DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
Lesson title: Disaster Preparedness: Understanding the Materials:
Psychosocial Impact of Disasters Book, pen and notebook
Learning Targets: References:
At the end of the module, students will be able to: Veenema, T.G. (2019) Disaster Nursing and
1. Identify the psychosocial effects likely to occur in various Emergency Preparedness for Chemical,
types of disasters. Biological, and Radiological Terrorism and
2. Identify the elements of a community impact and resource other Hazards 4th Edition
assessment.
3. Formulate strategies that helpers can use to assist children
and their families in the immediate aftermath of a disaster.
4. Discuss the impact of disaster trauma on first responders
and helpers.
5. Describe community reactions to a large-scale disaster.
6. Describe the manifestations of normal grief and mourning.
A. LESSON PREVIEW/REVIEW (5 minutes)
Instruction: what are the five phases of disaster management?
1. 4.
2. 5.
3.
B. MAIN LESSON (40 minutes)
Disaster Preparedness: Understanding the Psychosocial Impact of Disasters
Disasters, by their very nature, are stressful, life-altering experiences, and living through such an experience can
cause serious psychological effects and social disruption. Disasters affect every aspect of the life of an individual, family,
and community. Depending on the nature and scope of the disaster, the degree of disruption can range from mild anxiety
and family dysfunction (e.g., marital discord or parent–child relational problems) to separation anxiety, posttraumatic
stress disorder (PTSD), engagement in high-risk behaviors, addictive behaviors, severe depression, and even suicidality
While there are common mental health effects across different types of disasters, each disaster is unique and
many factors can determine a given disaster’s effect on survivors. Natural disasters, such as floods, hurricanes, forest
fires, and tornadoes most often result in property loss and dislocation. When physical injury and loss of life are minimal,
the incidence of psychiatric sequelae may be reduced
The mental health effects of any type of disaster, mass violence, or terror attack are well documented in the
literature to be related to the intensity of exposure to the event. Documented potential indicators of mental health
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
problems following the event are: sustaining personal injury, death of a loved one due to the disaster, disaster-related
displacement, relocation, and loss of property and personal finances (Neria & Shultz, 2012).
BIOTERRORISM AND TOXIC EXPOSURES
“Bioterrorism is an act of human malice intended to injure and kill civilians and is associated with higher rate of
psychiatric morbidity than are ‘Acts of God’”
Common psychological reactions to bioterrorism
- Horror, anger, or panic
- Magical thinking about microbes and viruses
- Fear of invisible agents or fear of contagion
- Attribution of arousal symptoms to infection
- Anger at terrorists, the government, or both
- Scapegoating, loss of faith in social institutions
- Paranoia, social isolation, or demoralization
The following are recommended interventions to minimize the potential psychological and social consequences
of suspected or actual biological exposures:
1. Provide information on the believed likelihood of such an attack and of possible impact.
2. Communicate what the individual risk is.
3. Clarify that negative health behaviors, which may increase during time of stress (i.e., smoking, unhealthy eating,
excessive drinking), constitute a greater health hazard than the hazards likely to stem from bioterrorism.
4. Emphasize that the only necessary action against terrorism on the individual level is increased vigilance of
suspicious actions, which should be reported to authorities.
5. Clearly communicate the meaning of different levels of warning systems when such warnings are issued
6. When issuing a warning, specify the type of threat, the type of place threatened, and indicate specific actions to
be taken.
7. Make the public aware of steps being taken to prevent bioterrorism without inundating people with unnecessary
information.
8. Provide the public with follow-up information after periods of heightened alert.
NORMAL REACTIONS TO ABNORMAL EVENTS
Normal reactions to stress and bereavement can and do vary— sometimes even among members of the same family.
Factors that affect expressions of stress and bereavement include age, gender, ethnicity, religious background,
personality traits, coping skills, and previous experience with loss, especially traumatic loss. Stress symptoms can occur
due to secondary exposure, meaning that those experiencing distress need not have been present at the site of the
disaster but may have witnessed it secondhand either via media coverage or through retelling of the event by a person
who was present. As these reactions can be quite startling and overwhelming to those who have not experienced them
before, it is helpful for survivors to hear that their experiences are entirely normal, given the tremendous stress to which
they have been exposed.
