Nur 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 22

LESSON TITLE: Psychological First Aid Materials:

Book, pen and notebook
LEARNING OUTCOMES:
References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Explain how do crisis events affect people. Emergency Preparedness for Chemical,
2. Understand what psychological aid is and is not. Biological, and Radiological Terrorism and other
3. Describe the Action Principles of PFA. Hazards 4th Edition
4. Identify general guidelines to provide PFA. https://www.who.int>mental _health
https://www.youtube.com/watch?v=nCtKGrJQ
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LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the approaches to emergency and disaster management in the community?

MAIN LESSON (40 minutes)

How do crisis events affect people?

Different kinds of distressing events happen in the world, such as war, natural disasters, accidents, fires and interpersonal
violence (for example, sexual violence). Individuals, families or entire communities may be affected. People may lose their
homes or loved ones, be separated from family and community, or may witness violence, destruction or death. Although
everyone is affected in some way by these events, there are a wide range of reactions and feelings each person can
have. Many people may feel overwhelmed, confused or very uncertain about what is happening. They can feel very fearful
or anxious, or numb and detached. Some people may have mild reactions, whereas others may have more severe
reactions. How someone reacts depends on many factors, including: » the nature and severity of the event(s) they
experience; » their experience with previous distressing events; » the support they have in their life from others; » their
physical health; » their personal and family history of mental health problems; » their cultural background and traditions; »
their age (for example, children of different age groups react differently).

Psychological first aid: WHO (2010) and Sphere (2011) describe psychological debriefing as promoting ventilation by
asking a person to briefly but systematically recount their perceptions, thoughts and emotional reactions during a recent
stressful event. This intervention is not recommended. This is distinct from routine operational debriefing of aid workers
used by some organizations at the end of a mission or work task. Every person has strengths and abilities to help them
cope with life challenges. However, some people are particularly vulnerable in a crisis situation and may need extra help.
This includes people who may be at risk or need additional support because of their age (children, elderly), because they
have a mental or physical disability, or because they belong to groups who may be marginalized or targeted for violence.

What PFA Is?

Humane, supportive and practical assistance to fellow human beings who recently suffered exposure to serious
stressors, and involves:
– Non-intrusive, practical care and support
– Assessing needs and concerns

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– Helping people to address basic needs (food, water)
– Listening, but not pressuring people to talk
– Comforting people and helping them to feel calm
– Helping people connect to information, services and social supports
– Protecting people from further harm

What PFA is NOT?

• It is NOT something only professionals can do
• It is NOT professional counseling
• It is NOT “psychological debriefing” – No detailed discussion of the distressing event
• It is NOT asking people to analyze what happened or put time and events in order
• Although PFA involves being available to listen to people’s stories, it is NOT pressuring people to tell you their feelings
or reactions to an event

PFA is an alternative to “psychological debriefing” which has been found to be ineffective. In contrast, PFA involves
factors that seem to be most helpful to people’s long-term recovery (according to various studies and the consensus of
many crisis helpers). These include:
» feeling safe, connected to others, calm and hopeful;
» having access to social, physical and emotional support; and
» feeling able to help themselves, as individuals and communities.

Who is PFA for?

PFA is for distressed people who have been recently exposed to a serious crisis event. You can provide help to both
children and adults. However, not everyone who experiences a crisis event will need or want PFA. Do not force help on
people who do not want it, but make yourself easily available to those who may want support.

People who need more immediate advanced support:

» people with serious, life-threatening injuries who need emergency medical care
» people who are so upset that they cannot care for themselves or their children
» people who may hurt themselves » people who may hurt others

Who needs more advanced support than PFA alone?

• People with serious lifethreatening injuries
• People so upset they cannot care for themselves or their children
• People who may hurt themselves
• People who may hurt or endanger the lives of others.

When is PFA provided?

Although people may need access to help and support for a long time after an event, PFA is aimed at helping people who
have been very recently affected by a crisis event. You can provide PFA when you first have contact with very distressed
people. This is usually during or immediately after an event. However, it may sometimes be days or weeks after,
depending on how long the event lasted and how severe it was.

Where is PFA provided?

