Nurses respond to Hurricane Hugo victims' disaster stress

Hugo, a class IV hurricane, hit South Carolina September 22, 1989, and left behind a wake of terror and destruction. Sixty-one nursing students and five faculty were involved in disaster relief with families devastated by the hurricane. A review of the literature led these authors to propose a formulation of the concept of disaster stress, a synthesis of theories that explains response to disaster as a crisis response, a stress response, or as posttraumatic stress. With the concept of disaster stress serving as a theoretical foundation, the nurses observed, assessed, and intervened with one population of hurricane Hugo victims, noting their immediate psychosocial reactions and coping mechanisms. Victims' reactions to disaster stress included confusion, irritability, lethargy, withdrawal, and crying. The most frequently observed coping strategy of these hurricane Hugo victims was talking about their experiences; other coping tactics involved humor, religion, and altruism.     

Group Protocol to Mitigate Disaster Stress and Enhance Social Support in Adolescents Exposed to Hurricane Hugo

Literature reports that cognitive understanding and social support can mitigate stress in both adults and adolescents. As a subcomponent of the Carolina Adolescent Health Project (CAHP), this research evaluated the efficacy of a Cognitive Social Support (CSS) group protocol designed to mitigate the disaster stress of adolescents who had been exposed seriously to Hurricane Hugo. A purposive sample of 259 students participated in and evaluated the CSS. This article reports the specific structure, content, process, rationale, and cost of the CSS. Evaluations indicated that 82 % of the students evaluated the small-group component of the CSS as “very good” or “excellent,” while 70% rated the large-group component as “very good” or “excellent.”     

Relationship of social support to stress responses and immune function in healthy and asthmatic adolescents

Although most clinicians believe that social support has beneficial effects on health, the mechanisms mediating this relationship have not been clearly established. We examined the direct effect of social support on several immune measures and its role in moderating the response to academic exams in healthy and asthmatic adolescents. Three types of students—healthy, mild asthma, and severe asthma—completed social support and stress questionnaires and gave blood samples during the midsemester and final exam periods. Social support and natural killer cell (NK) function showed a significant reduction during exams in both healthy and asthmatic adolescents. Social support, however, did not have a direct effect on immune responses. Nevertheless, high social support appeared to attenuate the magnitude of exam-induced reduction in NK activity, suggesting a role for social support in protecting against immune decrements during times of stress. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 117–128, 1998     

Testing a bioecological model to examine social support in postpartum adolescents.

PURPOSE: The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression. DESIGN: Cross-sectional design with convenience sampling (n=85) of adolescents at 4-6 weeks postpartum, recruited from two community hospitals. METHODS: Approval was received from the university's IRB (institutional review board), each recruitment site, the adolescent mothers, and their parents or guardians. Data were collected by a research assistant during home visits using a battery of self-report instruments to measure macro, meso, and microsystems of social support. Demographics, exposure to community violence (macrosystem), social support, social network (mesosystem), and perceived stress, mastery, and self-esteem (microsystem) were predictor variables. Depressive symptoms were measured by using the Center for Epidemiologic Studies of Depression (CES-D) Scale. FINDINGS: Variables from each system were significant predictors of depressive symptoms but perceived stress was the strongest predictor. Many postpartum adolescents reported that they had been victims of violence. Significant symptoms of depression were identified in 37% of the postpartum adolescents. CONCLUSIONS: Context is important to consider in comparing international studies of social support. Researchers and clinicians should investigate variables associated with the low incidence of treatment for depressive symptoms in postpartum adolescents. CLINICAL RELEVANCE: Feelings of high self-esteem and mastery should be fostered in nursing interventions with postpartum adolescents and routine screening for symptoms of depression should be considered in relevant healthcare settings.     

Validation of the PRQ85 social support measure for adolescents.

The purposes of this study were to factor analyze the 25-item Personal Resource Questionnaire (PRQ) 85-Part II, a social support measure, and to establish construct validity for the instrument among adolescents by testing two hypotheses derived from theoretical propositions by Weiss (1974) concerning the relational provisions of social support. The purposes were accomplished using a sample of 325 adolescents, aged 12 to 21. According to the criteria used in this study, a four-factor structure, resulting from a principal components analysis with an oblique rotation, best represented the multidimensionality of the PRQ85-Part II in adolescents. A second-order factor analysis indicated that the four first-order factors correlated to form one factor, which consisted of 17 items and was labeled Perceived Social Support. Evidence in support of construct validity for both the 17-item and 25-item PRQ85-Part II was provided by statistically significant correlations found between the two scales and the theoretically relevant variables of perceived health status and symptom patterns. The contributions of this study to the psychometric properties of the PRQ85-Part II can be used in future research concerning social support in adolescents.     

