Nurses’ Experiences Following Disaster: Moral Distress and Relational Loss

Abstract

Background

Nurses working in areas affected by the Great East Japan Earthquake and the subsequent radiation disaster faced prolonged and complex stressors.

Aim

This study aimed to describe nurses’ subjective experiences and conflicts, and interpret them from the perspective of moral distress and relational loss.

Research design

This is a qualitative descriptive study based on open-ended responses. Previous quantitative analyses suggested persistent posttraumatic negative cognitions among affected nurses. To deepen understanding of the experiences underlying these findings, this study qualitatively analysed open-ended responses from repeated questionnaire surveys conducted during the first two years following the disaster among nurses from two healthcare facilities. In each of the three survey waves, the participants were asked to describe the stress they experienced during the disaster. Data were analysed using qualitative content analysis and responses were segmented into meaning units, coded, grouped into subcategories, and synthesised into themes through iterative discussions within the research team.

Ethical considerations

This study was approved by the relevant institutional ethics committees. A written informed consent was obtained from all participants, and participation was voluntary and de-identified.

Findings

Six themes were identified. Nurses’ narratives depicted the layered impact of disrupted living foundations and ongoing threats, exhaustion from sustained emotional labour, and unavoidable choices under severe constraints. These experiences were interpreted as reflecting moral distress and, in some accounts, features suggestive of moral injury. Participants also described relational loss, including the erosion of trust, fragmentation within teams, and reduced mutual support in the workplace.

Conclusions

Nurses’ experiences in a compound disaster setting were characterised by intertwined moral suffering and relational loss. Organisational approaches that validate nurses’ responses as understandable in context provide psychologically safe spaces to reframe disaster-time actions, and intentionally support the repair of fractured relationships may help protect nurses’ well-being during and after disasters. Preserving professional integrity through sympathetic presence may be particularly important in extreme conditions wherein action is constrained.