You can offer PFA wherever it is safe enough for you to do so. This is often in community settings, such as at the scene of
an accident, or places where distressed people are served, such as health centers, shelters or camps, schools and
distribution sites for food or other types of help. Ideally, try to provide PFA where you can have some privacy to talk with
the person when appropriate. For people who have been exposed to certain types of crisis events, such as sexual
violence, privacy is essential for confidentiality and to respect the person’s dignity.

Why PFA?
Key resilience factors
• People do better over the long-term if they…
– Feel safe, connected to others, calm & hopeful
– Have access to social, physical & emotional support
– Regain a sense of control by being able to help themselves

Frequent Needs of People After Crisis Event

• Basic needs: shelter, food, water, sanitation

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 • Health services for injuries or help with chronic medical conditions
• Understandable and correct information about event, loved ones and available services
• Being able to contact loved ones
• Access to specific support related to one’s culture or religion
• Being consulted and involved in important decisions

Crisis situations can be chaotic

Often require urgent action
Wherever possible BEFORE you enter a crisis site, try to obtain accurate information so you can be safe and effective.

Wherever possible, before you enter a crisis site, try to learn about……

The Crisis Event Where?

When?
How many and who are affected?
Available Services Who is providing for basic needs (emergency medical care, food, shelter)?
When & where can people access services?
Who is helping, including community members?
Safety & Security Is the crisis over or ongoing (aftershocks, fighting)?
What dangers may be in the environment?
Are there places to avoid due to insecurity or because it is not permitted to
be there?

The three basic action principles of PFA are look, listen and link. These action principles will help guide how you view and
safely enter a crisis situation, approach affected people and understand their needs, and link them with practical
support and information

Scenario: Natural Disaster

• The setting:
– A large earthquake suddenly hit the center of the city in the middle of the work day. Many people are affected, the
extent of the damage is unclear

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• Key PREPARE questions:
– Am I ready to help?
– What information do I have about the crisis situation?
– Will I travel alone or together with colleagues?
– What support can I expect from my agency or others?
• Key LOOK questions:
– What services and supports are available?
– Where will I provide PFA?

Prepare • Learn about the crisis event.

• Learn about available services and supports.
• Learn about safety and security concerns

Readiness: consider your health and personal situation

• Gather as much accurate information as you can about: who is affected, how severely affected, where they are
• Work in pairs/teams for support/safety
• Your agency may be able to provide you with: equipment, updated information, support with coordination

Look •Observe for safety.

•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions.
•Safety issues: fallen or unstable buildings
•Services (i.e., emergency medical) may be disrupted
•Look for seriously injured or trapped people
•Look for people who are upset, anxious or in shock
•Look for people who may need special assistance: separated children, immobile/elderly

Look •Observe for safety.

•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions

• Crisis situations can change rapidly.

• What you encounter may be different from what you learned before entering.
• Take time - even a quick scan - to LOOK around you before offering help
Be calm Be safe
Think before you act

Look •Observe for safety.

•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions.

Safety •What dangers can you observe? If you’re not certain about safety…DO
•Can you be there without harm to NOT GO! Seek help from others.
yourself or others? Communicate from a safe distance.
People with obvious urgent basic •Is anyone critically injured Know your role. Try to obtain help for
needs •Does anyone need rescue? people who need special assistance.
•Obvious needs (torn clothing…)? Refer critically injured people for care.
•Who may need help to access
services or to be protected?
•Who else is available to help?
People with serious distress •How many & where are they? Consider who may benefit from PFA
•Is anyone extremely upset, and how best to help.
immobile, not responding to others or

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 in shock?

People who Likely Need Special Attention (to be safe…to access services
• Children and adolescents – Especially those separated from caregivers
• People with health conditions and disabilities
– Chronic illness, elderly, pregnant or nursing women, non-mobile, hearing/visual impairments (deaf/blind)
• People at risk of discrimination or violence
– Women, certain ethnic or religious groups, mental disabilities

Helping people in distress

• Most people recover well over time, especially if they can restore basic needs and receive support (PFA).
• Those with severe or long-lasting distress may require more support.
– Try to make sure they are not left alone.
– Try to keep them safe until the reaction passes or you can find help from others

Listen •Make contact with people who may need support.

•Ask about people’s needs and concerns.
•Listen to people and help them feel calm.

GUIDELINES:
❖ Be polite, don’t intrude and ask respectful questions about how you can help
❖ Often useful to make contact through practical helping (eg, wound care, giving medications
❖ Speak slowly, calmly and respectfully

If people want to talk with you, listen carefully, focus on what they are trying to tell you and how you can help. Do
not actively elicit details of the traumatic experience or their loses.

TRY TO AVOID:
❖ Assuming you know peoples’ experiences or what they have been through
❖ Assuming that everyone is traumatized
❖ Do not apologize
❖ Do not increase people’s helplessness by taking – your task is to help themselves
❖ Assuming that everyone wants (or needs) to talk

1. Establish contact
Goal: To initiate non-intrusive engagement.
▪ Introduce yourself and ask about their immediate needs.
▪ Try to find somehow private.
▪ Ensure confidentiality is maintained.
▪ Make contact with a parent (or guardian) before speaking with children.
▪ It is ok if people don’t want to speak with you.
▪ For Example:
Hello, my name is… And I’m working with …. I am checking with people to see how they are doing. May I speak
with you for a few minutes? May I ask your name? Before we speak, is there anything you need immediately
(perhaps some water)?
Hello, my name is …. and I am working with…. I will need to check your wound. Before I do so, do you have any
questions? Is there anything you need before I look at your wound? Are there any other things I can help you
with?

2. Safety and Comfort

Goal: Enhance immediate and ongoing safety and promote emotional comfort.
▪ Give current, accurate information, but avoid too much information.

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 ▪ Ensure immediate physical safety.
▪ Promote social contact with others
▪ Ensure children who are separated from caregivers are protected.

3. Stabilization
Goal: To calm and orient emotionally overwhelmed and disoriented survivors.
▪ Observe for physical symptoms (shaking, headaches, feeling very tired, loss of appetite)
▪ Crying, sadness, depressed mood, grief
▪ Anxiety, fear, confused, appearing withdrawn, disorientation
▪ Being “on guard “or jumpy
▪ Insomnia, nightmares
▪ Not responding to others, not speaking at all, not being able to care for themselves

4. Information gathering
Goal; Identify immediate needs and concerns.
▪ For Example:
o Are they separated from or concerned about a loved one?
o Do they have any illnesses?
o What support do they have?
o What coping strategies are they using?

5. Practical Assistance
Goal: Offer practical assistance and meet survivor needs.
▪ Enhance problem solving by:
o Identify most immediate needs.
o Help the person clarify the needs.
o Develop an action plan.
o Help the person act.

6. Connect to social groups

Goal: To establish contact with support persons.
▪ Key elements of support include:
o Emotional support
o Social connection
o Reassurance of self-worth
o Physical assistance
▪ Increasing Support: Enhance access to primary support, encourage use immediately available persons
▪ Discuss support seeking and giving, model supportive responses.

7. Information on coping
Goal: To provide information on stress reactions and coping.
▪ Provide basic information on stress reactions.
▪ Review common psychological reactions to trauma.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

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Multiple Choice

(For 1-10 items, please refer to the questions in the Rationalization Activity)

RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates for 10 minutes.

1. What is psychological first aid?

a. Is a humane, supportive and practical first response given to people or persons in emotional distress
b. Helping people access information and services
c. Understanding their needs and concerns, and respond accordingly
d. Protecting affected persons from any further harm
ANSWER: ________
RATIO: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

2. What are the 3 action principles of PFA? Select that all apply.
a. Prepare
b. Look
c. Listen
d. Link
ANSWER: ________
RATIO: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

3. Who delivers psychological first aid?

a. Depressed clients
b. Non-mental professional
c. Mental Professional
d. All of the above
ANSWER: _______
RATIO: _____________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________________

4. Who receives psychological first aid? Select that all apply.

a. Disaster survivors
b. Individual in crisis
c. Disaster responders
d. None of the above
ANSWER: _______
RATIO: _____________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________________

5. Which of the following is NOT a sign that a survivor may need stabilization??
a. Excessive talking
b. Insomnia
c. Fear
d. Nightmares
ANSWER: _________
RATIO: ____________________________________________________________________________
_________________________________________________________________________________

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 __________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER:
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________

LESSON WRAP-UP (5 minutes)

Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1 This strategy provides a structure for students to record their own comprehension and
summarize their learning. It also gives the teacher an opportunity to identify areas that need re-teaching, and areas of
student interest.

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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