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Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20

Experiences in disaster-related mental health


relief work: An exploratory model for the
interprofessional training of psychological relief
workers

ZhengJia Ren, HongTao Wang & Wei Zhang

To cite this article: ZhengJia Ren, HongTao Wang & Wei Zhang (2016): Experiences in
disaster-related mental health relief work: An exploratory model for the interprofessional
training of psychological relief workers, Journal of Interprofessional Care, DOI:
10.1080/13561820.2016.1233097

To link to this article: http://dx.doi.org/10.1080/13561820.2016.1233097

Published online: 18 Nov 2016.

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JOURNAL OF INTERPROFESSIONAL CARE
http://dx.doi.org/10.1080/13561820.2016.1233097

ORIGINAL ARTICLE

Experiences in disaster-related mental health relief work: An exploratory model for


the interprofessional training of psychological relief workers
ZhengJia Rena, HongTao Wangb, and Wei Zhanga
a
Mental Health Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China; bDepartment of Burns and
Cutaneous Surgery, Burn Centre of PLA, Xijing Hospital, Fourth Military Medical University, Xi’an, China

ABSTRACT ARTICLE HISTORY


The purpose of this study was to begin to generate an exploratory model of the disaster-related mental Received 10 November 2015
health education process associated with the training experiences of psychological relief workers active Revised 20 June 2016
during the Sichuan earthquake in China. The data consisted of semi-structured interviews with 20 Accepted 2 September 2016
psychological relief workers from four different professions (social workers, psychiatric nurses, psychia- KEYWORDS
trists, and counsellors) regarding their experiences in training and ideas for improvement. The model Disaster management;
explains the need to use a people-centred community interprofessional education approach, which interprofessional education;
focuses on role-modelling of the trainer, caring for relief workers, paying attention to the needs of the psychological services;
trainee, and building systematic interprofessional education strategies. The proposed model identifies qualitative research
areas for the comprehensive training of relief workers and aims to address the importance of people-
centred mental health service provisions, ensure intentional and strategic training of relief workers using
interprofessional concepts and strategies, and use culturally attuned and community-informed strate-
gies in mental health training practices.

Introduction different from many Eastern traditional cultures, such as


those in rural China, which relate more to interpersonal
On 12 May 2008, an earthquake with a magnitude of 8.0
interdependence (Markus & Kitayama, 1991) and have their
struck Wenchuan in Sichuan province, China, leaving 87,476
own common language, customs, belief systems, and cultural
dead and 374,643 injured (McClean, 2010). The large-scale
resilience, including resources for coping with disasters, loss,
devastation of the affected populations resulted in an urgent
illness, and grief, which are undervalued and unappreciated
need for mental health services (Chan, 2008). Currently, in
(Chiang, Lu, & Wear, 2005). Western popular individualized
Sichuan province there are only 1.24–1.54 psychiatrists per
psychotherapy was even stigmatized and treated as alien in
100,000 people and 1.91–2.65 licensed psychiatric nurses per
the communities affected by the disaster (Keats & Wang,
100,000 population (Liu et al., 2013; Mathers, Fat, & Boerma,
2013; Ren, 2009). Moreover, most of the training was found
2008). Additionally, the services provided by psychologists,
to focus on the spread of knowledge, attitudes, and helping
psychological counsellors, and social workers are new to
behaviours; this approach was focused on the short-term and
China; these services were mostly unavailable before the
lacked follow-up, supervision, and sensitivity to relief workers
earthquake. A number of studies have recommended that
and their own chronic fatigue and emotional disturbances
interprofessional collaboration is at the core of ‘best practices’
(Ng et al., 2009; Yan, Turale, Stone, & Petrini, 2015). Until
for patient care and can significantly improve patient out-
now, the training needs and training experiences of long-term
comes (Pechacek et al., 2015; Tierney & Vallis, 1999).
psychological relief workers who provide disaster-related
However, most professionals are poorly trained to and ill
mental health services have been largely unknown. This qua-
prepared for collaboration in China, as most of their training
litative research study was designed to explore relief workers’
is primarily hospital-based, institutionalization-oriented, bio-
training experiences in depth, as these experiences are infor-
medical, and single-profession focused; comprehensive and
mative for developing comprehensive, collaborative, and cul-
collaborative mental health training has long been neglected
turally sensitive disaster-related mental health training
in the psychiatric and psychological training curriculum in
programmes.
this country (Gao et al., 2010).
Additionally, a large proportion of the disaster-related
psychological intervention techniques and practices used in Methods
Sichuan were created and previously used in Western cultures
We utilized a qualitative research design with tenets from
that gravitate towards individualism. This is fundamentally
grounded theory for this study; the grounded theory approach