The moderator-mediator role of social support in early adolescents

The purpose of this study was to examine social support as both a mediator and a moderator of the relationship between perceived stress and symptom patterns in early adolescents. Data were collected from 148 early adolescent boys and girls, ages 12 to 14, who responded to the Perceived Stress Scale, the Personal Resource Questionnaire 85-Part II, and the Symptom Pattern Scale. Using multiple regression analysis procedures specified for the testing of moderation and mediation, results indicated that social support did not play a moderating role in the relationship between perceived stress and symptom patterns, but social support did play a mediating role in this relationship. The findings are interpreted within the two major theoretical orientations that guided the study.     

Response of the New Mexico Disaster Medical Assistance Team in St. Croix after Hurricane Hugo

Our DMAT pulled together with the energy, flexibility, and adaptability necessary to make things work. Sally Coan expressed it best, saying, "I was with a group of people who would do anything [that was] needed." Dedication and trust within the DMAT helped create lasting friendships. The islanders were appreciative and we formed attachments to them that made them too dear to leave without sadness. The DMAT did leave, but we left in place an established medical system that the island would not otherwise have had a standard of care of which we felt proud.     

Neural pathways link social support to attenuated neuroendocrine stress responses

It is well established that a lack of social support constitutes a major risk factor for morbidity and mortality, comparable to risk factors such as smoking, obesity, and high blood pressure. Although it has been hypothesized that social support may benefit health by reducing physiological reactivity to stressors, the mechanisms underlying this process remain unclear. Moreover, to date, no studies have investigated the neurocognitive mechanisms that translate experiences of social support into the health outcomes that follow. To investigate these processes, thirty participants completed three tasks in which daily social support, neurocognitive reactivity to a social stressor, and neuroendocrine responses to a social stressor were assessed. Individuals who interacted regularly with supportive individuals across a 10-day period showed diminished cortisol reactivity to a social stressor. Moreover, greater social support and diminished cortisol responses were associated with diminished activity in the dorsal anterior cingulate cortex (dACC) and Brodmann's area (BA) 8, regions previously associated with the distress of social separation. Lastly, individual differences in dACC and BA 8 reactivity mediated the relationship between high daily social support and low cortisol reactivity, such that supported individuals showed reduced neurocognitive reactivity to social stressors, which in turn was associated with reduced neuroendocrine stress responses. This study is the first to investigate the neural underpinnings of the social support-health relationship and provides evidence that social support may ultimately benefit health by diminishing neural and physiological reactivity to social stressors.     

Effects of a long-term psychosocial nursing intervention on adolescents exposed to catastrophic stress

This research tested the effects of a long-term psychosocial nursing intervention designed to decrease mental distress in adolescents following a catastrophic event. Advanced Practice Psychiatric Nurses conducted the Catastrophic Stress Intervention (CSI) in two South Carolina high schools for three years following Hurricane Hugo. The CSI consisted of nine protocols designed to decrease adolescents' mental distress by increasing their understanding of stress and by enhancing their self-efficacy and social support. Adolescents (N = 1030) were randomized to intervention or control groups and completed one baseline and five postintervention measures of mental distress, self-efficacy, and social support. The hypothesis was that intervention adolescents would have less mental distress than control adolescents. The research also addressed the particular time points at which differences between intervention and control adolescents might be shown. Repeated measures multivariate analysis of variance, with exposure to the hurricane, self-efficacy, and social support as control variables, showed that intervention adolescents reported less mental distress than control adolescents at 12, 18, and 24 months but that this difference dissipated by 30 and 36 months. Implications for the CSI and timing of interventions with adolescents after a catastrophic event are discussed.     

Gender comparison of exposed trauma and posttraumatic stress disorder in a community sample of adolescents.

