Disaster Mental Health Nursing: Implications for Disaster Preparedness and Practice in New Zealand

<p>Disaster mental health care is now a recognised nursing specialty in many countries, including Australia, Sweden and the United States of America (Raphael & Meldrum 1993). Despite compelling international literature on the benefits of disaster mental health response, (Myers 1993, Speier 1995),New Zealand has not followed these trends recognising the importance of such health care. Disaster mental health care is conspicuously absent in any meaningful form within our current health system. The majority of Crown Health Enterprise (CHEs), including Capital Coast Health Ltd and Midcentral Health Ltd preparedness plans imply only that mental health services will respond. Unfortunately, the plans say little of how these services are to be met or what is required in terms of knowledge, skills and resources to meet these objectives. The focus of disaster management in New Zealand is trauma orientated, directed towards the surgical, physical and medical needs of casualties. In his experience (Burkle, 1996) argues that triage and disaster management plans, for the most part, fail 3 to include in their classifications the primary casualty who also suffers acute psychological consequences of the physical trauma. New Zealand has experienced many memorable disasters that would seem to have been forgotten in the planning of health care, especially in relation to mental health care needs, both at the national and local service level of planning. The aim of this literature review is to inform the reader regarding knowledge of disaster health care issues such as understanding the impact, public health effects,clinical implications, interventions and the issues, problems and challenges that nurses in New Zealand can learn about mental health disaster preparedness and response. The ultimate goal of this review is to contribute towards the development and implementation of national health care standards and guidelines, focusing on the mental health aspects of disaster care in New Zealand. The framework chosen for this literature review is a combination of epidemiologic public health and service issues, rather than focusing on a singular nursing framework. This is intentional because in New Zealand, mental health nursing is hugely undeveloped or in the main, absent in this area. The frameworks used are expected to inform nursing in the professional provision of disaster mental health care. The rationale for the combination of frameworks used is that disasters affect a community in numerous ways and are considered a public health problem (WHO 1980). Noji (1991) points out that surveys have shown that each kind of disaster has its own common epidemiologic profile and pathologic characteristics. This is crucial in planning and in designing and implementing prevention activities. Within an epidemiologic framework, follow-up studies can assist in identifying risk factors for nurses that would serve as the basis for planning strategies in preventing or reducing impact related morbidity in future disasters. Practical applied and operational research can be useful for nurses in planning public health responses to future disasters. Within this framework it also provides nurses with information useful for client care and developing appropriate mental health relief response.Ideally, the disaster mental health team should be inter-disciplinary and multi-skilled - professionals. Disaster mental health nursing within inter-disciplinary teams is now a well recognised, but still developing specialty in overseas literature, (Myers 1993; Raphael & Meldrum 1993). This literature review supports an interdisciplinary approach as the preferred way of how nursing would fit within disaster mental health care. It is envisaged that the resulting discussion and recommendations form the background for further clinical research and/or background towards formulating health care policies and standards in regards to all aspects of service and professional provision of disaster mental health care in New Zealand, including nursing. It is imperative that both readers and health policy plamers alike are challenged into assisting with frameworks in the areas of preparedness planning, recruitment, training and other local and national relief efforts of various professional groups and disaster service organisations. There is an expectation that all services will respond in a disaster, including mental health. The current reality is that when the next disaster does strike, the public of New Zealand could be failed.</p>

Disaster Mental Health Nursing: Implications for Disaster Preparedness and Practice in New Zealand

