NCM 0120 RELATED LEARNING EXPERIENCE

2nd Semester, Academic Year 2024-2025

MODULE 4 CONTENT: POST IMPACT: RECOVERY, RECONSTRUCTION,

REHABILITATION
Module Overview
Involvement in a disaster is a life-altering event, whether one is a survivor, a
bereaved family member, a neighbor, or a helper. Although we know that individuals
closest to a disaster will be most affected, information about the type and scope of the
disaster can enhance estimates of the intensity and duration of the psychosocial resources
that will be needed to assist those who will be affected by it.

Resistance to psychosocial intervention, however, is such a common reaction

among disaster survivors that mental health services must be made readily available and
easily accessible to those at greatest risk, by taking services out to survivors and the
bereaved.

PSYCHOLOGICAL FIRST AID

●​ First aid for the mind and our social networks is just as important as first aid for the
body.
●​ Learning psychological first aid skills for mental health crisis could save a life.
●​ PFA provides a framework to prepare survivors and the bereaved for the emotional
challenges that lie ahead, and to identify those individuals and families needing
additional follow-up and referral.
-​ Provides emotional and practical support to individuals, families, or
communities who are having difficulty coping.
●​ It is about establishing a connection with people in a compassionate
non-judgmental manner to bring calm and comfort.
●​ It also helps to reduce stigma associated with mental health crises and can reduce
negative health outcomes through general public and community building
strategies on self-care and promoting conversations about wellness.
 ●​ PFA was developed by the National Child Traumatic Stress Network and the
National Center for PTSD, with contributions from individuals involved in disaster
research and response.

Goal
To prepare survivors and the bereaved for the emotional challenges that lie ahead, and to
identify those individuals and families needing additional follow-up and referral.

Who, What and Where of Psychological First Aid

Who? – any distressed person

What? – Before, during, or immediately after a crisis event

Where? – anywhere it is safe, but privacy is important in some situations

Self-Care Plan
●​ Understanding and taking care of yourself is a critical part of providing
Psychological First Aid.
●​ It is difficult to support someone else if you are not taking care of yourself.
●​ Self-care plan identifies the support systems and protective factors you will use to
manage stress to maintain your physical, mental, and emotional health. It is
something that should be revisited regularly and will likely change.
1.​ Stress Assessment
2.​ Support Systems
3.​ Personal Factors

Steps that can be taken immediately to reduce potential psychological harm include:
1.​ Education about the normal reactions to extreme stress and traumatic bereavement
is an important strategy at both the community and individual levels.
2.​ The prevention of re-traumatization—limiting the number of persons with whom
victims must interact in order to receive services, as well as reducing the amount of
red tape required. “Telling the story” can be a source of trauma for some individuals;
therefore, forcing someone to tell his or her story is contraindicated.
3.​ Prevention of new victims—limiting the number of people exposed to the sights,
the sounds, and the smells of a disaster site, whenever possible. Those who do not
need to be at the disaster site should be discouraged from witnessing any of the
horrors of the aftermath.
 4.​ Prevention of “pathologizing” distress—avoid labeling normal reactions as
pathological can prevent symptoms from being interpreted as a medical condition
or disorder that requires treatment. Providing anticipatory guidance about the
emotional, cognitive, behavioral, and physiological responses survivors are likely to
experience in the coming weeks and months normalizes these reactions and helps
survivors to regain perspective and self-confidence. If prepared for these responses,
individuals will be less likely to become frightened or overly worried by them.
5.​ Identification of individuals showing signs of acute distress—Those who may need
immediate medical intervention include individuals with obvious and active
physiological stress reactions (exceedingly frantic, panicky, or extremely angry) or
individuals who are profoundly shut down (numb, dissociated, disconnected).

Psychological First Aid (PFA) Core Actions

1.​ Contact and Engagement
To respond to contacts initiated by affected persons, or initiate contacts in a
nonintrusive, compassionate, and helpful manner.