CONTACT Wei Zhang or HongTao Wang weizhang27@163.com; wanght@fmmu.edu.cn Mental Health Center, West China School of Medicine and West
China Hospital, Sichuan University, #28 Dian Xin Nan Jie, Chengdu, Sichuan 610041, China; Department of Burns and Cutaneous Surgery, Burn Centre of PLA, Xijing
Hospital, Fourth Military Medical University, No. 169, Changle West Road, Xi’an, Shanxi 710032, China.
Colour versions of one or more figures in the article can be found online at http://www.tandfonline.com/ijic.
© 2016 Taylor & Francis
2 Z. REN ET AL.

is an inductive method of qualitative research that involves only when we reached theoretical saturation (Thai et al.,
analysis of social interactions or experiences, and the research 2012).
aim is to develop a theory from the ground up (Corbin & Quotations, field notes, and memos regarding each topic
Strauss, 1990). Grounded theory uses a recursive process of were integrated and evaluated to illustrate processes and pat-
data collection, data coding, comparative analysis, and theo- terns identified within the categories and to formulate emer-
retical sampling of phrases until theoretical saturation has gent theoretical constructs. Memos written at the beginning of
been reached (Corbin & Strauss, 1990; Thai, Chong, & the research, which were used to maintain a record of emer-
Agrawal, 2012). ging ideas related to data collection, sampling, and analysis,
were eventually used as the analytical building blocks from
which the new model was developed. The rigor of the study
Participants and sampling was maintained via member checks, peer checks, and expert
Twenty participants who had been working in disaster set- checks.
tings and had been trained in disaster-related mental health
services by various organizations (e.g., universities, hospitals,
non-governmental organizations, and psychological consulta- Ethical considerations
tion programmes) were recruited. We purposely recruited
psychiatrists, psychiatric nurses, psychological counsellors, Ethics Committee of West China Hospital, Sichuan
and social workers who had been routinely trained for service. University, and verbal and written consent was obtained
First, we used a selective sampling strategy aimed at phenom- from all study participants.
enological variation; we then proceeded to use theoretical
sampling. The average period of time the participants spent
working in the earthquake psychological relief zone was Results
47.7 months (24–75 months), and the average number of
hours worked per week was 31.95 (6–60 hours). This section initially presents details of the following themes
generated from the analysis: ‘role-modelling of the trainer’,
‘needs based training’, ‘caring for relief workers’, and ‘building
Data collection systematic interprofessional education strategies’. The section
then presents the model developed from these analysed data.
The authors conducted semi-structured interviews in Chinese.
Each was digitally recorded and ranged from 60 to 90 minutes
in length. The questions that were initially part of the inter-
view included the following: how well did your training for Role-modelling of the trainer
work in the disaster areas prepare you for providing disaster-
The data indicated that role-modelling was a favoured style
related mental health services; what parts of the training were
used extensively by participants. It has been widely acknowl-
helpful; which parts did you not find especially relevant; and
edged by relief workers that it is important to obtain informa-
what advice can you provide to guide future mental health
tion from the trainers; however, the trainees’ morals, attitudes,
disaster trainers? All interviews were transcribed verbatim.
and behaviours were more strongly influenced by the tea-
Field notes were written at the completion of each interview
cher’s behaviour and attitude than by what he or she said.
for future data analysis. Data collection continued until theo-
As indicated in the following quote:
retical saturation was achieved.
It is the trainers’ attitudes that matter more, especially attitudes
towards disaster survivors and their trainees . . . What they can
Data analysis really influence is a person’s attitude. They [the attitudes] are
more important than the teacher’s professional knowledge or
The first two authors performed line-by-line coding and practical experiences . . . that part deeply influenced my disaster
used both inductive and deductive processes that involved relief work. (P15, psychiatric nurse)
going back and forth between the data and emerging
codes, categories, and themes to generate a thematic cod- As relationships grow between relief workers and trainers,
ing framework. First, categories were abstracted through it was found that the behaviour of influential role models
constant comparisons among cases, instances, and codes. shaped the behaviour of trainees through their interactions
Then, axial coding was explored by putting the data back during the training process:
together in a new way and constantly comparing cases, At the beginning of the disaster, many trainers came to provide
instances, and codes to identify relationships between the training for us, but several years later, just a few trainers still stand
different categories of conceptual properties and dimen- beside me . . . Without their professional and emotional support, I
sions; the categories were studied in terms of their con- couldn’t have kept going for so many years. This is what I learned
from my trainer, so I accompanied many survivors and their
texts, consequences, causes, conditions, covariance, and suffering. . . (P18, psychiatrist)
contingents (Backman & Kyngas, 1999). Lastly, selective
coding was initiated to integrate the different categories Indeed, most relief workers stated that professional ten-
into a core variable to build a model. The three coding dencies and attitudes are the most valued thing and that they
processes mentioned above were recursive and complete can be learned through simply imitating their teachers.
JOURNAL OF INTERPROFESSIONAL CARE 3

Caring for relief workers The training is supposed to train disaster relief workers to accom-
pany and support disaster survivors; this is what disaster survivors
Working with traumatic emotions is part of the job of mental need, right? Future disaster-related mental health training is not
health disaster services and can result in deep personal trans- training for a clinical or family psychologist. That is not the aim of
formation as reported by many relief workers. Interviewed disaster-related mental health training. The training is to cultivate
a person who has a practical capability to help disaster survivors.
mental health disaster relief workers commonly reported
(P16, counsellor)
burnout, compassion fatigue, and secondary trauma:
During that period, I was struggling, upset, depressed, and angry.
I was stuck in a bad mood. . . In addition to professional training, Building systematic strategies of interprofessional
we also need care on the personal level. (P4, counsellor) education
During that period, I knew several of my colleagues who took The data suggested that interprofessional education needs to
SSRIs (selective serotonin reuptake inhibitors) to handle their involve knowing the roles and responsibilities of fellow relief
stress. You know it is too much; most of the job is to care for workers and enhance team efficiency across different profes-
disaster survivors, but the relief workers also need care, and the
sions to work well in complex situations. Disaster situations
training needs to take that part into consideration. (P18,
psychiatrist) are highly complex and the relief workers active in them
frequently requested training to better understand other pro-
Taking care of mental health disaster relief workers is fessional duties, responsibilities, and limitations and ethical
extremely important. Without properly prepared and sup- standards. Systematic interprofessional education can aid in
ported disaster relief workers, it was noted the disaster-related the response to local complex issues because such a collabora-
mental health services will suffer: tive approach can facilitate a comprehensive understanding of
the local reality, whether that means bridging the gap between
Many relief workers quit disaster relief work because they neither
received enough supervision nor emotional support. (P12, social theory and practice or reconciling local needs and interna-
worker) tional guidelines. Interprofessional education strategies are
integrative, which underpins the process of developing colla-
Another participant stated the importance of caring for borative competency and cultural sensitivity in community-
relief workers: based disaster settings. These strategies include four interac-
When you did not have good psychological well-being while tive and progressive processes: ‘regulation of training’,
doing this job, it was painful not only for yourself but also for ‘enrichment of interprofessional cooperation’, ‘continuous
the survivors. . . There needs to be more training to care for supervision’, and ‘empowerment of culturally informed
disaster mental health relievers’ mental health and wellness. practices’.
(P17, counsellor)

Many of the participants complained of burnout and other Regulation of training


psychosocial disturbances related to their relief work. Most of This element was used to maintain and monitor the quality of
the time, the participants could only try their best to comfort training programme contents, standards, ethics, and code of
themselves as well as the survivors. Their experiences expose a conduct at all levels. Relief workers were confronted with
common theme: training systems have not been developed to many unregulated, one-time trainings. The workers recog-
adequately address relief workers’ wellness, and they lack nized that those short trainings did not sufficiently prepare
sensitivity to their psychological needs. them to react to the challenges of emergency situations, but
instead caused more challenges and chaos:
It seems to me that they [the training programs] are just bom-
Needs-based training barding us. It looks like they are fighting for academic authority
. . . They fly in from different countries and feel like they need to
The data suggested that needs-based training should be do something big here (5/12 Wenchuan Earthquake). It leads to
designed to address the local and ongoing elements of disaster secondary trauma. It’s inhumane. . . We need to standardize the
relief work. Disaster-related mental health training pro- training here. More chaos is not needed here. (P3, counsellor)
grammes need to identify the specific needs of relief workers Many mental health disaster relief workers reported that
in their clinical encounters and then design a course or most of their training was conducted during short-term
programme that addresses these specific needs: courses and often lacked any follow-up, making it hard to
put what they learned into practice in their clinical
My suggestion for future training of disaster relief workers is to
listen to the needs of front line workers. . . They encounter many encounters:
problems in their clinical encounters; knowing their difficulties
We need comprehensive training. . . One of the big problems in
can help them to help survivors more effectively. (P9, social
training is inconsistency. Every time you would have different
worker)
trainers, so you were confused about which one . . . to follow.
More importantly, the data indicated that needs-based Different trainers tell you different approaches, and sometimes
those approaches even conflict with each other. (P6, counsellor)
training is grounded in local and professional knowledge
and should reflect the needs of survivors. After all, training Some relief workers claimed that some of their trainings
for future relief workers must also strongly relate to the needs contradicted each other. They went on to say that some did
of the victims: not work, and some even caused negative effects:
4 Z. REN ET AL.

Some trainers came to do two days of training, and then they’d The majority of relief workers stated a strong desire for
run away. You did not really get it, and you did not know how to interprofessional training, which helped them work together,
practice it. . . You saw many relief workers who worked in the
same way. They came to do several days worth of service, and
learn about each other, and capitalize on individual profes-
then they ran away. I believe this phenomenon was related to their sions’ strengths; learning about each other’s roles improves
own training, which was inconsistent and fragmented. Their mental healthcare.
training did not work, even worse, it may have caused negative
effects. . . (P7, counsellor)
Continuous supervision
Many relief workers mentioned the need to develop train- Relief workers almost unanimously agreed that supervision is
ing regulations, with standards and regulations for both indi- a key part of the mental health disaster field. Most post-
viduals and organizations to provide qualified training to disaster mental health training is inconsistent, impractical,
relief workers and avoid unnecessary, redundant, unscientific, and unusable. Continuous supervision provides a chance for
and harmful training. trainers to facilitate learning and supervise trainees so that
they can be more efficient in their clinical settings and
become better acquainted with local situations. Supervisors
Enriching interprofessional cooperation competencies can also support trainees in their struggles and help build
As previously stated, China has limited experience in provid- deeper relationships:
ing disaster-related mental health services, and hence the
crisis of 5/12 overwhelmed the mental health services system. You need to digest many things there. One is the negative feelings
Most mental health professionals were hospital-based and not sent from your patients. In the meantime, I myself suffer from
confusion about how to handle and balance the complicated
community-based. They were often single profession workers relationship between counsellor and patient. It involves frustra-
who knew little about other relevant professions. Coming tion and disappointment as well as joy when a patient shows
together in the disaster zones prompted professionals to rea- improvement. After I talked with my supervisor, I felt like there
lize the importance of interprofessional cooperation. Indeed, was nothing special between us from our talk, but I did feel more
training can help many professionals transition from acute to relaxed afterwards. . . (P11, counsellor)
community-based care. One relief worker provided the fol- Many participants cited the importance of continuous
lowing comment: supervision of their clinical work:
You cannot do the job by yourself or just with your team; instead, In the past, I knew the theories behind the methods, but I was
we have to cooperate with different organizations because the confused in my clinical practice. [The trainer] taught me hands-
survivors have many needs. We have cooperated with hospitals, on how to practice, which I felt was quite helpful. (P13, psychia-
communities, and the government. (P19, counsellor) tric nurse)
Many relief workers reported difficulties related to working When I report to my supervisor, I can not only learn about
in a disaster setting. Especially in the rural disaster setting, an practical techniques, but, most importantly, my supervisor can
ill-prepared mental health system makes it difficult for differ- tell me how I can improve. (P6, counsellor)
ent types of professionals to collaborate. Lack of collaboration Supervision is of central importance, but most participants
is inefficient, leads to overlapping roles, and contributes to reported a lack of supervisors, which made their work harder:
redundancy, which confuses situations and has a negative
impact on survivors: One of the common problems we encountered was a lack of
supervision. . . It’s undeniable that there were almost no super-
In the beginning, many different teams came to provide services visors equipped with enough theory and practical experience.
to the disaster survivors. Sometimes, different relief workers (P12, social worker)
would give multiple interventions to the same survivor. In the
beginning, there was a lack of communication and cooperation The aim of supervision is not only to support and help
between different teams . . . The situation was a mess. (P2, relief workers to develop the necessary skills to become a
psychiatrist) competent practitioner when doing fieldwork but also to
The capacity for interprofessional cooperation is essential provide companionship and emotional support for them.
and requires training relief workers to cooperate with each
other and better understand which task each person can be Empowering culturally informed practices
responsible for, to whom survivors with differing needs can be Relief workers revealed that most of the training they experi-
referred, and when and where to cooperate with each other: enced did not fit their setting. They felt confused about what
to do and how to provide mental health disaster-related
If I found a disaster survivor in need of psychiatric services, I first
services; therefore, most of the time, the workers experienced
obtained his consent and then contacted the psychiatrist; then, I
worked together with the psychiatrist, and I followed up with the strong feelings of powerlessness. After they creatively worked
client to instruct him on how to take his medication. (P13, with disaster survivors, the relief workers suggested the
psychiatric nurse) importance of culturally informed services:
I had worked in the hospital before. It was simple work. I just Once, when we had a free clinic, we had a sign outside the clinic
prescribed drugs to my clients, I did not have any experience with that said Mental Health Service. No one came to us. Then, I
psych rehabilitation services and community services. Some train- changed the sign to say Insomnia Clinic because I discovered
ing is really good . . . You can hear different opinions from the that many people had problems sleeping after the earthquake.
training. (P2, psychiatrist) Then, people came to us one after another. (P18 psychiatrist)
JOURNAL OF INTERPROFESSIONAL CARE 5

Figure 1. People-centred community interprofessional training model.

