# Situation: Six weeks after a strong typhoon destroyed homes in a coastal barangay, a nurse from the Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) visits an evacuation center. She sees a 38-year-old fisherman and his 14-year-old daughter. The fisherman becomes tearful when the typhoon is mentioned. The nurse listens but does not ask him to describe the event in detail. What is the reason for this approach?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630204  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: Six weeks after a strong typhoon destroyed homes in a coastal barangay, a nurse from the Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) visits an evacuation center. She sees a 38-year-old fisherman and his 14-year-old daughter.

The fisherman becomes tearful when the typhoon is mentioned. The nurse listens but does not ask him to describe the event in detail. What is the reason for this approach?

## 보기

1. Retelling is harmful only when it is done in a group session
2. Pressing him to retell may deepen distress and does not help **✔ 정답**
3. Only survivors who screen as high risk should be asked to retell it
4. Talk of feelings should wait until his basic needs have been met

**정답: 2**

## 해설

mhGAP-IG advises listening carefully without pressuring the person to talk about the event, while addressing basic and social needs at the same time. Requiring people to recount a traumatic event, whether in a group or one to one and whatever their risk level, does not prevent later disorder and can increase distress.

## 심화 해설

Core principle in post-disaster mental health first aid

The nurse’s decision not to ask the fisherman to describe the typhoon in detail reflects a central recommendation of the WHO mhGAP-IG for acute stress after a traumatic event. Listening with empathy is encouraged, but actively pressing a survivor to retell or relive the traumatic experience does not prevent later mental disorders and may intensify immediate distress. This applies whether the retelling occurs one-to-one or in a group, and regardless of whether the person has been classified as high risk.

The rationale is grounded in how acute stress responses work. Immediately after a disaster, the sympathetic nervous system remains activated, and intrusive memories, hypervigilance, and emotional flooding are common. Forcing a detailed narrative during this window can reactivate the same fear circuitry without providing therapeutic processing. In contrast, psychological first aid and mhGAP-aligned care prioritize safety, stabilization, and practical support over emotional debriefing.

Watch out! The incorrect options all contain a kernel of truth but distort the principle. Retelling is not harmful only in group settings; the harm relates to pressure, not format. Screening is not the deciding factor; even high-risk survivors should not be pushed to recount the event. And while basic needs matter, the mhGAP-IG does not say emotional support must wait until every basic need is met; listening and practical care occur simultaneously.

The scope of this guidance extends beyond adults. A systematic review of mhGAP-IG implementation for child and adolescent mental health in low- and middle-income countries found that non-specialist providers can deliver effective care when the intervention is adapted to the developmental stage of the child . In the scenario, the 14-year-old daughter would also benefit from the same non-pressuring, supportive approach, with attention to age-appropriate communication and family functioning.

Implementation research in humanitarian settings reinforces why this principle matters operationally. Studies on mhGAP integration in fragile and conflict-affected areas emphasize that non-specialist providers need clear, simple protocols that prevent harm while addressing the mental health treatment gap . The instruction to listen without forcing retelling is one such safeguard: it protects survivors from iatrogenic distress while allowing nurses and other primary care workers to offer meaningful support without specialized psychotherapy training.

The underlying evidence also cautions against assuming that early emotional ventilation is inherently therapeutic. Research on early intervention after trauma notes that persistent symptoms such as intrusive re-experiencing, avoidance, and hyperarousal can emerge in the weeks and months following exposure . The goal in the immediate post-disaster period is not to extract a complete trauma narrative, but to reduce acute distress, restore a sense of safety, and identify those whose symptoms persist and may require more structured intervention later.

| Approach | What the nurse does | Why it is appropriate |
| --- | --- | --- |
| Active listening without pressure | Acknowledges the tearfulness, stays present, does not ask for a detailed retelling | Validates distress without forcing re-exposure to traumatic memory |
| Forced retelling or debriefing | Asks the survivor to describe the event step by step | Can increase acute distress and does not prevent PTSD or depression |
| Simultaneous basic needs support | Assesses safety, shelter, food, and social connection while listening | Addresses the full context of recovery rather than isolating emotional processing |

Key point! The mhGAP-IG does not prohibit talking about the event if the survivor spontaneously chooses to share. The distinction is between inviting expression and pressuring disclosure. A nurse who listens calmly, offers practical support, and allows the person to lead the conversation is practicing the recommended approach.

## 임상 시나리오

Post-Disaster Acute Stress: Listening Without PressuringWHO mhGAP-IG Guidance for RHU Nurses
After a traumatic event, listen carefully with empathy, but do not pressure the survivor to retell or relive the experience. Forcing a detailed narrative does not prevent later mental disorders and may intensify immediate distress.

This principle applies regardless of format (one-to-one or group) and regardless of risk level. Even survivors screened as high risk should not be pushed to recount the event.

Prioritize safety, stabilization, and practical support. Address basic and social needs simultaneously with emotional support—do not wait for all basic needs to be met before listening.

CautionAvoid emotional debriefing as a routine intervention. Pressuring survivors to talk through trauma can reactivate fear circuitry and worsen acute stress responses such as intrusive memories and hypervigilance.

## 핵심 개념

- **mhGAP-IG** — WHO Mental Health Gap Action Programme Intervention Guide for non-specialized health settings.
- **Psychological First Aid** — Humane, supportive response to a fellow human being who is suffering and may need support.
- **Acute Stress Response** — Immediate physiological and psychological reaction to a traumatic event involving sympathetic activation.
- **Trauma-Informed Care** — Approach that recognizes trauma's impact and avoids re-traumatization in care delivery.
- **Emotional Debriefing** — Structured review of a traumatic event; not recommended as routine post-disaster intervention.

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