UNIVERSIDAD DE MANILA

One Mehan Gardens, Ermita, Manila

COLLEGE OF HEALTH SCIENCES
Department of Nursing

DISASTER NURSING

UNDERSTANDING THE PSYCHOSOCIAL IMPACT OF DISASTERS AND

MANAGEMENT OF THE PSYCHOSOCIAL EFFECTS OF DISASTER

Presented by:
Group 2
Cajuelan, Fiona Nicole
Dacut, Jefferson
Ereve, Franchesca
Godes, Cielo
Rico, Stephanie
Roda, Kriscelyn
Romano, Francisco
Selda, Cyril
Sumilang, Oohris Moira

Prof. Perdriluz Joy Love S. Gamas LE, RN, MAN

 UNDERSTANDING THE PSYCHOSOCIAL IMPACT OF DISASTER

I. BIOTERRORISM AND TOXIC EXPOSURE

Bioterrorism has an entirely different profile from that of natural disasters or even sudden violent
events, such as bombings and explosions. Although bioterrorism is also a man-made disaster, the
effects are more uncertain and occur over a longer period of time.

Common Psychological Reactions to Bioterrorism Include:

• Horror, anger, or panic

• Magical thinking about microbes and viruses
• Fear of invisible agents or fear of contagion
• Attribution of arousal symptoms to infection
• Anger at terrorists, the government, or both
• Scapegoating, loss of faith in social institutions
• Paranoia, social isolation, or demoralization

Holloway and colleagues (2002) suggest the following interventions by medical personnel to
minimize the potential psychological and social consequences of suspected or actual biological
exposures:

1. Prevention of group panic

2. Careful, rapid medical evaluation and treatment (to distinguish between hyperarousal,
intoxication, and infection)
3. Avoidance of emotion-based responses (e.g., kneejerk quarantine)
4. Effective communication regarding potential risk
5. Control of symptoms secondary to hyperarousal (provide reassurance, and if unsuccessful,
consider diazepam-like anxiolytics for acute relief)
6. Management of anger, fear, or both
7. Management of misattribution of somatic symptoms
8. Provision of respite as required
9. Restoration of an effective, useful social role (e.g., as worker at triage site).
10. Return to usual sources of social support in the community.
II. COMMUNITY IMPACT AND RESOURCE ASSESSMENT

By brainstorming about potential disaster scenarios and the cope of resources anticipated to be needed under
each scenario, the intensity and duration of mental health response can also be anticipated. Effective
community planning requires the deployment of mental health resources in the most efficient manner.

A rapid assessment about the psychosocial impact among communities aims to protect or promote
psychosocial well-being and/or prevent or treat mental disorder. A resource assessment is vital as it gathers
information about the resources available to address a particular need, it answers the capability of the
community to meet the psychosocial needs of the community and their preparedness about the disaster.

III. NORMAL REACTION TO ABNORMAL EVENTS

• THERE IS NO RIGHT OR WRONG WAY TO FEEL AFTER EXPERIENCING AN UNSETTLING
EVENT
• Normal Reaction to stress and bereavement can and do vary- Each person reacts to trauma in his or her
own way. Keep in mind that you are a normal person having normal reactions – the only thing that is
abnormal is the situation you have just experienced.

Four Phases of Emotional Recovery by American Red Cross (1995)

1. Heroic Phase
➢ Disaster survival and evacuation, covers rescue and recovery immediately after the event.
➢ Raised anxiety, numbness, shock and elation when life is saved.
2. Honeymoon Phase
➢ Weeks-months following disaster when assistance is available
➢ Community pulls together to cope with the disaster and survivors are grateful.
3. Dillusionment Phase
➢ weeks- years
➢ strong sense of disappointment, resentment and anger toward how things are or are not moving
4. Reconstruction Phase
➢ Emotional well- being occurs and may continue for years.

