RN-Aim 2012 7 th Annual Conference: Nurse as Advocate Advocacy for Disaster Victims: Psychological First Aid

1. Marcia Shannon RNCS, MSN RN-Aim 2012 7th Annual Conference: Nurse as AdvocateAdvocacy for Disaster Victims: Psychological First Aid

3. 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

5. 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 History of Critical Incident Response

6. 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

7. 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

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

9. Population Exposure Model (DeWolfe, 2000)

10. Ratio of behavioral: medical casualties was 5:1 • Five years post event PTSD was at approximately 14% Tokyo Sarin Attack

11. Hurricane Katrina • 85% of individuals directly impacted experienced two or more stressors • PTSD which normally decreases several months after a disaster has increased

12. 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) Psychological First Aid Developed By:

14. How Do We Know How to Respond Following Disasters?

15. Five Empirically-Supported EarlyIntervention Principles

16. 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?

17. An evidence-informed modular approach to assist children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. What is Psychological First Aid?

18. PFA is for individuals: • Experiencing acute stress reactions • Who appear to be at risk for significant impairment in functioning Who Is It For?

19. Vulnerable Populations in Disaster

20. 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. Evolution in Critical Incident Response-PFA

21. Recognizing Disaster-related Stress Psychological First Aid: Helping Others in Times of Stress

22. 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 Strengths of Psychological First Aid

23. Psychological First Aid Core Actions

24. 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) What are PFA’s Principle Actions?

26. 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 Who Delivers PFA?

27. 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 Where Can PFA be Delivered?

29. (Adapted from Zunin/Meyers) Disaster Response Phases

31. 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… • 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?

32. 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

33. 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 Requirements for PFA Providers (cont.)

35. 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

36. 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

38. Adrenaline runs dry • Immune system and cognitive functioning become impaired • Exhaustion • Decreased effectiveness • Incidence of illness and accidents increase • Burnout Staff Condition Over Time

39. 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

40. Monitor providers who meet certain high risk criteria • Conduct trainings on stress management practices Provider Care: Management (cont.)

41. 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

42. 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 Provider Care: Personal (cont.)

43. 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 Take Home Messages

44. 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