Hurricane Katrina, one of the most devastating natural disasters in the history of the United States, ravaged New Orleans on August 29, 2005. The storm closed college campuses in New Orleans for the rest of the fall semester and displaced more than 50,000 college students (Ladd, Marszalek, & Gill, 2006). The building that housed a New Orleans-based nurse anesthesia program received 1 to 2 feet of water (Smith, 2005); because of this damage, it became apparent that the education of the student registered nurse anesthetists (SRNAs) would be disrupted.
Disasters on college campuses are not unique. In the past 5 years, campus shootings and natural disasters have affected college campuses across the nation. Disaster literature on college students exists; however, no study has been conducted regarding SRNAs or any other advanced nurse practitioner (ANP) students and natural disasters.
SRNAs are RNs who are enrolled as students in an accredited nurse anesthesia program and have at least 1 year of intensive care unit experience. Nurse anesthesia programs are housed in nursing schools, schools of allied health, medical schools, and other graduate schools. All programs offer at least a master’s degree in nursing or in nurse anesthesia. This New Orleans-based nurse anesthesia program, housed in the nursing school, lasts 32 months and upon satisfactory completion awards a master of nursing degree with a specialization in nurse anesthesia option. The nurse anesthesia program is a full-time graduate-level program, and students are classified as freshmen, junior-level, or senior-level (senior) students within the program. The senior SRNAs documented in this article had less than 9 months left in their training when the storm disrupted their education.
Within 1 month of the storm, classes resumed in Baton Rouge, which is 74 miles northwest from New Orleans. When classes resumed, all students were required to attend classes for 5 consecutive days to “make up” missed classroom time because of Hurricane Katrina. After this initial week, classes were held on a weekly basis, and distance-learning technologies were implemented to decrease the driving requirements of the students who were attending clinical rotations outside of the Baton Rouge area. The use of distance learning technology allowed the students to synchronously attend class using their computers. This format allowed faculty members and students to sign into a specified cyber classroom; the faculty member was able to view a list of all participants who were signed in. The students were able to listen to the faculty member lecture while viewing the lecture material (i.e., Microsoft® PowerPoint®) being presented and were able to participate in classroom discussion by typing comments viewable to the faculty member and other students.
This study was a focused ethnography using group interviews to determine: (a) the shared experience of SRNAs whose senior year was disrupted by Hurricane Katrina, and (b) the psychosocial impact Hurricane Katrina had on these SRNAs. The protocol was approved by the applicable Institutional Review Boards, and appropriate consents were obtained from all participants.
Focused ethnography describes a specific aspect of a culture and is generally conducted by someone familiar with the culture; therefore, fieldwork may not be warranted (Knoblauch, 2005; LeCompte & Schensul, 1999). Focused ethnography differs from traditional ethnography in that the latter includes extensive fieldwork (immersion of the investigator into the culture being investigated) that lasts from months to years. The investigator was familiar with all of the SRNAs whose senior year was disrupted by Hurricane Katrina, and fieldwork was not feasible for this study because the event (Hurricane Katrina) had passed. Culture can be described as a “persistent group pattern of behaviors, beliefs, norms, and attitudes” (LeCompte & Schensul, 1999, p. 21). The culture in this study was a group of senior-level SRNAs who were affected by a natural disaster. In an appropriately conducted focused ethnography, the relatively small sample is offset by the in-depth information provided about the phenomenon under study (Creswell & Plano Clark, 2007).
A convenience sample of 10 participants representing former SRNAs whose senior year was disrupted by Hurricane Katrina participated in one of three focus groups. Thirty-five senior-level students were continuously enrolled in the nurse anesthesia program for at least 22 months on August 29, 2005. The investigator (M.G.-E.) personally knew all of the students and was able to contact 20 of them via e-mail to invite them to participate in the study. The investigator was unable to contact the other 15 former students because they had relocated after the storm and did not provide contact information to either the investigator, the school, or their former classmates at the time of this investigation. Prior to the focus group interview, the participants were asked to complete a demographic survey, and the results were analyzed using SPSS version 13.0.