This study surveys the prevalence of exposed traumatic events and posttraumatic stress disorder among the high school students. A total of 735 students were selected by stratified cluster sampling. The self-report trauma checklists and Mississippi Scale were used. The most common traumatic experiences were "witnessing or being in a bad car accident," "getting some really bad news unexpectedly," and witnessing violence. The last 2 experiences were more common among girls. The rate of the subjects who scored more than the cutoff point in the Mississippi Scale was 27.2%. There is an extremely high rate of exposed trauma rate, and approximately one third of them have posttraumatic stress disorder symptoms.     

The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu.

The Asian earthquake and subsequent tsunami of December 2004, one of the largest natural disasters in recent history, resulted in the deaths of over 250,000 people and massive destruction in 8 countries. As with any disaster, children are at risk for developing short- and long-term psychological consequences, including posttraumatic stress disorder (PTSD). One area particularly affected by this disaster was southern India. Five hundred twenty-three juvenile survivors of the tsunami were studied to determine the prevalence of PTSD. The survey was conducted in 2 waves. Interviews were conducted by postgraduate psychiatric social work students, proficient in the local language of Tamil and trained in PTSD-related data collection. The Impact of Event Scale-8 items Tamil Version and Child Behaviour Checklist Post-traumatic Stress Disorder-Tamil Revised Version, with age-specific measures and validated for the local culture and language, were used for the study. Our study revealed a prevalence of 70.7% for acute PTSD and 10.9% for delayed onset PTSD. PTSD was more prevalent among girls and more severe among adolescents exposed to loss of life or property. These results indicate that PTSD is widely prevalent among the survivors of the tsunami, reinforcing the need to develop an effective, culturally sensitive outreach therapy strategy for them.     

The relation of life stress and social support to emotional disequilibrium during pregnancy

A convenience sample of 141 medically normal adult women in the mid-trimester of pregnancy were tested with standardized instruments during a routine prenatal visit. Life stress was measured for the 12-month-period preceding testing. The dependent variable, emotional disequilibrium, was a factor-analyzed construct derived from measures of state anxiety, trait anxiety, depression, and self-esteem. Life stress accounted for 29.71% of the variance in emotional disequilibrium (p = .0001), and social support accounted for a separate and non-interactive 3.11% of the variance (p = .01). Emotional disequilibrium in pregnancy decreased as a function of decreasing life stress and increasing social support.     

The relationship between social support, self-esteem, and maternal-fetal attachment in adolescents

Limited information is available about factors related to prenatal attachment in adolescents. In this study, relationships among self-esteem, social support, and maternal-fetal attachment were examined. A culturally diverse sample of 90 adolescents between 14 and 19 years of age was recruited from two of the three licensed residential maternity homes in Los Angeles County. The four research instruments administered included: a background questionnaire, Coopersmith's Self-Esteem Inventory, Norbeck's Social Support Questionnaire, and Cranley's Maternal-Fetal Attachment Scale. Although nonsignificant correlations were found between total maternal-fetal attachment scores and measures of self-esteem and social support, four key variables were identified through regression analyses. These significant predictors of prenatal attachment were total functional support, total size of network, planning of pregnancy, and intent to keep the infant. Implications for clinical practice are discussed related to these findings.     

ICU护士职业压力与社会支持的相关性研究

目的 明确ICU护士职业压力的主要来源,探讨其职业压力与社会支持的相关性.方法 采用描述性相关性的研究方法 ,2007年7-10月对8个ICU 159名护士和普通病房160名护士进行问卷调查,并对结果 进行统计分析.结果 ICU护士的职业压力评分均值为(3.41±0.73)分,处于中等偏高水平.其中最大的职业压力来源是认为护理是高风险职业,其次是工作强度大、经常超负荷工作、持续夜班工作;而普通病房护士的职业压力评分均值为(3.29±1.05)分,其中最大的职业压力来源是认为护理是高风险职业.ICU和普通病房护士的职业压力评分的比较,差异无统计学意义(P＞0.05).ICU护士的职业压力与社会支持呈显著负相关(r=-0.159,P＜0.05),经多重线性回归分析,进入回归方程的因子为朋友帮助.结论 ICU护士的职业压力较高;实施科学人力资源管理,减轻护士压力,减少工作负荷,充分发挥各个社会支持系统的作用对减轻ICU护士职业压力具有重要的作用.