COMMON REACTIONS OF DISASTER SURVIVORS
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Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
Emotional
Shock, feeling numb
Fear
Grief, sadness
Anger
Guilt, shame
Feelings of helplessness
Interpersonal
Distrust
Conflict
Withdrawal
Work or school problems
Irritability
Loss of intimacy
Feeling rejected or abandoned
Cognitive
Confusion
Indecisiveness
Worry
Shortened attention span
Trouble concentrating
Physical
Tension, edginess
Fatigue, insomnia
Body aches, pain, nausea
Startling easily
Racing heartbeat
Change in appetite
Change in sex drive
SPECIAL NEEDS POPULATION
Certain populations affected by disasters may be more vulnerable and therefore require special consideration both in
disaster planning and response. In particular, women, older people, children and young people, people with disabilities,
and people marginalized by ethnicity are more vulnerable (Sim & Cui, 2015).
1. Children and Youth - while most children are resilient, many children do experience some significant degree of
distress. Poverty and parents with mental health challenges put children at higher risk for long-term impairments
(McLaughlin et al., 2009).
2. Older Adults - Older adults are particularly vulnerable to loss. Factors such as age and disability affect
vulnerability to a disaster. Both of these vulnerability traits are apparent in the elderly population. They are often
lacking in social supports, may be financially disadvantaged, and are traditionally reluctant to accept offers of
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
help. Older adults are also more likely to have preexisting medical conditions that may be exacerbated, either
directly because of the emotional and psychological stress, or because of disruptions to their care, such as loss of
medications or needed medical equipment, changes in primary care providers, lack of continuity of care, or lack of
consistency in self-care routines due to relocation.
3. The Seriously Mentally Ill - According to Austin and Godleski (1999), the most psychologically vulnerable people
are those with a prior history of psychiatric disturbances. Although previous psychiatric history does not
significantly raise the risk of PTSD, exacerbations of preexisting chronic mental disorders, such as bipolar and
depressive disorders, are often increased in the aftermath of a disaster. Those with a chronic mental illness are
particularly susceptible to the effects of severe stress, as they may be marginally stable and may lack adequate
social support to buffer the effects of the terror, bereavement, or dislocation.
4. Cultural and Ethnic Groups - Sensitivity to the cultural and ethnic needs of survivors and the bereaved is key
not only in understanding reactions to stress and grief but also in implementing effective interventions. Mental
health outreach teams need to include bilingual, multicultural staff and translators who are able to interact
effectively with survivors and the bereaved.
5. Disaster Relief Personnel - The list of those vulnerable to the psychosocial impact of a disaster does not end
with the survivors and the bereaved. Often victims can include emergency personnel: police officers, firefighters,
military personnel, Red Cross mass care and shelter workers, cleanup and sanitation crews, the press corps,
body handlers, funeral directors, staff at receiving hospitals, and crisis counselors.
COMMON STRESS REACTIONS BY DISASTER WORKERS
Psychological
Denial
Anxiety and fear
Worry about the safety of self or others
Anger
Irritability and restlessness
Sadness, moodiness, grief, depression
Distressing dreams
Guilt or “survivor guilt”
Feeling overwhelmed, hopeless
Feeling isolated, lost, or abandoned Apathy
Behavioral
Change in activity level
Decreased efficiency and effectiveness
Difficulty communicating
Outbursts of anger, frequent arguments, irritability
Inability to rest or “let down”
Change in eating habits
Change in sleeping patterns
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
Change in patterns of intimacy, sexuality
Change in job performance
Periods of crying
Increased use of alcohol, tobacco, and drugs
Social withdrawal/silence
Vigilance about safety of environment
Avoidance of activities/places that trigger memories
Cognitive
Memory problems
Disorientation
Confusion
Slowness of thinking and comprehension
Difficulty calculating, prioritizing
Poor concentration
Limited attention span
Loss of objectivity
Unable to stop thinking about disaster
Blaming
Physical
Increased heart/respiratory rate/blood pressure
Upset stomach, nausea, diarrhea
Change in appetite, change in weight
Sweating or chills
Tremor (hands/lips)
Muscle twitching
“Muffled” hearing
Tunnel vision
Feeling uncoordinated
Proneness to accidents
Headaches
Muscle soreness, lower back pain
“Lump” in the throat
Exaggerated startle reaction
Fatigue
Menstrual cycle changes
Change in sexual desire
Decreased resistance to infection
COMMUNITY REACTIONS AND RESPONSES
It is important to understand common responses and needs after a disaster, regardless of the type of disaster. It is
important to recognize:
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
1. Everyone who sees or experiences a disaster is affected by it in some way.
2. It is normal to feel anxious about your own safety and that of your family and close friends.
3. Profound sadness, grief, and anger are normal reactions to an abnormal event.
4. Acknowledging your feelings helps you recover.
5. Focusing on your strengths and abilities helps you heal.
6. Accepting help from community programs and resources is healthy.
7. Everyone has different needs and different ways of coping.
8. It is common to want to strike back at people who have caused great pain.
Large-group preventive techniques for children have been used for some time in California during the aftermath of
community-wide trauma (Eth, 1992). This type of school-based intervention occurs as soon after the event as possible,
and follows three phases:
1. Preconsultation—identifying the need; preparing the intervention with school authorities
2. Consultation in class—introduction, open discussion (fantasy), focused discussion (fact), free drawing task,
drawing or story exploration, reassurance and redirection, recap, sharing of common themes, and return to school
activities
3. Postconsultation—follow-up with school personnel and triage/referrals, as needed
MOURNING, MILESTONES, AND ANNIVERSARIES
The normal process of mourning is often facilitated by the use of rituals, such as funerals, memorials, and events marking
key time intervals, such as anniversaries. It is important to include the community in the services, as well as the
immediate family members. Community-wide ceremonies can serve to mobilize the supportive network of friends,
neighbors, and caring citizens and provide a sense of belonging, remembrance, and letting go.
Websites and social media groups link the bereaved and can also provide special support during important anniversaries
or milestones. Ceremonies or memorials in schools should be developmentally appropriate and involve students in the
planning process. Websites and pages to be created in the aftermath of a disaster serve as a place for people, both
directly and indirectly impacted, to express their condolences and offer support.
The phases of the mourning process have much in common with the emotional phases of disaster recovery, and Worden
(1982) has identified specific tasks that need to be accomplished at each phase of mourning for successful resolution:
- Period of shock, or “numbness.” The task is to accept the reality of the loss (as opposed to denying the reality of
the loss).
- Reality, or “yearning,” and “disorganization and despair.” The tasks are to accept the pain of grief (as opposed to
not feeling the pain of the loss) and to adjust to an environment in which the deceased is missing (as opposed to
not adapting to the loss).
- Recovery, or “reorganized behavior.” The task is to reinvest in new relationships (as opposed to not loving).
NORMAL MANIFESTATIONS OF GRIEF
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
Feelings
Sadness
Anger
Guilt and self-reproach
Anxiety
Loneliness
Fatigue
Helplessness
Shock (most often after sudden death)
Yearning (for the deceased person)
Emancipation
Relief
Numbness
Physical Sensations
Hollowness in stomach
Tightness in chest
Tightness in throat
Oversensitivity to noise
Sense of depersonalization/derealization
Breathlessness, shortness of breath
Weakness in muscles
Lack of energy
Dry mouth
Behaviors
Sleep disturbance
Appetite disturbance
Absentmindedness
Social withdrawal
Avoiding reminders (of deceased)
Dreams of deceased
Searching, calling out
Restless overactivity
Crying Treasuring objects
Visiting places/carrying objects of remembrance
Thoughts
Disbelief
Confusion
Preoccupation
Sense of presence
Hallucination
CHECK FOR UNDERSTANDING (10 minutes)
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
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:
Multiple Choice
1. It is an act of human malice intended to injure and kill civilians and is associated with higher rate of psychiatric
morbidity than are ‘Acts of God’”
a. Disaster
b. Bioterrorism
c. Calamity
d. Natural disaster
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. They are considered to be more vulnerable and therefore require special consideration both in disaster planning
and response?
a. Special needs population
b. Older people
c. Children and youth
d. Ethnic people
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Who are considered to belong in those who have special needs population?
a. Children and youth
b. Older people
c. Cultural and ethnic people
d. All of the above
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. A disaster survivor started to have trouble sleeping at night days after the disaster. What could be the explanation
for this?
a. It is a normal reaction.
b. It is not a normal reaction to the situation
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
c. Her sleep deprivation is caused by overstimulation
d. She was just not tired.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
5. Which of the following may facilitate the process of mourning for the bereaved?
a. Telling them to move on
b. Acting as if nothing happened
c. Facilitate rituals, ceremonies, or memorials
d. Give them all the space they can have
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
C. LESSON WRAP-UP (5 minutes)
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DISASTER NURSING
Module #3 Student Activity Sheet
Name: ________________________________________________________ Class number: ______
Section: ____________ Schedule: _________________________________ Date: _____________
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
AL Activity: Minute Paper
1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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