Ages of the participants during Hurricane Katrina ranged from 29 to 48, with the majority age range of 30 to 40. Five participants were women; 7 were Caucasian, 1 was African American, 1 was Asian, and 1 was Native American. Four reported being married, 3 reported being single, 2 reported being divorced, and 1 did not report a marital status at the time of Hurricane Katrina. Most of the participants had experienced more than 10 hurricanes, and all but one reported that they evacuated for Hurricane Katrina. No one lost family members, although 3 participants lost pets due to Hurricane Katrina. The reported property damage from Hurricane Katrina ranged from minimal to total loss of home and belongings.
Data Collection and Analysis
Three focus groups were interviewed. Two of the focus groups consisted of 3 people and one focus group consisted of 4 people. Many investigators believe the ideal focus group consists of 8 to 10 participants. Due to the number of people willing to participate in this study and their work schedules, smaller focus groups were used. The focus group interviews took place around a conference table in a quiet room with a co-facilitator, an experienced focus group researcher, who recorded notes and the participants’ nonverbal cues. The co-facilitator was introduced to the participants, and her role was explained to them.
To facilitate the interviews, the investigator used an interview guide consisting of a predetermined set of semi-structured questions, follow-up questions, and probes based on the Lazarus and Folkman (1984) stress, appraisal, and coping model. The interviews, which lasted between 45 and 60 minutes, were audiorecorded. When the interviews were completed, the participants were given the contact information of an experienced disaster counselor who had agreed to provide counseling if needed. The audiorecordings of the interviews were transcribed verbatim, and the investigator checked them for accuracy by reading the transcripts while listening to the audiorecordings. The investigator analyzed the resulting transcripts for codes, patterns, and emerging themes using NVivo8 software.
The purpose of this study was to describe the shared experiences of SRNAs whose senior year was disrupted by Hurricane Katrina, examine the psychosocial impact Hurricane Katrina had on them, and analyze emerging themes based on their focus group interviews. Three major themes emerged from more than 70 pages of transcripts and notes from the co-facilitator and investigator. These themes were Seriousness of Urgency, Managing Uncertainty, and Stability Equaled Relief.
Seriousness of Urgency
The participants expressed a sense of urgency regarding the evacuation from and the impact Hurricane Katrina had on New Orleans. All but one participant evacuated for the storm, although several did not initially plan to evacuate. Some participants were urged by their family members to leave New Orleans. One participant stated, “My dad never did leave either [for prior hurricanes], but even he was in Houston saying, ‘You better get out of there.’” Another participant recalled, “You know, I wasn’t going to leave because we never leave, and my mom left, which was like, oh, she never leaves either.” When the mayor of New Orleans called for a mandatory evacuation, some participants realized the seriousness surrounding the storm. One participant shared:
Kind of hit home when he made that announcement. Because before that we were like, oh, it’s another hurricane, we’ll be alright. Then, you know, on TV here he is, oh, this is definitely serious…. He started doing all these scenarios that could happen, like this could be the worst storm in decades.
The seriousness of the storm did not end with the evacuation. Several participants remembered watching television coverage of the city in the aftermath of Hurricane Katrina and expressed disbelief at what was happening. One participant stated, “I had the computer and I was streaming information and we started seeing all the things that were happening [in the city] as the day went on…. We were all just kind of like, we can’t believe we can’t go home.” Another recalled, “When I started seeing the television with the water everywhere and all these people like at the airport and everything, I was like, oh my God, you know.”
The participants shared expressions of uncertainty regarding resumption of classes, graduating on time, returning to clinical rotations, status of family and pets, and damage to their property. They expressed great anxiety regarding the status of the nurse anesthesia program and whether classes would resume or if they would be able to complete their program of study and graduate. The participants of one focus group agreed with their colleague who stated:
It was a little bit chaotic, I guess, because without hearing anything from the program, there was a lot of uncertainty…if we were going to graduate on time, if we were going to graduate at all because, we had no idea what was really going in New Orleans, if the nursing school was still there.
