DISASTER NURSING

• Psychological first aid

  A humane, supportive response to provide practical care and support, assess needs and concerns, listen if people want to talk, comfort if appropriate, and protect people from further harm. It does not require a detailed recounting of the traumatic event and is not about pressuring people to share their feelings.
• Professional counseling


  A more in-depth therapeutic process
• Feeling sad, anxious, or overwhelmed is normal during a crisis. Different people may express their emotions in different ways, and the time it takes for people to start recovering may be different.
• Not everyone going through a crisis will need or want support, so it's important not to force help on people who do not want it.
• Before providing psychological first aid

  • Know what crisis occurred, understand the local culture and customs, and be aware of relevant resources available for those in need. Support should be provided in a culturally appropriate and dignified manner.
• Vulnerable groups that psychological first aid can provide extra support to

  • Children and adolescents separated from caregivers
  • Those with physical or mental health disabilities
  • Pregnant women
  • The elderly
  • Marginalized populations
• Three Core Steps of Providing Psychological First Aid

  1. LOOK: Check the surroundings for safety and identify people with immediate physical or mental health needs.

  2. LISTEN: Be a patient and calm listener, showing care and empathy, without interrupting or rushing the person.

  3. LINK: Provide people with links to their basic needs, such as food, water, shelter, and relevant resources.
• Key points in psychological first aid

  • Crises and disasters can have long-lasting physical and emotional impacts, including loss of tangible and intangible things.
  • Psychological first aid (PFA) is a first step in helping to reduce the impact of these losses and build resilience in people.
  • The primary components of PFA are safety, comfort, connectedness, and empowerment.
• Safety


  Providing a physically and emotionally safe environment for survivors
• Comfort


  Listening actively, using calming techniques, and providing emotional support
• Connectedness


  Helping survivors connect with their loved ones and access resources
• Empowerment


  Providing information, guidance, and enabling survivors to meet their own needs
• Active listening, using calming techniques, and providing emotional support are important for comfort.
• Helping survivors connect with loved ones and access resources is crucial for connectedness.
• Providing information, guidance, and enabling survivors to meet their own needs is key for empowerment.
• Self-care for the responders providing PFA is important, as they may be exposed to traumatic experiences.
• Strategies for self-care


  • Maintaining a regular routine
  • Exercising
  • Seeking support
• The psychological first aid help card can be a useful resource for responders, listing the key components of PFA.
• Critical incident stress management (CISM) in disaster nursing


  Involves providing timely support and interventions to help healthcare professionals cope with the emotional and psychological impact of traumatic events. This includes strategies like debriefing sessions, education on stress management techniques, and access to mental health resources.
• The goal of CISM


  To prevent and mitigate the negative effects of stress and trauma on nurses and other healthcare workers, ensuring their well-being and ability to continue providing care effectively during and after disasters.
• Components of a CISM management plan

  • Education before an incident about critical incident stress and coping strategies
  • Field support (ensuring that staff get adequate rest, foods and fluids, and rotating workloads) during an incident
  • Defusing, Debriefings, Demobilization, and Follow up care after incident
• Defusing


  A process by which individual receives education about recognition of stress reactions and management strategies for handling stress.
• Debriefing


  A more complicated intervention; it involves a 2- to 3- hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications.
• Demobilization


  A brief, informational and rest period immediately after personnel have been released from active duty at the scene of a large scale (requiring 100 personnel or more) traumatic incident, and before they return to routine duties.
• Follow-up care


  Members of then CISM team of a contact the participants debriefing and schedule a follow-up meeting if necessary. People with ongoing stress reactions are referred to mental health specialists.
• Psychological and emotional responses

  • Immediate reactions: anxiety, frustration, physical symptoms, anger
  • Delayed reactions: feelings of loss, grief and guilt, flashbacks, nightmares
• Nursing interventions for immediate stress reaction

  • 5 minutes break at least every hour
  • Monitor for shaking, trembling, loss of coordination
  • Provide rest area
  • Rotate frontline personnel
• Nursing interventions for delayed reaction

  • 2 mandatory debriefing sessions
  • Encourage liberal leave policy
  • Begin stress management class
• Managing short- and long-term psychological effects after a disaster

  • Provide active listening and emotional support
  • Provide information as appropriate
  • Refer to therapist or other resources
  • Discourage repeated exposure to media regarding the event
  • Encourage return to normal activities and social roles
  • Critical incident stress management (CISM)
  • Programs that include education, field debriefing, defusing, and follow-up support, demobilization, components
  • Persons with ongoing stress reactions should be referred to mental health specialists
• The WHO (IASC) initiated the Guidelines for Mental Health and Psychosocial Support in Emergency Settings (MHPSS), which reflect the insights of numerous agencies and practitioners worldwide and provide valuable information to organizations and individuals on how to respond appropriately during humanitarian emergencies.
• MHPSS in emergencies


  To enable humanitarian actors and communities to plan, establish and coordinate a set of minimum multi-sectoral responses to protect and improve people's mental health and psychosocial well-being in the midst of an emergency. It addresses the psychological, emotional, and social well-being of individuals, recognizing the interconnectedness of mental health and overall health.
• During emergencies, individuals may experience trauma, grief, loss, anxiety, and other psychological distress. Mental health and psychological support aims to mitigate the negative impact of these experiences and promote resilience and recovery.
• Key components of MHPSS

  • Psychological First Aid: Immediate support addressing basic needs and promoting coping strategies
  • Community-Based Support Systems: Establishing networks for ongoing support and access to essential services
  • Psychological Interventions: Evidence-based interventions addressing psychological and social needs
  • Access to Basic Services: Ensuring access to essential services for individual's well-being
• 6 core principles on MHPSS in emergency settings

  • Human Rights and Equity
  • Participation
  • Do no harm
  • Building on available resources and capacities
  • Integrated support systems
  • Multilayered supports
• Multilayered supports


  • Basic Services and Security: Advocacy for basic services that are safe, socially appropriate and protect dignity
  • Community and Family Support: Loss of family member, Youth clubs, etc. Communal traditional supports, supportive child-friendly spaces, activating social networks
  • Focused, non-specialized supports: Basic Mental health care by PHC doctors, basic emotional and practical support by community workers (counselling)
  • Specialized Services: Referral to mental health services, care by mental health specialists (e.g., psychiatrist, psychiatric nurse, psychologist)
• Common mental health issues that arise during emergencies

  • PTSD: Persistent re-experiencing of the traumatic event, flashbacks, nightmares, and hyperarousal.
  • Depression: Feelings of sadness, hopelessness, loss of interest, and changes in appetite and sleep patterns.
  • Anxiety: Excessive worry, restlessness, panic attacks, and difficulty concentrating.
  • Grief and Loss: Emotional pain, sadness, and mourning due to the death of loved ones or loss of homes and belongings.
• Different stakeholders involved in providing MHPSS in emergency settings

  • Healthcare professionals
  • Emergency responders
  • Community leaders and organizations
  • Government agencies and NGOs
• Role of nursing in providing MHPSS in emergency setting

  • Assessment and care
  • Psychological first aid
  • Therapeutic communication
  • Education and support
  • Collaboration and advocacy
• Components/domains (minimum response) of MHPSS

  • Coordination
  • Assessment, monitoring and evaluation
  • Protection and human rights standards
  • Human resources
  • Health services
  • Education
  • Dissemination of information
  • Food security and nutrition
  • Shelter and site planning
• Food security


  Psychosocial factors related to food security, nutrition and food aid