<p>Disaster mental health care is now a recognised nursing specialty in many countries, including Australia, Sweden and the United States of America (Raphael & Meldrum 1993). Despite compelling international literature on the benefits of disaster mental health response, (Myers 1993, Speier 1995),New Zealand has not followed these trends recognising the importance of such health care. Disaster mental health care is conspicuously absent in any meaningful form within our current health system. The majority of Crown Health Enterprise (CHEs), including Capital Coast Health Ltd and Midcentral Health Ltd preparedness plans imply only that mental health services will respond. Unfortunately, the plans say little of how these services are to be met or what is required in terms of knowledge, skills and resources to meet these objectives. The focus of disaster management in New Zealand is trauma orientated, directed towards the surgical, physical and medical needs of casualties. In his experience (Burkle, 1996) argues that triage and disaster management plans, for the most part, fail 3 to include in their classifications the primary casualty who also suffers acute psychological consequences of the physical trauma. New Zealand has experienced many memorable disasters that would seem to have been forgotten in the planning of health care, especially in relation to mental health care needs, both at the national and local service level of planning. The aim of this literature review is to inform the reader regarding knowledge of disaster health care issues such as understanding the impact, public health effects,clinical implications, interventions and the issues, problems and challenges that nurses in New Zealand can learn about mental health disaster preparedness and response. The ultimate goal of this review is to contribute towards the development and implementation of national health care standards and guidelines, focusing on the mental health aspects of disaster care in New Zealand. The framework chosen for this literature review is a combination of epidemiologic public health and service issues, rather than focusing on a singular nursing framework. This is intentional because in New Zealand, mental health nursing is hugely undeveloped or in the main, absent in this area. The frameworks used are expected to inform nursing in the professional provision of disaster mental health care. The rationale for the combination of frameworks used is that disasters affect a community in numerous ways and are considered a public health problem (WHO 1980). Noji (1991) points out that surveys have shown that each kind of disaster has its own common epidemiologic profile and pathologic characteristics. This is crucial in planning and in designing and implementing prevention activities. Within an epidemiologic framework, follow-up studies can assist in identifying risk factors for nurses that would serve as the basis for planning strategies in preventing or reducing impact related morbidity in future disasters. Practical applied and operational research can be useful for nurses in planning public health responses to future disasters. Within this framework it also provides nurses with information useful for client care and developing appropriate mental health relief response.Ideally, the disaster mental health team should be inter-disciplinary and multi-skilled - professionals. Disaster mental health nursing within inter-disciplinary teams is now a well recognised, but still developing specialty in overseas literature, (Myers 1993; Raphael & Meldrum 1993). This literature review supports an interdisciplinary approach as the preferred way of how nursing would fit within disaster mental health care. It is envisaged that the resulting discussion and recommendations form the background for further clinical research and/or background towards formulating health care policies and standards in regards to all aspects of service and professional provision of disaster mental health care in New Zealand, including nursing. It is imperative that both readers and health policy plamers alike are challenged into assisting with frameworks in the areas of preparedness planning, recruitment, training and other local and national relief efforts of various professional groups and disaster service organisations. There is an expectation that all services will respond in a disaster, including mental health. The current reality is that when the next disaster does strike, the public of New Zealand could be failed.</p>

Geographic variability of post-disaster mental health: case study after the 2017 flood in Bangladesh

Every year Bangladesh faces enormous damages due to flooding. Facing these damages the Government adopts various recovery approaches. However, the psychological dimension of any disaster is generally overlooked in disaster management. Researchers have found that the spatial distribution of post-disaster mental health can help the authorities to apply recovery procedures where they are most needed. For this research, Posttraumatic Stress Checklist (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to estimate posttraumatic stress, major depressive disorder and anxiety following three episodes of severe floods in 2017 that affected at least 8 million people. To better understand the spatial pattern of psychological vulnerability and reach a comprehensive scenario of post-disaster mental health, Moran’s I was applied for spatial autocorrelation and Pearson’s correlation and regression analysis for a study of the relationship between the psychological aspects. It was found that psychological vulnerability showed a spatial clustering pattern and that there was a strong positive linear relationship among psychological aspects in the study area. This research might help to adopt disaster management policies that consider the psychological dimension and spatial distribution of various psychological aspects to identify areas characterized by high vulnerability and risk so that they can be reached without delay.