One participant in a different focus group stated:
I think that would have been like the straw that broke the camel’s back because we were all just busting our butts to try and get done and to be told, Oh, you’re not going to graduate on time, that would have been devastating for a lot of people.
The rest of the participants in this particular focus group nodded their heads in agreement with this statement.
Several participants sought employment as RNs to support themselves while waiting to hear about resumption of classes. One person noted, “I figured the best thing to do was for me to get a job and start making some money and then just trying to get back in touch with everybody and figuring out where everybody was.”
Uncertainty existed regarding clinical assignments. Students were assigned to rotate in clinical sites in New Orleans as well as other sites around the state of Louisiana and a few sites in Mississippi, Tennessee, and Texas. Communication was poor after the storm, and several of the clinical sites were damaged. The participants stated they were unsure where to report for clinical assignments after Hurricane Katrina and before classes resumed. This uncertainty was exacerbated by faculty members’ inability to communicate with the students initially after the storm. A few participants noted that they were contacted by the program director and told to go to their assigned clinical sites if at all possible. Eventually all students were contacted by the program director and advised to view the school’s emergency website and their school e-mail accounts for information pertaining to the nurse anesthesia program and for communication with the faculty members. A few participants recalled reporting to a clinical site only to be told they were not needed because the site was using displaced certified registered nurse anesthetists (CRNAs). One participant reported that the site refused to let her complete her clinical assignment:
I showed up at [the hospital] I think the Friday morning after the hurricane, and the CRNAs over there told me that with the…not knowing anything about what the status of the nursing school was, that with regard to liability and stuff…I wasn’t protected, so they pretty much said, “You can’t function here as an SRNA because without us knowing what status the school is in, you’ve got no protection whatsoever,” and it was like a liability thing for them to let me work [train] there.
Travel and housing were also areas of concern and uncertainty. Some participants reported being thankful that housing was provided by some of the clinical sites, while others reported that they had a difficult time finding housing near their sites. One person said a CRNA preceptor rented her a pool house 30 minutes from the clinical site, and another stated that she stayed with a classmate’s family who lived near her site. The participants mentioned they had difficulty finding fuel for their vehicles and had to carry full gasoline cans with them when they traveled to clinical sites and to school, because many gas stations were damaged and closed after the storm.
The participants shared further uncertainty regarding the status of their family members, pets, and homes. Communication was sporadic, as several participants noted that “there was no communication with the outside world besides texting.” One participant recalled, “You know, we lost our houses. And you can’t get in touch with your family members because everybody’s trying to call on the phone.” Another participant revealed that “just [the] anxiety of the unknown, how are your loved ones, how are your animals, what am I going to do about money? What am I gonna do about housing? It was ongoing and, you know?” One person left her cats at home prior to evacuating because she thought she would be able to return within a few days to take care of them: “I got stressed about that. Oh God, you get visions in your head of your cats drowning and starving to death.”
The participants shared their concerns about the rumors surrounding lawlessness in the city and worried for their personal safety when they returned to their homes to assess storm damage. One participant stated, “I bought my handgun and a shotgun in the next couple of weeks and so it was just…feeling like I was having to fend for myself in…almost a primal way, you know, worried about my personal safety.” A few participants “snuck” back into the city to check on their homes and pets prior to the mayor officially allowing citizens to return to New Orleans. Those who illegally re-entered the city recalled being frightened because of the lawlessness, yet the city was relatively “peaceful and quiet and there were no birds chirping.” They also noted trees and power lines were down around the city and that the grass was gray, brown, and crunchy.
Stability Equaled Relief
All of the students expressed relief regarding the resumption of classes after Hurricane Katrina and the ability to graduate on time. Within a month after the storm devastated New Orleans, classes resumed in Baton Rouge. During the regular semester, classes were held 1 day per week. After Hurricane Katrina, classes were held every day for the first 5 days and weekly thereafter. Face-to-face class attendance was mandatory during the first full week, but afterward the students were given the choice to attend class via distance technology or in person; most of the participants chose to attend class in person. A few participants who did use the distance technology expressed being grateful for the convenience of not having to search for gas and drive to campus to attend class. One participant pointed out that storm debris cluttered the highways, which made driving hazardous.
Some participants lost books, computers, professional attire, and anesthesia equipment due to Hurricane Katrina, of which they were able to purchase or borrow new items. They shared that manufacturers gave them scrubs, and one person even received a free pair of shoes to replace the ones she lost in the storm. Other participants stated that although they did not lose their books, computers, scrubs, and anesthesia equipment, they were unable to retrieve these items for several weeks following the storm because they were not allowed to return to their homes.
When asked about their thoughts with respect to the resumption of classes, relief and the return to stability were common responses from participants. One participant stated that “the fact that school started back up and we were allowed to get back into clinical, it gave me some sense that you were gonna be OK, that the school was intact, you were going to graduate eventually.” Another participant noted “immediate relief. We were all just rejoicing, so happy. Immediate relief. We were fine, let’s get on with it. It was something to hold onto.” Another participant recalled:
I was very glad we were going to resume because I think from my standpoint, it was more of a financial burden and was hoping that geez, I hope I don’t have to sit out another year to just keep borrowing more and more money. So that was a major concern of mine, so I was much relieved to hear that we were resuming classes and the way things planned out.
Another person’s response to the resumption of classes was, “But when we found that it was coming back, it’s just… oh, we were just relieved with thank goodness. So great relief. Ready to get back to something stable, yeah.”
The participants were asked about the first class after Hurricane Katrina when everyone was together in one room. Several quotes summarize the shared experiences expressed by the participants:
- Oh, it was wonderful to-body. It was great to be able to just to hug everybody and make sure everybody was OK. And then, of course, you know, then you could actually hear everybody else’s stories and it was definitely… not only was an educational thing, but also just more of a social structure.
- You realize everybody around OK, we made it through, you know. Because some people’s stories, just everybody [would] get really quiet and listen and then other people, of course, had funny things that happened and, you know, it’s just like, oh gosh, the same experience. So it was… that was very cathartic to be able to meet with everybody and visualize everybody and say, Oh my gosh, we’re all, we made it, we’re back…. You just wanted to blink your eyes and for it to be over with to come back to New Orleans.
- I think that it was just a sense of relief because we were assured that the very first day that we were going to graduate on time, you know, so regardless of what sacrifices we were going to have to make because the program wasn’t able to function in New Orleans anymore, the timeline [of graduation] was not going to be disturbed at all.
Every participant expressed relief when they were told by the program director and the other anesthesia faculty members that they would graduate on time, in May 2006. One participant stated, “I felt really reassured by you guys saying, ‘You are going to graduate.’ And I think with [the program director]...I felt assured if anybody could get it done, she was going to make sure that we got out of there.” Other participants expressed gratitude that they were able to graduate on time. Some of them stated that they were concerned about finding jobs after graduation because many of the New Orleans hospitals were still closed in May 2006.
Psychosocial Impact of Hurricane Katrina
One aim of this study was to examine the psychosocial impact of Hurricane Katrina on the former SRNAs whose senior year was disrupted by the every disaster. All of the participants denied having any long-term psychosocial impact from Hurricane Katrina. Several participants mentioned short-term stress and anxiety related to experiencing Hurricane Katrina. Several revealed that the stress and anxiety were related to the uncertainty of being able to complete their education. Most described a short-term increase in alcohol consumption after the storm to decrease their stress. One person started smoking cigarettes as a result of the events surrounding the disaster.