Active listening allows the disaster worker to establish a sense of respect and trust
and to better understand the survivor’s situation and needs.

Several tips for active listening:

Allow silence. Silence gives the survivor time to reflect and become aware of
feelings. “Being with” the survivor and his/her experience is very supportive.

Attend nonverbally. Eye contact, head nodding, and caring facial expressions let
survivors know you are in tune with them.

Paraphrase. Repeating portions of what the person has said conveys interest,
understanding, and empathy. Paraphrasing also clarifies meaning and checks for
misunderstandings.

Reflect feelings. If the survivor’s tone of voice or nonverbal gestures suggest anger,
sadness, or fear, the worker may state, “You sound/appear angry, scared, etc.; does
that fit for you?” This helps the survivor to identify and articulate his/her emotions.

2.​ Safety and Comfort

To enhance immediate and ongoing safety, and provide physical and emotional
comfort.

Allow expression of emotions. Expression of intense emotions through tears or

angry venting is an important part of healing; it often helps the survivor work
 through feelings so that he/she can better engage in constructive problem-solving.
Workers should stay relaxed, breathe, and let the survivor know that it is okay to
feel.

3.​ Stabilization (if needed)

To calm and orient emotionally—overwhelmed/distraught survivors.

Because survivors are often so overwhelmed by their situation, it is difficult for

many to know where to start. Thus, counselors may advise survivors not to make any
new or big decisions while undergoing a crisis. While some are immobilized by the
stress, others may feel pressured to take some action.

4.​ Information Gathering: Needs and Current Concerns

To identify immediate needs and concerns, gather additional information, and tailor
PFA interventions.

Identify and define the problem. Ask survivors to describe the problems/challenges
they are facing right now. Selecting one problem that is relatively solvable is helpful,
in that immediate success can bring the survivor some sense of control and
confidence.

5.​ Practical Assistance

To offer practical help to survivors in addressing immediate needs and concerns.

6.​ Connection with Social Supports

To help establish brief or ongoing contacts with primary support persons or other
sources of support, including family members, friends, and community help
resources.

Social support networks can provide important affective and material aid that
mitigates the adverse effects of disaster trauma

7.​ Information on Coping

To provide information (about stress reactions and coping) to reduce distress and
promote adaptive functioning.

Assess the survivor’s functioning and coping. Ask the survivor how he or she has
coped with stress in the past, and how he or she is doing right now. Through
observation, asking questions, and reviewing the magnitude of the survivor’s
problems and losses, the worker develops an impression of the survivor’s ability to
address the current challenges. Based on this assessment, the worker may make
 referrals, point out coping strengths, and facilitate the survivor’s engagement with
social supports.

8.​ Linkage with Collaborative Services

To link survivors with needed services, and inform them about available services
that may be needed in the future

Evaluate available resources. Ask who might be able to help with this problem, and
what resources/options might help. Use existing sources of assistance and support
when they are available, and refer to relief agencies when they are not.

FEAR MANAGEMENT TECHNIQUES

Anxiety (fear or worry) is a feeling of uneasiness or distress about some real or perceived
threat or situation that is occurring now or that is believed will occur in the future, and to
which is believed will, or is likely to, result in a negative outcome.

Psychotherapy ​
Talking with a mental health professional can help you manage your specific phobia.
Exposure therapy and cognitive behavioral therapy are the most effective treatments.

●​ Exposure therapy focuses on changing a person’s response to the object or

situation that he fears. Gradual, repeated exposure to the source of his specific
phobia and the related thoughts, feelings and sensations may help him learn to
manage his anxiety. For example, if he is afraid of elevators, his therapy may
progress from simply thinking about getting into an elevator, to looking at
pictures of elevators, to going near an elevator, to stepping into an elevator.
Next, he may take a one-floor ride, then ride several floors, and then ride in a
crowded elevator.

●​ Cognitive behavioral therapy (CBT) involves exposure combined with other

techniques to learn ways to view and cope with the feared object or situation
differently. Enables a person to manage his fears by helping him gradually
change the way you think. It's based on the interconnectedness of thoughts,
beliefs, feelings, and behaviors.

Medications
Medications may be used during initial treatment or for short-term use in specific,
infrequently encountered situations, such as flying on an airplane, public speaking or going
through an MRI procedure.
 ●​ Beta blockers. To block the effects of adrenaline

●​ Sedatives. To relax and reduce anxiety more accurately.

Lifestyle and home remedies

●​ Mindfulness strategies may be helpful in learning how to tolerate anxiety and
reduce avoidance behaviors.

●​ Relaxation techniques, such as deep breathing, progressive muscle relaxation

or yoga, may help cope with anxiety and stress.

●​ Physical activity and exercise may be helpful in managing anxiety associated

with specific phobias.

GUIDELINES IN DISASTER AND EMERGENCY SITUATIONS

MENTAL HEALTH AND PSYCHOLOGICAL SUPPORT IN EMERGENCY SETTINGS

Emergency situations such as armed conflicts, natural disasters and other humanitarian
crises exacerbate the risk of mental health conditions. Nearly all people affected by these
emergencies will experience psychological distress, with one in five likely to have a mental
disorder such as depression, anxiety, post-traumatic stress disorder, bipolar disorder or
schizophrenia. Stressful events such as violence and loss, as well as poverty, discrimination,
overcrowding, and food and resource insecurity, are common in emergencies and can
increase the risk of developing mental health conditions. People with severe mental
disorders are particularly vulnerable.

Those that may need immediate medical intervention include individuals with obvious and
active physiological stress reactions or individuals who are profoundly shut down (numb,
dissociated, disconnected); elderly survivors are also particularly vulnerable because of
preexisting medical or cognitive limitations.

However, while emergencies have a detrimental effect on mental health, they have also
been shown to provide opportunities to build sustainable mental health care systems in the
period following the event. WHO works around the world to ensure that the humanitarian
mental health response is both coordinated and effective.
Reducing resistance to psychosocial intervention
●​ Emotional distress is equated with mental illness. This concern is the reason why
medical professionals are often reluctant to include mental health professionals on
the team and that victims do not seek psychiatric consultation. This is a barrier that
needs to be overcome, however, as the immediate mental health response to a
disaster should be educationally oriented, not treatment oriented.
●​ Resistance to outside help can be so difficult to overcome that survivors are not
likely to present themselves to an emergency room or a clinic for psychiatric
treatment even when in extreme need.

Goals of post impact intervention

●​ is to foster and stimulate the natural healing process that occurs within the
community.
●​ ought to be decreasing the resistance to treatment among individuals whose
emotional suffering exceeds the natural healing capacity of the group and to make
that treatment easily available. - Therefore, a plan that includes outreach services is
critical.

Main reasons to include mental health workers as part of the immediate medical response:
1) Personal experience of the disaster and its immediate aftermath may increase the
credibility of mental health counselors in a way that is likely to facilitate their subsequent
work with victims and responders.

2) Early intervention allows mental health professionals to be seen as part of the medical
team, rather than as distant and possibly threatening figures.

3) In the emotionally charged atmosphere of the post impact phase of the disaster, a special
bonding may occur between helper and victim, which may facilitate subsequent
counseling and treatment.

4) Early intervention provides an opportunity for “psychological triage” and identification

of those who may be at particular risk for adverse reactions

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.
 -​ Targeting interventions to those at greatest risk is both more efficient and more
effective than attempting to provide mental health interventions to everyone who
has been exposed

Mental Health Referrals

-​ Reactions to stress and bereavement should be assessed in greater detail for the
presence of a mental disorder if they are significantly distressing to the individual or
impair an important aspect of social or occupational function
-​ Factors that may influence whether trauma exposure progresses to PTSD include
one’s natural resilience, genetic loading, the type of trauma, whether the trauma is
natural or man-made, past traumas, and psychiatric comorbidities

Special Needs Population

Children

-​ in infancy through age 19, are particularly vulnerable to psychological harm because
of their unique developmental status.