Differences in post-disaster mental health among Vietnamese and African Americans living in adjacent urban communities flooded by Katrina

Some communities recover more quickly after a disaster than others. Some differentials in recovery are explained by variation in the level of disaster-related community damage and differences in pre-disaster community characteristics, e.g., the quality of housing stock. But distinct communities that are similar on the above characteristics may experience different recovery trajectories, and, if so, these different trajectories must be due to more subtle differences among them. Our principal objective is to assess short-term and long-term post-disaster mental health for Vietnamese and African Americans living in two adjacent communities in eastern New Orleans that were similarly flooded by Hurricane Katrina. We employ data from two population-based cohort studies that include a sample of African American adults (the Gulf Coast Child and Family Health [GCAFH study]) and a sample of Vietnamese American adults (Katrina Impacts on Vietnamese Americans [KATIVA NOLA study]) living in adjacent neighborhoods in eastern New Orleans who were assessed near the second and thirteenth anniversaries of the disaster. Using the 12-Item Short Form Survey (SF-12) as the basis of our outcome measure, we find in multivariate analysis a significant advantage in post-disaster mental health for Vietnamese Americans over their African American counterparts at the two-year mark, but that this advantage had disappeared by the thirteenth anniversary of the Katrina disaster.

The consequences of the COVID-19 pandemic in nurses in the pre-hospital emergency syste

Introduction The COVID-19 pandemic has highlighted the crucial role of nurses and their commitment to their work in facing the situation. Italy has seen a substantial increase in the number of requests for respiratory assistance, and nurses employed on emergency vehicles have been overwhelmed by the situation, with psychological and physical repercussions such as depression and Post Traumatic Stress Disease (PTSD). The study aims to assess the impact of the pandemic on nurses in the Local Emergency System (SET). Method Depression and PTSD via “Screening Questionnaire for Disaster Mental Health”. The questionnaire was distributed among Italian SET nurses with non-probability sampling between 1 December 2020 and 31 January 2021. Results A total of 441 Italian nurses participated in the study, with an average age of 43.28 years (SD ± 9.38) and average working experience in EMS of 11.68 years (SD ± 7.98). 6.12% of the participants worked in an Operations Centre (CO), 72.34% worked in local emergency services and 21.54% worked in both settings. 17.01% of the sample were at high risk for PTSD and 15.65% for depression.

Effetti della pandemia COVID-19 negli infermieri del sistema di emergenza pre-ospedaliera

La pandemia da COVID-19 ha fatto emergere il ruolo cruciale degli infermieri e il loro impegno nel fronteggiare tale situazione. L’Italia ha mostrato un incremento sostanziale di richieste di soccorso per patologie respiratorie e il personale infermieristico impiegato sui mezzi di soccorso è stato travolto dalla situazione con conseguenti ripercussioni psicofisiche quali depressione e Post Traumatic Stress Disease (PTSD). Lo studio mira a valutare l’impatto dell’emergenza pandemica sugli infermieri del Sistema di Emergenza Territoriale (SET). Metodo Analisi di depressione e PTSD mediante “Screening Questionnaire for Disaster Mental Health”. Il questionario è stato distribuito tra gli infermieri italiani afferenti al SET con campionamento non probabilistico tra il 1° dicembre 2020 e il 31 gennaio 2021. Risultati Hanno partecipato allo studio 441 infermieri italiani con età media 43,28 anni (DS ± 9,38), l’esperienza lavorativa media nel SET è 11,68 anni (DS ± 7,98). Il 6,12% dei partecipanti lavora presso una Centrale Operativa (CO), il 72,34% è impegnato nel soccorso territoriale e il 21,54% opera in entrambi i setting. Il 17,01% del campione è ad alto rischio per PTSD e il 15,65% per depressione. Discussione Il campione è costituito da infermieri generalmente esperti nel soccorso territoriale. Il rischio di PTSD e depressione rientra nei range individuati in letteratura. L’analisi per setting operativo ha evidenziato un maggior rischio di sviluppare PTSD per gli infermieri che svolgono attività di CO, con valori quasi doppi rispetto a chi opera solo sui mezzi di soccorso. Il personale con poca esperienza nel SET risulta soggetto a maggiori esiti per le 2 sintomatologie. Conclusione Il personale inesperto e quello impegnato nelle CO è risultato maggiormente vittima di PTSD e depressione. È essenziale attuare piani per permettere al personale del SET di superare tali situazioni di criticità e prevenirle. PAROLE CHIAVE Emergency Nurse, pandemia, COVID-19, emergenza territoriale, PTSD, depressione

The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin

Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986–1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.