The participants discussed the impact Hurricane Katrina had on their family members and other people more so than the impact it had on them. One participant stated:
I think that for me it was hard for me to allow myself to feel any kind of stress or anxiety because I knew that there were other people who were in a much worse place than I was. I mean, you know, people losing their houses and stuff. You know, the fact that somebody had broke into my apartment and stole a few things, I mean, it just kind of paled in comparison, you know, to the people who lost houses and lost family members and whatnot, and so I think that I…if there was anything going on with me, like, it got kind of like suppressed or repressed.
Several participants noted that older family members were more affected by Hurricane Katrina than the participants themselves were because the older people had to see “everything they built up just come apart.” The participants described themselves as cohesive and resilient. One participant mentioned that the first-year students in the nurse anesthesia program had a more difficult time than the seniors regarding their educational process: “God, if you were, you know, a freshman, that would have been so much more difficult. You know, and our class is really close and to see everybody, you know, once a week was so important, and not to have that, you know.” One participant mentioned losing everything and how that made her feel: “It was weird because I was so materialistic…. After you got over…losing everything, it was like a cleansing.” Another participant agreed with her by responding with “uh-huh.”
This focused ethnography described the shared experiences of students whose senior year was disrupted by Hurricane Katrina as well as elucidated the psychosocial impact the storm had on them. This study was based on the stress, appraisal, and coping theory of Lazarus and Folkman (1984), which describes stress as a relationship between a person and the environment; in other words, a transactional process that emphasizes the individual’s analysis of the event, the individual’s cognitive appraisal of the importance of the event, and the individual’s determination of the response to the event, including available resources to cultivate the response (Matthieu & Ivanoff, 2006). For this study, the cultural environment of being a SRNA produced a template for the participants to frame their shared, stressful experiences. The Figure depicts the theoretical framework of the study.
The unexpected and urgent need to evacuate for a powerful hurricane; the graphic images on television that showed what was taking place in the city in the aftermath of the storm; the concern for the condition of their family members, pets, homes, and school; and the concern for personal safety were all shared stressors related to the events surrounding Hurricane Katrina. Most SRNAs appraised the hurricane as a potential serious threat and responded by urgently evacuating from the city. After the storm, they realized they were experiencing a crisis when they appraised a lack of communication with school officials and clinical preceptors, thereby causing concern regarding the status of the school and completion of their education. Lack of communication also led to shared uncertainty regarding the status of family members, pets, and homes. Coping measures that were shared among the SRNAs included anxiety, a temporary increase in alcohol consumption, seeking nursing jobs, and staying heavily focused on their education and pending graduation once classes resumed. As mentioned above, one participant purchased guns out of extreme concern for his personal safety. Many engaged in downward social comparison (“I was fortunate, we weren’t affected as much as other people”) and other forms of cognitive reframing (“It was like a cleansing”).
Very little research exists in reference to disasters and college campuses/students, although tragedies on campuses are not uncommon. McCarthy and Butler (2003) found that college students who were exposed to a tornado on campus experienced a progressive decline in anxiety, anger, and irritability over time. Their findings parallel those in this focused ethnography, where the participants experienced short-term anxiety that dissipated over time. Blanchard et al. (2004) surveyed college students on campuses in New York, Georgia, and North Dakota regarding the World Trade Center terrorist tragedy of September 11, 2001. They found widespread high levels of acute stress related to the tragedy. These findings are similar to those of this focused ethnography, in which the participants experienced high levels of stress and anxiety related to Hurricane Katrina and its aftermath. Cardenas, Williams, Wilson, Fanouraki, and Singh (2003) found that college students had an increased level of alcohol and substance abuse following the events of September 11, 2001. This is congruent with the findings of this focused ethnography, in which the participants responded to the events surrounding Hurricane Katrina with temporary increased alcohol consumption.
A number of limitations are associated with this study. First, the study took place 4 years after the storm, and memories may have changed over time. Another limitation is the study’s use of convenience sampling, and the results may not be transferable except to other SRNAs whose senior year is disrupted by a hurricane or other similar natural disaster. Finally, the study may have been biased toward those who wished to tell their stories.
