Marcia Shannon RNCS, MSN

RN-Aim 2012 7th Annual Conference:

Nurse as Advocate

Advocacy for Disaster Victims: Psychological First Aid

1. Understand the basic interventions, strategies and objectives of Psychological First Aid and how to advocate for these

2. Appreciate ways to take care of yourself before, during and after disaster work, and advocate for the same

Objectives

History of Critical Incident Response

American Revolutionary War (1770’s) – “Rail Road Spine”

Civil War (1860’s) – “Soldiers’ Heart”

WW I (Early 1900’s) -- “Shell Shocked”

WWII (1940’s) -- Applying the Tools of Newly Emerging Field of Psychiatry – “Combat Fatigue”

Viet Nam (1960’s) -- Dx of PTSD Comes to National Awareness

First Responders (1980’s) -- Recognition of Need, Development of Models

Sept. 11, 2001 -- Widest Application of CIRS to General Population

2002 to Present -- Research, Evaluation, Validation of Best Practices

Most reactions to disaster are common and expectable…most people will recover on their own.

DMH and PFA interventions can help facilitate recovery.

Some clients require special care, but less than 6-8%

Resiliency

Recent studies suggest debriefing is NOT always an appropriate intervention, and in some instances may add to distress and impair recovery.

This especially occurs if the person is from a culture that values stoicism or if talking about feelings is embarrassing or considered immature

Debriefings Be Aware

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Psychological Consequences of a Disaster For Example:

Change in travel patterns

Smoking Alcohol

consumption

Behavioral Changes

For Example: Insomnia Sense of vulnerability

For Example: PTSD Major depression

Psychiatric Illness

From IOM publication “Preparing for the Psychological Consequences of Terrorism” www.nap.edu NOTE: Indicative only; not to scale

DistressResponses

Population Exposure Model

(DeWolfe, 2000)

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Tokyo Sarin Attack

Ratio of behavioral: medical casualties was 5:1

Five years post event PTSD was at approximately 14%

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Hurricane Katrina

85% of individuals directly impacted experienced two or more stressors

PTSD which normally decreases several months after a disaster has increased

Psychological First Aid Developed By:

National Child Traumatic Stress Network www.NCTSN.org

National Center for Posttraumatic Stress Disorder www.ncptsd.va.gov Endorsed by the Surgeon General as the official method to use during

disasters Substance Abuse Mental Health Services Administration (SAMHSA) National Association of County and City Health Officials (NACCHO)

How Do We Know How to Respond Following Disasters?

Five Empirically-Supported EarlyIntervention Principles

What is Psychological First Aid?

The practice of recognizing and responding to people who need help because they are feeling stress, resulting from the disaster situations within which they find themselves.

What is Psychological First Aid?

An evidence-informed modular approach to assist children, adolescents,

adults, and families in the immediate aftermath of disaster and terrorism.

Who Is It For?

PFA is for individuals: Experiencing acute stress

reactions Who appear to be at risk for

significant impairment in functioning

Vulnerable Populations in Disaster

Evolution in Critical Incident Response-PFA

Positions the organization’s leadership as competent and compassionate.

Provider serves more as “consultant” and “psycho-educator” than “counselor” and the intervention as more educational than cathartic.

Assumes recovery and defines that recovery in terms of return to work and function.

Promotes a flexible approach that allows for unique response and taps into the strengths and resources of the individual to return to adaptive functioning.

Normalizes symptoms to reduce anxiety regarding them without “prescribing” them.

Provides strategies for self-care and re-entry to life and work.

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Psychological First Aid: Helping Others in Times of Stress

Recognizing Disaster-related Stress

Strengths of Psychological First Aid

PFA is a comprehensive intervention model that: Uses evidence-informed strategies Involves a modular approach Includes basic information-gathering

techniques Offers concrete examples Incorporates a developmental framework Attends to cultural factors Includes user-friendly handouts

Psychological First Aid Core Actions

1 Contact and Engagement

2 Safety and Comfort

3 Stabilization

4 Information Gathering

5 Practical Assistance

6 Connection with Social Supports

7 Information on Coping

8 Linkage with Collaborative Services

What are PFA’s Principle Actions?

PFA’s principle actions are to: Establish safety and security Connect to restorative resources Reduce stress-related reactions Foster adaptive short- and long-term

coping Enhance natural resilience (rather than

preventing long-term pathology)

Who Delivers PFA?

PFA is delivered by disaster response workers who provide early assistance, including: First responders Mental health professionals School personnel Religious professionals Disaster volunteers Health and public health officials Anyone with training

Where Can PFA be Delivered?

PFA can be delivered in a broad range of emergency settings, such as: General population shelters Schools Special needs shelters Hospitals or medical triage areas Family assistance centers Public health emergency settings

Disaster Response Phases

(Adapted from Zunin/Meyers)

Long lines Too hot Too cold A smiling child Mud A spontaneous hug A grateful mom Two people talking to you

at once Grieving relatives Little Debbie cakes “That’s my roommate?!”

Are you ready for disaster work?

A crying baby Too much to do Go find Mental Health!” Bugs Not enough to do A lost dog Tornado warning “You’re an angel.” Beanie Babies “What’s that smell?” New friends Little privacy Watching the healing

begin…

Requirements for PFA Providers

PFA providers must have the: Ability to work in chaotic and unpredictable

environments Capacity for rapid assessment of survivors Ability to provide services tailored to timing

of intervention, context, and culture Ability to tolerate intense distress and

reactions

Requirements for PFA Providers (cont.)

PFA providers must be able to: Accept tasks that are not initially viewed as

mental health activities Work with diverse cultures, ethnic groups,

developmental levels, and faith backgrounds

Have the capacity for self-care

Environmental: temperature, weather, noise, sights, odors, living conditions, ongoing threats

Work-related: long hours, volume of work, type of work, demanding clients, system breakdowns, insufficient resources, conflict with other workers

Vicarious trauma/compassion fatigue: hearing many tragic stories Sources of Worker Stress

Identification with the helper role

Observing the enormous need for help

Difficulty persuading staff to take time off

Ongoing personal issues Challenges to Helping Staff Avoid Burnout

Adrenaline runs dry Immune system and cognitive functioning become impaired

Exhaustion Decreased effectiveness Incidence of illness and accidents increase

BurnoutStaff Condition Over Time

Provider Care: Management

Mandated rotation where workers are moved from the most highly exposed assignments to varied levels of exposure

Enforced support by providing/encouraging: Regular supervision Regular case conferences Peer partners and peer consultation

Provider Care: Management (cont.)

Monitor providers who meet certain high risk criteria

Conduct trainings on stress management practices

Provider Care: Personal

Limit daily numbers of most severe cases Utilize the buddy system to share distressing

emotional responses Use benefit time, vacation, personal time Access supervision routinely Practice stress management during the

workday Stay aware of limitations and needs

Provider Care: Personal (cont.)

Providers should make every effort to avoid: Working too long by themselves without

checking in Working “around the clock” with few breaks Feeling like they are not doing enough Excessive intake of sweets and caffeine

Take Home Messages

Advocate for a flexible, pragmatic, approach, specific to the need, context, and phase of recovery

Advocate from a position of resilience and health NOT pathology and weakness

Advocate for safe working conditions for yourself and your colleagues

Disaster Preparedness and Response (online course) from ARC and STTI http://www.nursingknowledge.org/Portal/main.aspx?PageID=36&SKU=91775

Emergency Preparedness from AHRQ http://nursing.vanderbilt.edu/incmce/modules.html (online modules)

CDC Health Information and Disaster Relief http://www.bt.cdc.gov/disasters/volunteers.asp

Resources