Introduction
In their study of the research needs and priorities of disaster nursing (DN), Ranse, Hutton, Jeeawody, and Wilson (2014) demonstrate that psychological and psychosocial aspects of DN are of crucial importance and maybe the highest priority for modern studies in the field. The authors include both the needs of the disaster victims and those of the nurses themselves as significant. As a result, it is necessary to review psychological and psychosocial support in disaster nursing, and the present paper will consider the topic from the perspective of the preparation of nurses.
Psychological support includes the varied activities that are aimed at the psychological rehabilitation of disaster victims, and the psychosocial support has the same aim but combines the social and psychological perspectives on a patient’s well-being (Becker, 2007). The paper reviews the presently available literature on the topic, covering the aspects of the significance of psychological and psychosocial support and related education, as well as the perceptions of nursing, existing problems in the field, and the methods of preparing for and dealing with these problems.
The review concludes that the topics of psychological and psychosocial support in disaster nursing are indeed underresearched, but nurses view them as important and need extensive preparation and training in the field to be able to perform their roles during disaster management effectively.
The Need for Specific Psychosocial Support
Psychological trauma and other mental concerns are evidenced to be a rather prevalent issue for disaster survivors (Noguchi, Inoue, Shimanoe, Shibayama, & Shinchi, 2016). Moreover, the nurses and other members of the community that is involved in disaster management also experience notable psychosocial strain, which can result in issues (Griffiths, Emrys, Finney Lamb, Eagar, & Smith, 2003).
As a result, nurses are required to offer psychosocial interventions to respond to the psychosocial needs of disaster victims and their colleagues, while also monitoring their personal state. Therefore, the knowledge of mental care that would enable nurses to provide psychosocial support is one of the key competencies of modern nurses who are involved in disaster management (Kuntz, Frable, Qureshi, & Strong, 2008). DN education and training have to correspond to this requirement and provide at least the basic knowledge of mental health.
Nursing Education and Psychosocial Support
The key terms of the present paper are discussed in literature relatively extensively, which allows summarising their key features. Psychological support refers to the activities that nurses or other people use to promote the psychological rehabilitation of the victims and the community as a whole. Psychosocial support is a complex approach to mental care, which takes into account the social factors that can affect the victims. This factor makes the approach especially comprehensive in theory. Practically, psychosocial support incorporates a variety of short- and long-term interventions that respond to the mental health needs of patients (Becker, 2007).
Some of the key competencies in the field of psychosocial support in DN include the ability to distinguish a variety of reactions to stress and trauma and provide the required support with the help of available interventions appropriate for the age group and culture of the victim (Becker, 2007; Cianelli et al., 2013). The understanding of these interventions is necessary for a nurse to provide psychological and psychosocial support, and it can be achieved through education.
The process of training a nurse to respond to the psychosocial needs in a disaster management environment is complex, but it generally can be found in the nursing curriculum at educational instructions, in-service training, and continued education (Noguchi et al., 2016; Rumsey et al., 2014). Apart from that, the experience of non-disaster settings can also be helpful; for instance, prior work with traumatized people facilitates the provision of psychosocial support during disasters (Li, Turale, Stone, & Petrini, 2015). Among other things, the educational and experiential activities in the field of DN are meant to prepare nurses to work in disaster settings psychologically, which should help them in ensuring the provision of psychosocial support for themselves.
Indeed, as pointed out by Becker (2007), the education of nurses for delivering psychological and psychosocial support is crucial and offers multiple benefits. In particular, the author states that apart from providing the necessary skills and knowledge, it also enables well-trained personnel to work in underfunded, resource-poor settings. Moreover, Griffiths et al. (2003) and Li et al. (2015) highlight the fact that the basic understanding of mental issues (ability to diagnose them) and coping strategies are helpful for nurses’ self-care as well. In summary, the training of nurses is likely to improve their ability to provide effective care to survivors, nurses, and other staff members.
It is also noteworthy that certain aspects of education that are not related to mental nursing competencies can also be helpful in preparing nurses for psychosocial support, especially concerning self-care. Griffiths et al. (2003) cite the evidence which indicates that reactions to traumatic experiences occur in people regardless of their training, but training can equip nurses to deal with some stressful aspects of work, which helps to reduce the likelihood of the development of burnout. Similarly, the connection between extensive disaster management training and confidence in one’s abilities is found (Nash, 2017). Thus, to improve nurses’ self-care ability and reduce their need for psychosocial interventions, the training that focuses on other disaster management competencies may also be helpful.
However, nurses are often described as having insufficient knowledge of DN, and their skills may be reported as inadequate in recent studies (Loke & Fung, 2014). Similarly, the issues related to the educational system can be found in the modern literature on the topic (Rumsey et al., 2014). Thus, certain issues that are related to DN education on psychosocial support need to be discussed, especially from the perspective of nurses themselves.
Nurses’ Perspectives on Psychosocial Support in Disaster Nursing
It must be stated that nurses acknowledge the need for psychosocial support for the victims. For instance, Nilsson et al. (2014) develop a nursing competence scale with the help of over one thousand nursing students and prove that the latter view psychosocial support as one of the essential nursing competencies. Similar conclusions are presented by Ranse and Lenson (2012) and Li et al. (2015), although the latter focus on the stress experienced by the nurses who were made aware of the community needs directly during depression management. In summary, regardless of whether their knowledge comes from training or practice, nurses seem to view the psychological and psychosocial support of disaster victims as their professional and ethical obligation.
However, nurses often report having an insufficient understanding of DN, and their skills with respect to psychosocial support are self-perceived as lacking. For instance, in a study by Cianelli et al. (2013), which tested the application of a specific mental health training program for nurses in disaster settings, the authors evaluated the perceptions of the nurses. The latter reported the need for a better understanding of mental health, which motivated them to participate in the project.
Similar outcomes were found by Li et al. (2015), although the authors predominantly focus on the nurses’ stress related to the lack of knowledge. Li et al. (2015) discuss the psychosocial issues of disaster management with Chinese nurses, who report being unprepared to work in the highly-stressful settings from the psychological point of view.
They described the environment as “terrible” and impossible to work in (p. 9), stating that they would be very interested in additional training that would better equip them both from the skills viewpoint and that of psychological resilience. The fact that the lack of training caused stress in these nurses apparently makes it more necessary and difficult for them to ensure the provision of psychosocial support for themselves (Becker, 2007). Also, this problem means that the nurses would be required to provide more support to their colleagues. In summary, the consequences of the lack of preparedness, as demonstrated by Li et al. (2015), are most dire.
Thus, the issue of ineffective education appears to be a major one for the nurses engaged in disaster management. There are certain exceptions; for instance, Ranse and Lenson (2012) state that the nurses who responded to the events of the Black Saturday and Victorian bushfires reported being sufficiently prepared for their varied roles in the events. Therefore, the issues may be regional rather than universal, although their presence is still of importance, especially since it can affect nurses’ stress levels.
The topic of the nurses’ perceptions of their personal needs is slightly less well-developed. Hutton, Veenema, and Gebbie (2016) report that currently, the International Council of Nurses does not include the psychosocial elements of caring for nurses (self-care or care for one’s colleagues) in its framework of nursing competencies. However, the authors state that it is planned to add this element within five years since the publication of the article. The International Council of Nurses may be viewed as an organization that reflects the most advanced views on nursing, which suggests that there is a movement towards acknowledging the needs of nurses, but additional efforts are required to make it more widespread.
The Issues of Psychosocial Support in Disaster Nursing
General Research Issues
Ranse et al. (2014) report that the topic of psychosocial issues related to disasters is well-researched, although that of the role of the nurses in their mitigation may be understudied. Indeed currently, the psychological needs of the community are relatively well-accepted as important for disaster management (Becker, 2007). Moreover, their significance for nursing training is also acknowledged; for instance, the International Council of Nurses describes multiple psychological care competencies as required for nurses (Hutton et al., 2016). In general, there is a notable amount of information on psychosocial support, and it is sometimes applied to the nurses’ role in disaster management.
Unfortunately, as it was mentioned, the International Council of Nurses does not include the psychosocial care for nurses into its competencies officially for the time being (Hutton et al., 2016). Indeed, Ranse et al. (2014) find that the well-being of the nurses is not researched very extensively. The latter statement appears to be supported by the present literature review: the topic of disaster-related psychological issues manifested in nurses does seem to be less researched than that of the needs of disaster victims, especially in recent studies. For example, some authors, including Noguchi et al. (2016), mention the topic of psychosocial support for nurses, giving it no development.
Griffiths et al. (2003) consider it at length, but they also point out the fact that by the time of the article’s publication the topic of providing psychosocial support to nurses was not very well-developed. Apart from that, the study is not very recent and focuses on nurses that work with refugees rather than disaster-involved nurses in general.
It is also noteworthy that the topics of burnout, stress, and various other mental issues in nurses in other (non-disaster) settings are not under-researched, especially since these problems are prevalent (Mealer, Burnham, Goode, Rothbaum, & Moss, 2009). Such studies do not focus directly on DN, which limits their applicability, but they can be employed to illustrate the fact that there is a need for the consideration of the need of the nurses for psychological and psychosocial support. In summary, the topic of supporting nurses is clearly understudied in modern literature, which indicates insufficient attention to a crucial aspect of nursing competencies.
Education
There is extensive evidence of DN training being insufficiently effective in enabling nurses to provide psychosocial support in a variety of settings. For instance, Rumsey et al. (2014) review the problem of the inadequacy of psychosocial preparedness in the nurses of the Pacific Island countries. Similarly, according to Cianelli et al. (2013), the cultural specifics and prejudice, especially with respect to mental issues, can be hindering the process of developing advanced mental health training for DN, which affects, for instance, Haiti.
In particular, the participants of the study by Cianelli et al. (2013) report that the traditional Haitian view on healthcare as that related to physical bodies only may have been preventing the development and introduction of mental health-related aspects of care into the Haitian university curriculum.
