventory (pre/post). Following the training, participants provided saliva samples for analysis of cortisol and amylase levels to measure physiological stress levels. Participants were also invited to take part in a focus group after exercise participation.

A total of 22 participants were recruited. Significant elevation of self-reported anxiety levels was found on the State-Anxiety Inventory comparing pre- with post-training, but no Trait-Anxiety changes were noted. Amylase and cortisol levels were within normal ranges. Themes emerging from qualitative analysis include preparation, uncertainty, teamwork, realism, and decision making.

Disaster training may be anxiety provoking and stressful. ED nurses should consider how to include best practice approaches for simulation in design of exercises to prepare for the increasing number of multicasualty events.