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.
-​ They are often lacking in social support, may be financially disadvantaged, and are
traditionally reluctant to accept offers of help.
-​ Exacerbations of preexisting medical conditions, either directly because of the
emotional and psychological stress, or because of disruptions to their care, such as
loss of medications or needed medical equipment, changes in primary care
providers, lack of continuity of care, or lack of consistency in self-care routines due
to relocation.
-​ Loss of irreplaceable possessions—photographs, mementos, and heirlooms—may
have even greater meaning and value for older adults.
-​ Disasters may serve as a reminder of the fragility and ultimate finality of life. Older
adults may also be more likely to withhold information or refuse help due to fears of
losing their independence. Institutionalization remains a real concern among senior
citizens who suffer the trauma of a disaster.
Severely Mentally Ill
-​ 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.
-​ Those with a chronic mental illness are particularly susceptible to the effects of
severe stress, as they may be marginally stable and may lack adequate social support
to buffer the effects of the terror, bereavement, or dislocation.
-​ Follow up from menta health workers, outpatient connections

Normal reactions to abnormal events

●​ Normal reactions to stress and bereavement can and do vary—sometimes even
among members of the same family.
●​ Factors that affect expressions of stress and bereavement: include age, gender,
ethnicity, religious background, personality traits, coping skills, and previous
experience with loss, especially traumatic loss.
●​ Adults and children need not be present at a traumatic event to have stress
symptoms, especially if they consider themselves similar to the victims. As these
reactions can be quite startling and overwhelming to those who have not
experienced them before, it is helpful for survivors to hear that their experiences are
entirely normal, given the tremendous stress to which they have been exposed.

The American Red Cross recognizes four phases of emotional recovery following impact of
a disaster:
1.​ Heroic phase
-​ numbness, shock, and even elation when a life is saved, may be most evident.

2.​ Honeymoon phase

-​ survivors are grateful, and the community pulls together to cope with the
disaster.

3.​ Disillusionment phase

-​ depression and hopelessness may become more prominent, as the reality of how
life has changed post disaster becomes ever more apparent.
-​ The enormous drain of reserves— physical, financial, and emotional—takes its
toll.
 -​ Adults may experience physical reactions such as headaches, increased blood
pressure, ulcers, gastrointestinal problems, and sleep disorders.
-​ Emotional reactions may vacillate between emotional numbness and
expressions of intense emotion.
-​ Anxiety and depression are common emotional reactions, as are anger and
frustration— sometimes displaced onto relief workers when anger about the
disaster seems “less rational.”

4.​ Reconstruction phase

-​ gradually becomes more apparent as intense emotions are replaced by a sense of
acceptance, increasing independence, and emotional reinvestment in
relationships and activities of daily life.

Resiliency in the Face of Disaster

resiliency is often the most commonly observed outcome trajectory after exposure to a
potential traumatic event.

Characteristics associated with resiliency include family stability, social support, and
capacity to tolerate stress and uncertainty.

By promoting resilience and coping after disaster, mental health professionals can draw on
the individual’s strengths or create the supports needed to ward off lasting symptoms or
functional difficulties and avoid interventions that may actually interfere with one’s own
inherent resiliency and therefore impede recovery.

Helping Children, Teens, and Their Families Cope With Tragedy

1.​ Be honest and give age and developmentally appropriate explanations about the
traumatic event.
-​ For young children, in particular, only provide answers to questions they are
asking and do not overwhelm them with too much detail.
-​ Use language that young children can understand.
-​ Do not expose young children to visual images that are terrifying in the
newspapers or television.
-​ It may be easier for young children to express how they are feeling by asking
them to talk about how their stuffed animals or dolls are feeling or thinking.