Similarly, Nash (2017) conducts a comprehensive literature review of high-quality sources published between 2005 and 2015 on the topic of the US DN. These sources show that American nurses lack the required knowledge and skills, as well as self-confidence when dealing with disaster management, which, among other things, affects their ability to provide psychological and psychosocial support. Li et al. (2015) come to similar conclusions for Chinese nurses, highlighting the lack of psychological preparation for disaster management, which, as it was established, can be a risk factor for burnout and stress (Griffiths et al., 2003).
The above-mentioned nurses’ perceptions support these findings, which indicates that nursing education with respect to psychosocial support tends to be lacking in different countries all over the world. Given the previously-discussed issue of insufficient attention to the topic, especially with respect to self-care, the problem appears to be rather deep-rooted and interrelated with the absence of relevant research.
Preparedness for Psychosocial Support in Disaster Nursing
Preparation is essential for successful disaster-related care (Li et al., 2015). Some of the key activities that seem to be capable of promoting the preparedness of nurses in this regard include education and research (Nash, 2017). As it was mentioned, the education and research on the topic of psychological and psychosocial support in DN are not very well-developed, but their significance for disaster preparedness highlights the importance of advancing the two fields.
For instance, one of the key barriers to successful psychosocial support arrangement is the lack of culturally appropriate care (Griffiths et al., 2003; Rumsey et al., 2014). Research, education, and awareness improvement can resolve this issue. Similarly, Griffiths et al. (2003) report that nurses tend to employ various coping techniques that can be taught, which highlights the importance of training for the preparation of nurses and the resolution of the above-mentioned educational issues.
Another significant barrier to psychosocial care is the shortage of personnel, specially trained nurses (Griffiths et al., 2003; Rumsey et al., 2014). While education can be used to contribute to the improvement of this issue, another approach is also of importance: that is, organizational interventions. The problem psychological and psychosocial support is multi-level, and Griffiths et al. (2003) highlight the significance of a complex approach to it.
In particular, the authors make an argument about nurses’ need for psychosocial support as an organizational problem. Li et al. (2015) report a similar issue and highlight the fact that the lack of organized support for nurses is a major problem that deprives them of at least one option in coping with their stress and trauma. In summary, the authors suggest that there is a requirement for an organized acknowledgment of the nurses’ issue, which should be followed by the provision of help and reduction of preventable stressors. The latter, among other things, include the problem of education and its improvement, which demonstrates the fact that the issues related to psychosocial support provision in DN are interconnected.
Finally, the preparedness for psychosocial support is determined to a large extent by nursing leadership, which is currently a developing field of DN (Ranse, Hutton, Wilson, & Usher, 2015). Ranse et al. (2015) suggest that the organization of the response to the mental health needs of the community can be better shaped by nurses due to the fact that they are typically at the frontline of providing this type of care.
Similarly, the authors highlight the significance of the needs of the nurses and their colleagues, emphasizing the potential role of nursing leaders in organizing the support for them. Moreover, the suggestion of Griffiths et al. (2003), which focuses on the organized management of the challenge of supporting nurses, can be promoted through nursing leadership. Finally, it appears that the discovered issues which are connected to the lack of coverage of the topic and the inefficiency of related training can also be promoted by nursing leaders, as well as other nurses, through advocacy and workplace change. In summary, nursing leadership may be the primary tool in ensuring the preparation of nurses for providing psychosocial support to disaster victims and nurses, including self-care.
Conclusion
Having reviewed the literature on the topic of the preparation of nurses in providing psychological and psychosocial care to the victims of disaster and healthcare professionals, the paper can offer the following conclusions. The topic of the paper is of utmost importance for DN, which is true because of the prevalence of mental health issues in the victims of disasters and people involved in managing them. This fact appears to be acknowledged by nurses worldwide.
Nurses are the primary providers of mental health care to both mentioned groups in disaster settings, which highlights the importance of adequately preparing them for this role, in particular, with the help of education and training. However, certain issues have been reported with respect to the education relevant to the psychological and psychosocial care in DN. In particular, nurses from various countries report being unprepared to managing mental health issues, which, among other things, affects their personal mental state, making them more reliant on psychosocial support.
The problem of insufficient education also appears to be connected to the issue of the lack of scientific interest in the topic; the latter is reflected in the shortage of studies that would consider it, especially with respect to nursing. The topic that is especially underresearched and insufficiently acknowledged is that of the psychosocial needs of healthcare providers themselves.
The key problems of DN with respect to psychological and psychosocial support appear to include insufficient research and inadequate training. However, both are required for the improvement of nurses’ preparedness for fulfilling their roles during disaster management. The recent literature suggests that the primary approach to the issue is nursing leadership, which can promote the local and global acknowledgment of the importance of the topic while also tending to the needs of nurses right now in practice.
Apart from that, nursing leaders can promote positive organizational change, ensuring the arrangement of educational and psychosocial support for nurses. As a result of attracting attention to the issue of the psychological and psychosocial research and education, nursing leaders can promote both and help nurses to fulfill their roles in disaster management better.
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