IV. SPECIAL NEEDS POPULATION

Survivors and family members most likely to experience adverse reactions are seemingly those with the
fewest tangible resources: the unemployed or poor, divorced, or female. Along these lines, Solomon and
 smith (1994) recommend that prevention interventions for disaster survivors target single parents for special
help.

a. OLDER ADULTS - Older adults are particularly vulnerable to loss. Research has shown they are less
likely to heed warnings, may delay evacuation, or resist leaving their homes (DeWolfe,2000).
b. THE SEVERLY MENTALLY ILL - According to Austin and Godleski (1999), the most
psychologically vulnerable people are those with a prior history of psychiatric disturbances. Although
previous psychiatric history does not significantly raise the risk of PTSD, exacerbations of preexisting
chronic mental disorders, such as bipolar and depressive disorders, are often increased in the aftermath
of a disaster.
c. CULTURAL AND ETHNIC SUBGROUPS - Sensitivity to the cultural and ethnic needs of survivors
and the bereaved is key not only in understanding reactions to stress and grief but also in implementing
effective interventions
d. FIRST RESPONDERS AND OTHER HELPERS - The list of those vulnerable to the psychosocial
impact of a disaster does not end with the survivors and the bereaved. Often overlooked victims can
include emergency personnel, police officers, firefighters, military personnel, Red Cross mass care etc.
e. NURSES AND HOSPITAL PERSONNEL - Those medical personnel receiving disaster victims and
families at the local hospitals can also be affected by the intense emotions of those seeking help.
f. MENTAL HEALTH COUNSELOR - Ongoing support for the mental health counselors at the
disaster site is crucial. counselors were also vulnerable to the impact of rumors, delays, and
misinformation. A study by Lesaca (1996) further found that at 4 and 8 weeks after a 1994 airline
disaster, trauma counselors experienced significantly more symptoms of PTSD and depression than a
comparison group.

V. COMMUNITY REACTIONS AND RESPONSES

The cohesiveness of the survivor network can take on special prominence in the recovery following a
disaster. This network appears to develop a boundary of its own that has special permeability properties.
Although these properties include an early permeability to anyone who seems willing to help, this “trauma
membrane” later becomes tightly sealed and outsiders are only allowed in under certain circumstances and
for certain functions (Lindy & Grace, 1985).
Mourning, Milestones, and Anniversaries The normal process of mourning is often facilitated by the use of
rituals, such as funerals, memorials, and events marking key time intervals, such as anniversaries.
 MANAGEMENT OF THE PSYCHOSOCIAL EFFECTS OF DISASTER

I. THE MENTAL HEALTH RESPONSE TEAM

Designation of a mental health coordinator is a crucial first step in the formulation of a team. This
is the person who will manage and coordinate the mental health response from the command
center, decide what resources are needed, activate appropriate mental health agencies, and assign
staff to locations such as neighborhood centers, Red Cross shelters (when requested), family
assistance centers, schools, hospitals, and so on.

II. RECRUITMENT, SCREENING, AND TRAINING

One important responsibility of the mental health coordinator during the planning stage is to
identify and prescreen possible volunteers and staff for qualifications so they may join the team
from the start of the event.

a. Recruitment - The action of finding new people to join an organization or support a cause.
b. Screening - The evaluation of potential as part of the team, and to assess suitability for a
particular role or purpose.
c. Training - The action of teaching a person or animal a particular skill or type of behavior

III. DISASTER MENTAL HEALTH INTERVENTIONS

1. Psychological First Aid

➢ Psychological first aid (PFA) is an evidence-informed approach to assist and support
survivors in the immediate aftermath of a disaster.
➢ There has recently been a revived interest in PFA, with the main goal being to relieve
immediate distress and prevent or minimize the development of pathological sequelae
(Math, Nirmala, Moirangthem, & Kumar, 2015,)

Other steps that can be taken immediately to reduce potential psychological harm include:

• The prevention of re-traumatization—limit the number of persons with whom victims

must interact in order to receive services, as well as reduce the amount of red tape required.
 • Prevention of new victims—limit the number of people exposed to the sights, the sounds,
and the smells of a disaster site, whenever possible.
• Prevention of “pathologizing” distress—avoid labeling normal reactions as pathological
to prevent symptoms from being interpreted as a medical condition or disorder that requires
treatment.
• Identification of individuals showing signs of acute distress- (exceedingly frantic,
panicky, or extremely anger) or individuals who are profoundly shut down (numb,
dissociated, disconnected).

