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Stormís aftermath clouds region

Monday February 4, 2013
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Constantine Checa, RN
Physical injuries were one result of Superstorm Sandyís damage. Another concern left behind for East Coast residents is symptoms of mental distress, which nurses can help uncover.

Mental distress is a range of symptoms, such as depression, anxiety and confusion, that can be brought on by the loss of family members, friends or neighbors, homes and valued personal possessions in events such as Sandy. Some patients still might be displaced from work while buildings are rebuilt or jobs are relocated.

To identify the symptoms, nurses should ask patients the right questions and watch for behavior changes.

Sandy was followed by the holiday season, which often is a difficult time for people who have suffered loss, are alone or who are prone to mental health issues. Then came the devastating massacre of 26 people at Sandy Hook Elementary School in neighboring Connecticut on Dec. 14.

Adrienne Fessler Belli, LCSW
The effect is a pileup of mental distress, particularly in New York and New Jersey, said Donna Sabella, RN, PhD, MSN, MEd, assistant academic dean of health sciences at Arcadia University in Philadelphia. "We can only take so much at a time," she said.

Adrienne Fessler Belli, a licensed clinical social worker and director, disaster and terrorism branch of the Division of Mental Health and Addiction Services, New Jersey Department of Human Services, trains nurses and other healthcare providers in the wake of disasters. She said typical signs of traumatic stress are sleep problems — too much or too little — anxiety, fatigue, stomachaches, persistent digestive problems, muscle tension or changes in appetite.

"If someone is typically quiet, but now jumpy and talking a lot, thatís a change in their behavior that [nurses] can ask them about," Fessler Belli said. Some of that is very common after a disaster, she said, and each person will handle feelings in his or her own way.

"What you look for is when those symptoms are persistent," Fessler Belli said.

Stress from disasters can exacerbate existing conditions, such as a heart problem, and cause more stress.

One of the best things nurses can do is to help patients separate the things they can control from those they canít. When people watch their homes wash away or fill with water, get separated from pets and possessions and have to find new places to live and work, the feeling of helplessness can be debilitating, according to experts.

Helping patients find the most appropriate resources for support will help them regain some control.

Sometimes it helps to ask patients what has helped them cope in the past. Those things are likely to help again, Sabella said. For some, it is restarting an exercise routine or talking to friends and family. Some will call upon their faith.

Some wonít have the need to talk about it and nurses should respect that, experts said.

If patients donít want to talk, nurses still should keep the lines of communication open. "Let them know you are there," Sabella said.

People with a good support system, good insurance and jobs that allow time away from work are among those most likely to have the best coping mechanisms.

Some people may experience a type of survivorís guilt if their homes were untouched but their neighbors lost everything. They may think they shouldnít reach out for mental health services when others must be much more in need.

Recognizing these feelings and validating them can help give people the freedom to ask for help.

"There will always be people who are less fortunate and more fortunate," Fessler Belli said. "But these services are for everyone."

Constantine Checa, RN, a behavioral health nurse with the Visiting Nurse Service of New York, said she has seen a range of emotions after the storm.

"Many of the people the visiting nurses treat are homebound," Checa said. For some of those patients, this added a fear of being trapped when Sandy hit.

"Theyíre already a vulnerable population, and then having a natural disaster makes them even more vulnerable to greater anxiety or depression," Checa said.

A good way for nurses to open a conversation with patients, Checa said, is to tell them what made them personally fearful during the storm and ask, "Do you have any of those feelings?"

While nurses are looking for signs of post-Sandy distress, itís a good idea for them to check their own mental health as well. Some nurses were dealing with storm damage and loss in their personal lives at the same time they were hearing the stories and treating patient after patient, often in chaotic circumstances. The emotional toll can build and get hidden as nurses take on increased hours and a relentless workload.

"As nurses, weíre trained that you can deal with all of this, and you donít cry, and you keep moving because your job is to take care of other people," Sabella said. "But itís OK to stop and take care of yourself."

Marcia Frellick is a freelance writer.

To comment, email editorNY@nurse.com.
Mental health resources

These resources offer New York/New Jersey residents help with Superstorm Sandy-related mental health issues:

New Jersey Division of Mental Health Services website:

New Jersey disaster helpline:
877-294-4357; TTY: 877-294-4356

Substance Abuse and Mental Health ServicesAdministration disaster distress helpline:
800-985-5990 (provides immediate crisis counseling)

Visiting Nurse Service of New York:

Mental Health Association of New York City helpline: