From policy to practice: How frontline nurses navigate disaster preparedness in a South African public hospital

Abstract

Climate-related disasters have increased globally, placing sustained pressure on health systems, particularly in low- and middle-income countries (LMICs). Nurses comprise the majority of the healthcare workforce, yet their perspectives are often underrepresented in disaster policy evaluation. To explore frontline nurses’ and disaster committee members’ perceptions of hospital disaster preparedness policies and their implementation at a public tertiary hospital in (Anonymized for Review). This qualitative study included focus group discussions with nurses and individual interviews with the hospital disaster committee members to assess disaster readiness at a 530-bed hospital serving 4.5 million people. An inductive analysis was conducted in the first phase, followed by a secondary interpretive phase in which a health policy evaluation framework was applied to contextualize and deepen interpretation of the findings. Three categories emerged: 1) Resource and staffing constraints, 2) Lack of clear communication and information channels both within facility and externally, and 3) Disruptions affecting workflow and patient care. Nurses reporting that chronic resource shortages, role ambiguity, and inconsistent communication limited operational feasibility of disaster policies. Disaster committee members highlighted structural and logistical barriers to implementing idealized protocols. These analyses revealed that the hospital operates at or near disaster capacity daily, complicating its ability to respond effectively to large-scale disasters. Frontline nurses play a crucial role in operationalizing and evaluating hospital disaster policies. Integrating their insights into planning, training, and policy development can improve feasibility, adherence, and patient care during disaster events. Recommendations include context-specific risk assessments, mandatory disaster drills for all clinical staff, formalized communication roles, and strategies to control access to hospital facilities during disaster events.