2.​ Help children and teens to express how they are feeling about what they have seen
or heard.
-​ If children have difficulty verbally expressing their feelings, ask them to make a
drawing about how they are feeling.
 -​ Older school age children and teens can benefit from writing about how they
feel.
-​ Ask children and teens, “What is the scariest or worst thing about this event for
you?”

3.​ Reassure children that they did nothing wrong to cause what happened.
-​ Toddlers and preschool children especially feel guilty when something tragic
happens.

4.​ Tell children and teens that what they are feeling (e.g., anger, anxiety, helplessness)
is normal and that others feel the same way.

5.​ Alleviate some of their anxiety by reassuring children that we will get through this
together and will be stronger as a result of what we have been through.
-​ Emphasize that everything is now under control and that adults will be there to
help them through this and that they are not alone.

6.​ Help children and teens to release their tension by encouraging daily physical
exercise and activities.

7.​ Continue to provide structure to children’s schedules and days.

8.​ Recognize that a tragic event could elevate psychological or physical symptoms
(e.g., headaches, abdominal pain, or chest pain) in children and teens who are
already depressed or anxious.
-​ Remember that young children who are depressed typically have different
symptoms (e.g., restlessness, excessive motor activity) than older school age
children or teens who are depressed (e.g., sad or withdrawn affect, difficulty
sleeping or eating, talking about feeling hopeless).
-​ Anger can be a sign of anxiety in children and teens.
-​ Children, even teens, who are stressed typically regress (e.g., revert to doing
things that they did when they were younger, such as sucking their thumbs,
bed-wetting, or acting dependent upon their parents). This is a healthy
temporary coping strategy. If these symptoms persist for several weeks, however,
talk to your health care provider about them.

9.​ Use this opportunity as a time to work with children on their coping skills.

10.​ Be sure to have your child or teen seen by a health care provider or mental health
professional for signs or symptoms of depression, persistent anxiety, recurrent pain,
 persistent behavioral changes, or if they have difficulty maintaining their routine
schedules.

11.​ Remember that this can be an opportunity to build future coping and life skills as
well as bring your family unit closer together

REFERENCES

About PFA. (2018, March 29). The National Child Traumatic Stress Network.

[Link]

or-psychological-recovery/about-pfa

Canadian Red Cross Society. (2019). Psychological First Aid Pocket Guide. Canadian Red

Cross. Retrieved January 24, 2022, from [Link]

Hansen, P. (2018). A guide to Psychological First Aid: For Red Cross and Red Crescent

Societies [E-book]. KLS PurePrint, Hvidovre, Denmark.

Psychology Today. (2021). Fear. Retrieved January 24, 2022, from

[Link]

Specific phobias - Diagnosis and treatment - Mayo Clinic. (2016, October 19). Mayo Clinic.

Retrieved January 24, 2022, from

[Link]

nt/drc-20355162

Veenema, P. D. M. P. H. M. S. C. F., PhD, & Tener Goodwin Veenema, P. D. M. P. H. M. S. C. F.

(2018). Disaster Nursing and Emergency Preparedness. Springer Publishing.

WHO. (2022, January 11). Ensuring a coordinated and effective mental health response in

emergencies. World Health Organization. Retrieved January 24, 2022, from

 [Link]

-response-in-emergencies

Prepared by:
(SGD) Alpha Patricia G. Cabacungan, RN

Contributor:

Myron L. Roque, RN, MN

NCM 0120 Instructor

Peer Evaluator:
Evangeline C. Bautista, RN, MAN
NCM 0120 Instructor

Reviewed by:

Ma. Corazon M. Tanhueco, RN, MAN

Level IV Academic Coordinator

Angela P. Apostol, RN, MN

Level IV RLE Coordinator​

Debbie Q. Ramirez, RN, PhD

Assistant Dean

Approved by:
Zenaida S. Fernandez, RN, Ph.D
Dean, College of Nursing