2. Crisis Intervention
➢ Crisis intervention is a technique used to assist persons whose coping abilities have been
overwhelmed by a stressful event. Most survivors at some point in the evolution of a
disaster experience a level of stress so overwhelming that their usual coping is inadequate
to meet the need.
3. Social Support
➢ Social support networks can provide important affective and material aid that mitigates the
adverse effects of disaster trauma (van Ommeren, Hanna, Weissbecker, &
Ventevogel,2015)
4. Psychological Triage
➢ One of the most important roles of the mental health professional in the immediate
aftermath of a disaster is to identify which individuals are most at risk for psychiatric
complications and to make referrals for further mental health evaluation and treatment
when indicated.

Factors increasing the risk of ASD and PTSD in someone suffering a sufficient precipitating event
include the following:

• Loss of a loved one in the event

• Significant injury from the event
• Witnessing of horrendous images
• Dissociation at the time of the traumatic event
• Development of serious depressive symptoms within 1 week that last for 1 month or longer
• Numbness, depersonalization, a sense of reliving the trauma, and motor restlessness after the event
 • Preexisting psychiatric problems
• Previous trauma
• Loss of home or community
• Extended exposure to danger
• Toxic exposure
• Absence of social supports, or social supports who were also traumatized and thus are incapable of
adequate emotional availability (Lubit, 2016, “Etiology”)

Mental Health Referrals - Referrals to a mental health professional ought to be made when one or more
of the following symptoms are present (DeWolfe, 2000):

a. Disorientation—dazed; memory loss; inability to give date or time, state where he or she is, recall
events of the past 24 hours, or understand what is happening
b. Depression—pervasive feelings of hopelessness and despair, unshakable feelings of worthlessness
and inadequacy, withdrawal from others, inability to engage in productive activity
c. Anxiety—constantly on edge, restless, agitated, unable to sleep, frequent frightening nightmares,
flashbacks and intrusive thoughts, obsessive fears of another disaster, excessive ruminations about
the disaster
d. Psychosis—hearing voices, seeing visions, delusional thinking, excessive preoccupation with idea
or thought, pronounced pressure of speech (e.g., talking rapidly with little content continuity)
e. Inability to care for self—not eating, bathing, or changing clothes, inability to manage activities
of daily life
f. Suicidal thoughts or plans—expressing indirect or direct thoughts of harming self
g. Other behaviors of concern—problematic use of alcohol or drugs, domestic violence, child abuse,
or elder abuse.

IV. ACUTE STRESS DISORDER

Although a variety of psychiatric disorders may be seen in the aftermath of a disaster, within the first month
of a traumatic event, acute stress disorder (ASD) is the disorder most likely to be encountered by the disaster
response team. Again, those in closest proximity to the event are at greatest risk.

Although lack of social supports, history of childhood traumas, and poor coping skills may increase
likelihood of the disorder, ASD can develop in a child or an adult having no predisposing conditions,
particularly if the stressor is extreme. Because the likelihood of developing PTSD is elevated for those
having ASD, assessment of individuals for the presence of ASD is key to identifying those at high risk for
future complications.

Characteristic of the disorder is the development of anxiety, dissociation, and other symptoms occurring
within 1 month after the trauma, lasting a minimum of 2 days. If symptoms persist longer than 4 weeks post
trauma, a diagnosis of PTSD should be considered. In considering the diagnosis of either PTSD or ASD,
the individual must meet the following criteria:

1. Experienced, witnessed, or been confronted with an event that involved actual or threatened death
or serious injury, or a threat to the physical integrity of self or others.
2. Responded with intense fear, helplessness, or horror.

Psychological First Aid

• Once exposure to a disaster has already occurred, efforts must then be directed toward the reduction of
psychological harm. Individuals showing signs of ASD should be removed from ongoing trauma, if
possible; encouraged to rest; and assisted in connecting with available sources of social supports.

Traumatic Grief (Complicated Bereavement)

• Grief can be determined to be traumatic when it follows a loss that is sudden, violent, or is accompanied
by extreme and intense emotional distress. In such cases, the grief can be unrelenting and
overwhelming. Those experiencing a loss through sudden or violent death are often left with a feeling
of unreality about the loss. Involvement with protracted medical or legal investigations can delay the
grieving process.

