Caught in a Disaster


Caught in a Disaster

Nurses and mental health crisis counseling

By Christine Contillo, RN, BSN
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In any disaster, nurses may be called upon to lend a hand. The same neighbors who ask you if a laceration looks like it needs stitches may assume you’re skilled in all areas of nursing and expect you to volunteer your services amid disaster relief. You, on the other hand, may feel that your first aid skills are rusty and are hesitant to sign up with a major organization like the Red Cross. Not to worry. You may still be qualified to counsel others through mental health crises, an area in dire need of help.

Different from diagnostic and treatment focused services, crisis counseling is meant to help the general population cope with an unexpected community disaster. It is not aimed at those with serious and persistent mental health problems, those with prior traumas or those with substance abuse problems. Most people can get through a difficult time on their own, but crisis counseling helps them to recognize their own strengths. In fact, after 9/11 it was estimated that half of those who received even one session of crisis counseling reported that it decreased their anxiety and relieved some of their symptoms.

Disaster victims may react in a number of different ways to their losses, including anger, denial, hysteria or other psychological distress. They may also exhibit physical symptoms such as upset stomach, headache or temporary worsening of chronic conditions. Much of the way their feelings are expressed depends on what is already normal for their particular culture. People in the Midwest may consider it appropriate to be stoic, while those of Mediterranean heritage may be quite vocal about their needs.

As a crisis counselor, your role is not to be judgmental of the individual and what they are feeling, but to focus on supporting him or her in finding a coping skill that will work best. You will help them return to a functioning level of activity and find hope in their future. In other words, the goal for people who have suffered a tragic loss within their community will be to resolve it and adapt to their current circumstances.

Your role will be to talk to them, learn what has helped them through difficult times in the past, and help them access those adaptive skills. If, after several months, they have been unable to move forward, additional counseling may be warranted, and you should be able to offer a referral.

So how do you help? April Naturale, MSW, was the director for Project Liberty, the crisis counseling program launched by the New York State Office of Mental Health in response to the 9/11 attacks. Naturale says there are several key components to mental health crisis counseling and, done correctly, it can be helpful in many different  circumstances.

You begin by practicing “active listening” or what the Red Cross calls “having a compassionate presence.” You lend your full attention to the victim, letting them know that their problem is so important that you will not let anything distract you while they are telling you their story. It can be done just as easily over a cup of coffee as in an office, and active listening sets the stage for the steps that follow.  

While you act as a witness to someone’s personal trauma you validate that their experience and feelings are real. You may acknowledge what they are saying by nodding or voicing agreement. You do not try to share a similar experience of your own, or try to put their experience into perspective for them. This is their story and they need immediate permission to explain what it feels like to them.

You let them know that their response is probably normal and should be expected. This may include feelings such as sadness and nervousness; feeling fearful, upset or jumpy; and having trouble sleeping or concentrating, or exhibiting poor judgment. You may share with them that others in their situation are having the same feelings, and at this point you should be ready to give them educational information that they may take away from the encounter and review later.

You should help them recognize coping skills that have helped them in the past and assist them to reach out to those same aids again. Exercise, prayer and guided imagery are all well-accepted ways to decrease stress. Disasters often throw people out of work and, traditionally, when unemployment increases in a community so does the rate of alcoholism. You may be prepared with the location and times for local AA meetings.  
People are usually most interested in connecting with family, church or other social groups. Having Internet and phone access can facilitate this. Encourage social contact and try to find ways to reduce their isolation as much as possible. Be prepared with phone numbers to access housing, legal help and insurance representatives, and be ready to provide appropriate referrals for those who appear to need more.

Finally, help them reinforce their future plans in order to give them hope. Encourage them to think in concrete terms by reminding them of the methods they’ve successfully used in the past to reduce stress. Have they said that they like to exercise? Ask them when they plan to take that walk. Are they members of a church group? Ask them when they plan to return or offer to help them find transportation. You may even offer to help them meet with a crisis counselor again if you think they need that assurance.

In summary, Naturale suggests that you use active listening, validate and normalize the story of the disaster victim, find out what has worked for them in the past, and then encourage them to try that again. Leave information with them that they can review later, and encourage them to seek additional help if, over time, this proves unsuccessful in decreasing their anxiety and helping them cope.         Following these simple steps will help you organize your thoughts without being overwhelmed by the difficulties of those you are trying to help, and make you effective to others in any type of crisis.   

Christine Contillo RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.

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