Background
While the nursing role in disaster response is well described; real time disaster decision making and mental health response training receives less attention. Nurses must be effective and efficient in ethical decision making, including prioritization in a disaster, within a time limited and low resource setting. Training in these areas with an ethical framework may enhance outcomes. Further, Psychological First Aid is a critical component of any disaster readiness program. Studies have shown that individuals experiencing psychological related injury outnumber those who experience physical injury. Increased occurrence and impact of previous disasters highlights the need to have nurses trained in assessment and triage of mental health issues post-disaster. Psychological First Aid is an evidence-based modality to foster stress reduction and enhance coping and resilience building in those affected. There is a paucity of Psychological First Aid training in nursing curriculum.
Objectives
The objective was to develop and implement a program introducing nursing students to the concepts of psychological first aid and ethical decision making in disaster situations.
Results
Program included didactic and discussion on role of nurses in Psychological First Aid and Ethical Decision Making in disaster followed by simulated disaster scenarios. High Fidelity complex simulations using standardized patients were developed. The first scenario is immediate post disaster. The nursing students lead in an emergency department environment. The scenario progresses as gradually resources become harder to obtain and important ethical challenges are presented. The second scenario is a community meeting a few weeks post disaster. The nursing student leads the meeting addressing issues and questions from community members. Mental health issues such as fear, guilt, and anxiety are exposed as delayed response to the disaster. An additional tabletop simulation was developed for prioritization of resources and patient interventions. Debriefing was conducted following each scenario. The students experienced varying levels of stress elicited by the simulations. They vocalized applicability to their own experiences and newfound appreciation for the importance of including psychosocial interventions in response and recovery efforts. Some vocalized a desire to repeat similar training or support group sessions in their home communities.
Conclusion
Real time simulation in decision making and Psychological First Aid are important additions to nursing curriculum in disaster response or in a nursing emergency preparedness program. It also provides an opportunity for the nursing student to experience team leadership in a simulated environment.
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