Implications for Practice and Education
An implication of this study for SRNA and other student advanced nurse practitioner education includes developing plans, policies, and procedures for the relocation and resumption of nursing education after a disaster. This study highlights the necessity of developing policies for assuring ongoing communication between faculty and students in the immediate aftermath of a disaster. An implication for practice consists of developing policies regarding clinical assignments during disasters, educating the clinical preceptors of the policies, and communicating with the clinical sites that the educational program is open and students’ liability insurance is in effect. An implication for future research involves the examination of the reactions and responses of SRNAs and CRNAs in the global wake of natural disasters, such as tornadoes, earthquakes, volcanic eruptions, and flooding, and their impact on all levels of SRNAs’ and CRNAs’ physical and emotional aftermath.
On the basis of the findings of this study and others regarding college students and disasters, students’ psychosocial needs during—and in the immediate aftermath of the event—should be supported. Effective communication between the program faculty and students is essential to support the students’ psychosocial needs. Psychosocial support can be in the form of counseling referrals prior to the students returning to class and formalized crisis debriefing when the students return to class. Other forms of psychosocial support include individual assessments for anxiety and individual or group counseling.
The SRNAs shared a sense of urgency and gravity surrounding Hurricane Katrina, the evacuation process, and their sense of personal safety. They were uncertain whether they would be able to complete their education and graduate on time. Once classes resumed, they shared relief that their education would continue and that they would indeed graduate on schedule. This was the first study to systematically examine and document SRNAs’ reactions to a natural disaster and the impact the disaster had on their stress appraisal and coping mechanisms. This study can inform educators of the impact a natural disaster may have on graduate nursing students and the critical importance of having disaster policies in place. Disaster policies may include communication between the school faculty, students, and clinical preceptors after a disaster; education of students after a disaster; and psychosocial support of students following a disaster.
- Blanchard, E.B., Kuhn, E., Rowell, D.L., Hickling, E.J., Wittrock, D., Rogers, R.L. & Steckler, D.C.,… (2004). Studies of the vicarious traumatization of college students by the September 11th attacks: Effects of proximity, exposure and connectedness. Behaviour Research and Therapy, 42, 191–205. doi:10.1016/S0005-7967(03)00118-9 [CrossRef]
- Cardenas, J., Williams, K., Wilson, J.P., Fanouraki, G. & Singh, A. (2003). PTSD, major depressive symptoms, and substance abuse following September 11, 2001, in a midwestern university population. International Journal of Emergency Mental Health, 5, 15–28.
- Creswell, J.W. & Plano Clark, V.L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.
- Knoblauch, H. (2005). Focused ethnography. Forum: Qualitative Social Research, 6(3). Retrieved from http://www.qualitative-research.net/fqs-texte/3-05/05-3-44-e.htm
- Ladd, A.E., Marszalek, J. & Gill, D.A. (2006). The other diaspora: New Orleans student evacuation impacts and responses surrounding Hurricane Katrina. Paper presented at the annual meeting of the Southern Sociological Society. , New Orleans. .
- Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
- LeCompte, M.D. & Schensul, J.J. (1999). Designing and conducting ethnographic research. Walnut Creek, CA: Sage.
- Matthieu, M.M. & Ivanoff, A. (2006). Using stress, appraisal, and coping theories in clinical practice: Assessments of coping strategies after disasters. Brief Treatment and Crisis Intervention, 6, 337–348. doi:10.1093/brief-treatment/mhl009 [CrossRef]
- McCarthy, M.A. & Butler, L. (2003). Responding to traumatic events on college campuses: A case study and assessment of student postdisaster anxiety. Journal of College Counseling, 6, 90–96. doi:10.1002/j.2161-1882.2003.tb00230.x [CrossRef]
- Smith, R. (2005, September30). Hurricane Katrina recovery—Update #1. Retrieved from the Louisiana State University Health Sciences Center website: http://www.lsuhsc.edu/biweekly/update_20050930.aspx