V. POST-TRAUMATIC STRESS DISORDER (PTSD)

Posttraumatic stress disorder is a response to a recognizable, serious stressor that is characterized by specific
behaviors. The person experienced, witnessed, or was confronted with an event or events that involved
actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

PTSD in Children

• The clinical presentation of PTSD in children can be extraordinarily heterogeneous with a bewildering
array of symptoms. Describing children’s responses to trauma Terr (1991) presents four specific
symptoms characteristic of childhood PTSD: repeatedly perceiving memories of the event through
visualization, engaging in behavioral reenactments and repetitive play related to the event, fears related
 to the trauma event, and pessimistic attitudes reflecting a sense of hopelessness about the future and
life in general.

VI. INTERVENTIONS WITH SPECIAL POPULATION

Who is Included in the Special Population?

• Children and Youth

• Women
• Older Adults
• Person with existing health problems

Effective Management

• Efficient delivery of Mental Health Services

• Active Intervention of Health Care Workers
• Integrated use of Psychosocial Services

a. CHILDREN AND YOUTH - When working with children It is important to modify one's language
to match the child's developmental level using direct and simple language.
• Children's Disaster Mental Health Concept of Operations Model - it is a resilience-
enhancement strategy used by local communities, regions, and states to build a comprehensive
mental health response for children and families
b. OLDER ADULTS - They are the one who is vulnerable to loss.
c. INDIVIDUAL WITH MENTAL HEALTH PROBLEMS - The most psychologically vulnerable
people are those with a prior history of psychiatric disturbances.
d. CULTURAL, ETHNIC, AND RELIGIOUS SUBGROUPS - Sensitivity to the cultural and ethnic
needs of survivors and the bereaved is key not only in understanding reactions to stress and grief but
also in implementing effective interventions.
e. DISASTER RELIEF PERSONNEL – Rescue Team

VII. FATIGUE MANAGEMENT

Work Fatigue - Feeling of sleepiness, tiredness, or lack of energy in the field or workplace.

VIII. WHEN GRIEF AND STRESS GO AWAY

 • Mental health services will remain in place after the initial impact.
• Trauma counselors is promoting healing process and treating those who develop psychiatric
symptoms.
• The hallmark for diagnosing a psychiatric disorder is the presence of symptoms like, distressing,
impairment in social, occupational or other impaired daily-life functioning.
• Many types of psychiatric disorders can be seen in the aftermath of a disaster such as PTSD,
adjustment disorder, substance use disorder, major depression, complicated bereavement and
generalized anxiety disorder.
IX. TRAUMATIC GRIEF (COMPLICATED BEREAVEMENT)
• Grief can be determined to be traumatic when it follows a sudden loss, violent or is accompanied
by extreme and intense emotional distress.
• Those experiencing a loss through sudden or violent death are often left with a feeling of unreality
about the loss.
• The complications of grief usually present in one of three ways:
o Chronic
o Delayed
o Masked
• In normal grieving, there is no loss of self-esteem, but in complicated grieving, feelings of
worthlessness are common.
• Diagnosis of a mental disorder is made according to the presenting symptoms.
• Therapies for the treatment of complicated and/or traumatic bereavement:
o Traditional Therapy- Done in one-on-one basis over 8-10 visits.
o Traumatic Grief Therapy- Invades personal information regarding grief.
X. CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

It is a crisis intervention program to mitigate the psychological distress among emergency services personel
and assist them to normal duties.

CISM Strategies

• Pre-incident education/ mental preparedness training

• Individual crisis intervention and on-scene support
• Demobilization after large scale events
• Defusing
• Critical Incident Stress Debriefing (CISD)
 • Significant other support services for families and children
• Follow up services and professional referrals when necessary

Psychological Debriefing - most well-known of the CISM interventions, most controversial, defined as a
"systematic process of education, emotional expression and cognitive recognition".

7 phases that typically applied within 24-72 hours

1. Introduction
2. Facts
3. Thoughts
4. Reaction
5. Symptoms
6. Teaching/ Information
7. Re-entry

Defusing- is a crisis intervention procedure that is similar to debriefing, in which small discussion takes
place within a few hours (8-10) of the event.