Contextualization of Psychological First Aid: An Integrative Literature Review.

PURPOSE

Contextualization of psychological first aid (PFA) in different cultural, political, and socioeconomic contexts and in different population groups is essential. This review analyzes the efforts that have been made to contextualize PFA in different parts of the world for different disasters and emergencies.

DESIGN

Integrative literature review.

METHODS

The major databases that were searched for related literature published until August 2019 included JBI, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), BIOSIS, ISI Web of Knowledge, Scopus, EBSCOhost, and PsycINFO. A total of 17 studies published in peer-reviewed journals were included. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, and the 6W3H tool was applied to synthesize the results.

FINDINGS

PFA has been adapted to various disasters and populations in different countries and regions. The organizations that administer PFA range from community level to national level. Professional or "outside helpers" who enter disaster-affected locations include psychologists, fire fighters, social workers, and nurses. "Inside helpers," who live and work in the disaster-affected areas, include HR staff, teachers, and peer emergency personnel. Only a few studies have reported the exact number of first responders who administered PFA. Some studies revised PFA as group based, and a few reported the classification of groups of victims. Notably, all adaptations adhered to the basic principles of PFA, and the time at which PFA was administered ranged from a few days to months after an incident. PFA was conducted on site in all studies. The selection of the location depended on the type of disaster and local situation with due consideration of safety. Only a few studies specified the rationale for revising the PFA. None of these 17 studies reported the cost, cost-benefit, or cost-effectiveness of PFA.

CONCLUSIONS

Population-focused, context-specific, and group-based PFA is emerging worldwide. Nurses are actively playing a role in providing PFA. Research gaps exist in differentiating between the roles played by "outside" and "inside" responders, considering vulnerable age groups other than children, incorporating the major PFA concepts such as resilience, and evaluating the cost-effectiveness of PFA.

CLINICAL RELEVANCE

It is imperative that nurses and other emergency staff consider the intersection of age, gender, cultural, political, social economic, and spiritual contexts when developing a context appropriate PFA.