1. Nursing organizations and disaster care
Nurses’ associations around the world play an important role in areas such as post-disaster relief activities. Because nurses can be effective in emergency situations, governments and educational institutions need to codify preventive preparation for large-scale disasters into nursing education programs, including pre-registration education, in-service basic education, and continuing education.
2. Nursing during disasters
The ability of society to withstand disasters is a direct criterion for evaluating the soundness of society. There is no substitute for the role of health care workers in the soundness of post-disaster society. The responsibilities of nurses in the early post-disaster period include: carrying out emergency treatment, pre-screening and triage to identify the injured most in need of priority treatment; providing rescue workers; assisting in securing water, sanitation facilities and temporary shelters; disease monitoring and reporting; emergency implementation of therapeutic diet plans; nurses play an important role in caring for vulnerable groups, protecting women and children from sexual assault and human trade, etc. Nurses are an important resource in ensuring Nurses play an important role in caring for vulnerable groups, protecting women and children from sexual abuse and human trade, etc. Nurses are an important resource to ensure the physical and mental health of the affected population.
3. Early post-disaster care
In the short-term post-disaster response, nurses are concerned with the coordination and operation of necessary resources, such as access to water, food, sanitation facilities and shelters. They assist in emergency relief efforts and focus on vulnerable groups, such as patients, people with disabilities, children, women and the elderly. In addition, the protection, attention and support of relief workers is extremely important, and nurses face challenges in this regard, as relief workers also include nurses who have directly experienced the disaster. They are under tremendous stress and fatigue, and are expected to provide as much service as possible to disaster victims despite being at their physical and mental limits. Some studies have reported that nurses, along with other medical personnel, also experience post-traumatic stress syndrome during and after a disaster. For example, Yuuko Minami, president of the International Nurses Association, confessed that she herself experienced post-traumatic stress in the weeks following the 1995 Sakagami earthquake.
4. Nursing care in the middle of the post-disaster period
In the mid-term post-disaster period, in addition to the resettlement plan for the affected people, nurses also need to pay attention to and coordinate the psychological, social, economic and legal needs of the affected people, such as providing supporting documents, counseling and relocation. In the mid-term post-disaster reconstruction, the skills and knowledge of nurses are very important for the reconstruction of the area and the readjustment of the affected population. For example, in temporary shelters, refugee camps or newly built communities, nurses can provide coordination services, especially health services, in the reorganization of affected populations and the rebuilding of communities. So nurses should prepare, recognize, utilize and support their own responsibilities in this area and maximize efficiency.
5.Nursing in post-disaster reconstruction
Nurses also play an extremely important role in the long-term rehabilitation of the affected population and the reconstruction of the medical system in the affected areas. Disasters can destroy infrastructure, buildings and equipment in disaster areas, but they do not destroy the skills and knowledge of nurses and medical personnel, which are essential to the reconstruction of disaster areas and health services. For communities, nurses are a necessary resource. Not only do they effectively promote and maintain people’s health, the work of nurses in the aftermath of a disaster can also improve the coping skills of individuals affected by the disaster and facilitate the community’s return to its pre-disaster state. after the 2004 Indian Ocean tsunami, the Indonesian Ministry of Health asked nurses’ associations to conduct mobile medical services in the affected areas, and these activities allowed medical facilities to return to service as soon as possible. after the 2008 Wenchuan earthquake and the 2010 After the 2008 Wenchuan earthquake and the 2010 Zhouqu earthquake, China’s health sector also sent a large number of nursing staff to the front lines of earthquake relief to help rebuild the health care system. A number of factors can contribute to the spread of disease after a disaster, such as the lack of safe drinking water and water treatment facilities and cramped living conditions in temporary shelters. Therefore, post-disaster care should also include disease surveillance and prevention of disease epidemics and outbreaks in the affected areas. In addition, the destruction of social structures and social support systems can increase the risk of mental illness, and the cooperation of nurses with social workers, social service workers, and other health care workers is the key to the early return of individuals and families to society.
6. Ethical issues in disaster nursing
A number of ethical issues in post-disaster care must be taken into account. These ethical issues include access to fertile ground for essential medicines and vaccines, safety of rescuers, etc. During disasters, rescuers undergo great emotional stress and take great personal risks. For example, during the SARS outbreak epidemic in 2003, more than one medical personnel died in the line of duty. At the same time, we face many problems in the aftermath of a disaster, such as the risk of contagion among medical personnel or the threat of infectious diseases to themselves and their families. In addition, the risks faced by medical personnel are not only physical, but also psychological. It is important to consider psychological support for nursing staff in planning for large-scale disasters. In some cases nurses will experience conflict and confusion about their nursing duties, ethical issues of nursing, etc. The International Nurses Association’s revised Code of Ethics for Nurses can be a good guide for nurses. Ethical issues such as reciprocity and solidarity also need to be addressed when discussing the responsibilities of health care workers during emergencies and pandemics. It is an important principle of reciprocity that society, and especially their institutions and organizations, have an obligation and should support nurses and other health care workers when they are working at great risk. For example, when injuries must be classified for examination, especially when medical resources are extremely scarce, it means that some people have to be allowed to die. Society must help health care workers cope with the immense emotional stress caused by large-scale disasters by recognizing the dangers of their work and thanking them, such as ensuring the health and safety of staff, caring for sick staff, and providing fair and viable human resource programs in emergency situations, all of which require clear work plans, specific and detailed responsibilities and obligations.
7.Disaster rehabilitation care and psychological intervention
Disaster care is the systematic and flexible application of knowledge and skills unique to disaster care, as well as cooperation with other professional fields to reduce the risks posed by disasters to human life and health; rehabilitation care refers to the specialized care and various specialized functional training suitable for the requirements of rehabilitation medicine for people with disabilities, geriatric and chronic diseases with functional disorders, which can prevent the It can prevent the occurrence and development of disabilities and secondary disabilities, and reduce the impact of disabilities, so as to achieve the maximum rehabilitation and reintegration into society. Disaster care and rehabilitation care begin immediately after a disaster. The experience of a disaster undoubtedly causes significant physical and mental health effects for those affected by the disaster, and these effects can continue for years after the disaster. As a result, disaster victims need continuous and intensive support to maintain and promote physical and mental health. Nurses, on the other hand, are strong supporters and caregivers and counselors of disaster-affected people in terms of both on-site first aid, transport, and long-term rehabilitation, and their lack of disaster rehabilitation nursing knowledge can affect the treatment and rehabilitation of disaster-affected people.
The unpredictability and irresistibility of disasters and the extinguishing consequences they cause make it extremely easy for individuals to suffer from psychological imbalance and psychological trauma when they are directly confronted with sudden, terrible and cruel tragic fields, and this psychological damage not only constitutes an important element of disaster damage, but also poses a great obstacle to future disaster rescue work. Therefore, compared with life and property rescue, psychological assistance plays an immeasurable role in the reconstruction of people’s psychological balance and the guidance of stress behavior. To date, post-disaster psychological intervention is not mainstream and has not received the attention it deserves.
Psychological assistance includes both short-term crisis intervention and long-term psychological reconstruction. Approaches to how assistance is implemented vary from country to country. For example, in the U.S. government’s disaster support program, special attention is paid to psychological counseling for at-risk groups such as children, the elderly, and the disabled, as well as disaster relief workers. After the Sakagami earthquake in Japan, Hyogo Prefecture, which was severely affected by the disaster, began a 10-year-long reconstruction project called the “Immortal Bird Project,” which included an “emergency and emergency response period,” a “restoration period,” and a “pre-recovery period. It consists of four phases: the “emergency and emergency response period,” the “rehabilitation period,” the “pre-rehabilitation period,” and the “post-rehabilitation period. Through the establishment of “educational rehabilitation instructors” and “school personal life instructors” in elementary and secondary schools in the disaster area, and through close cooperation with parents and related organizations, we provide psychological support for students’ trauma.
Psychological intervention in major disasters is divided into six steps.
(1) Assessment and clarification of focus issues.
(2) Ensuring patient safety.
(3) Providing support, especially emotional support
(4) Develop coping resources.
(5) Finding solutions and developing a plan.
(6) Gaining patient commitment and cooperation.
Intervention methods for common disasters include shared reports, individual and group cognitive-behavioral therapy, play therapy, art therapy, psychological questioning, psychodynamic therapy, and pharmacological therapy, all of which are directed at disaster-affected individuals with disaster trauma. Shared reporting is a discussion-based intervention mostly used with adult survivors and disaster relief workers to help them bring closure to their experiences about the disaster by elevating them from feelings to a higher level of understanding. Sharing reports also serves an educational purpose, informing workers of normal and abnormal stress reactions and coping strategies that can be applied.
Cognitive-behavioral therapy, which incorporates many therapeutic techniques.
Exposure procedures, stress management and relaxation techniques, cognitive reconstruction procedures, anxiety management procedures, eye-movement desensitization, etc., are often used in the treatment of post-traumatic stress disorder and disaster-induced anxiety, fear, and other psychological symptoms. Art therapy and play therapy are often used in psychological assistance for children and adolescents. Through drawing, writing, and music, children can “talk” about the disaster, express emotions, clarify problems and conflicts, and strengthen problem-solving skills.
Post-disaster psychological assistance is of great relevance. While governments and scholars have recognized the importance of psychosocial assistance in disasters, it is important to establish a broadly participatory and effective approach. However, the establishment of a widely participated and effective disaster psychological relief system requires the unremitting efforts of governments, relevant institutions and psychologists.
China should study and learn from the relevant experience of foreign post-disaster psychological assistance and do a good job from the following aspects.
(1) as soon as possible to clarify the relevant laws on disaster psychological crisis intervention.
(2) Further clarify the selection and training measures of disaster psychological intervention professionals.
(3) Establish a disaster psychological intervention network as soon as possible, so that the government-organized disaster psychological assistance agencies and non-governmental agencies can form a good linkage mechanism.
(4) Carry out systematic research on disaster psychological intervention and effect evaluation to ensure that psychological intervention personnel use the most effective disaster psychological intervention methods to ensure the psychological health of the affected population.