The disaster setting is very different from the setting of our respond to the care of earthquake survivors with noticeable
regular mental health services. Many mental health profes- post-traumatic mental health disorders (Chan, 2008; Jia, Ying,
sionals had to respond to survivors in culturally sensitive ways: Zhou, Wu, & Lin, 2015). This limitation is primarily due to
the inadequacy of early training, which hinders the provision
I am a psychologist, but in the disaster setting, I felt like a social
worker. I had to step into survivors’ families to provide services to of efficient and qualified mental healthcare.
them or else they would never come to find help from you. Before Caring for caregivers, knowing the needs of the trainees and
the disaster, they knew nothing about mental health and mental survivors, and being aware of the importance of trainer role-
health services. (P16, counsellor) modelling are fundamental to ensuring further systematic stra-
To provide culturally sensitive services, many disaster relief tegies of interprofessional education. Inquiring as to their needs,
workers found local resources to work with disaster survivors: rather than relying on assumptions, helps identify the true needs
of trainees and local survivors, and this can help meet survivor,
Neither of us had any experience with disaster-related mental trainee, family, and community healthcare needs optimally and
health services. . . We had to rely on our basic knowledge and cost-effectively. The training institutions also have a responsi-
resources available in the affected areas. I was hesitant about this
before, but then I discovered that the locals could do embroidery, bility not only to be responsive to frontline workers’ training
so we developed an embroidery group. We performed psycholo- needs but also to ensure that they can function in their clinical
gical therapy while embroidering. Now I really feel proud of my work (Chastonay et al., 2015) Meanwhile, relief workers fre-
idea. (P1, counsellor) quently suffer from burnout and many other negative feelings,
Developing empowering strategies through the training pro- which all usually lead to lower competence, more clinical errors,
cess may be a means of helping relief workers recognize power- and less motivation and a tendency to quit relief work
lessness in difficult situations and take appropriate action. (Halbesleben & Rathert, 2008; Wilters, 1998). Thus, stress man-
agement, problem-solving methods, cognitive restructuring,
effective preventive measures, and various continuing psycho-
Model development social coping strategies for reducing burnout are needed
(Fothergill, Edwards, & Burnard, 2004; Rudman & Gustavsson,
As noted above, the above categories were used to develop an 2012; Skodova & Lajciakova, 2013). Moreover, other scholars
exploratory model called the ‘people-centred community suggest that providing practitioners with a better understanding
interprofessional training model’ (see Figure 1). of their boundaries and limitations in their caregiving role helps
This model identifies areas for the training of relief work- them to be mindful of their own psychological well-being and
ers and aims to address the importance of people-centred find meaning in their work, which is necessary to avoid feeling
mental health service provisions. It was also designed to threatened and exhausted (Moody et al., 2013; Nancarrow, 2004;
ensure intentional and strategic training of relief workers Shanafelt, 2009). Indeed, training in self-preparedness may con-
using interprofessional concepts and strategies, using cultu- tribute to better outcomes on a personal and organizational level
rally attuned and community-informed strategies in mental (Palm, Polusny, & Follette, 2004). Obviously, without proper
health training practices. care for relief workers, we can have no disaster-related mental
health services, because without proper care for the workers,
there will be no one to provide frontline services.
Discussion
Relief workers cannot simply rely on their skills and
Community-based disaster-related mental health services in instead must nurture trusting therapeutic relationships and
most developing countries do not have adequate resources to have a humanistic attitude. These necessary relationships and
6 Z. REN ET AL.

attitudes can be acquired from their trainers (Levine, 2015; very complicated; China has a parable from 2,000 years ago
Wright, Wong, & Newill, 1997). The spirit of professionalism that states ‘Sweet orange seeds of one orchard grow bitter in
and interprofessional teamwork is best learned specifically another’. This parable implies that a mechanical application of
through observation of role models (Byszewski, Hendelman, foreign methodology cannot solve problems locally and may
McGuinty, & Moineau, 2011; Selle, Salamon, Boarman, & even sometimes cause negative effects. Empowering culturally
Sauer, 2008). Relief workers identified the need for strong informed practices involves treating human beings with an
positive role models in their learning environment, especially integrity and promoting the use of social cultural resources of
in carrying out post-disaster services. The foundations of the people we serve (Shearer, 2009). Specifically, empower-
disaster-related mental health education need to teach relief ment requires the relief workers to recognize that any disaster
workers to treat traumatized people as whole persons, worthy mental health service will focus not only on the use of the
of respect. That humanistic spirit and attitude is best con- disaster survivor’s personal resources such as self-capacity, but
veyed by a role model, a teacher who the students perceive as also on their social cultural resources such as community
caring and who understands and gives weight to the needs support individuals, networks, agencies, and cultural
and voices of relief workers. This attitude is foundational in resources. From this perspective, empowerment is a dynamic
any humanitarian service and deserves focus during the edu- process focused on purposefully participating in a process of
cational process (Marcus, 1999; Umbach & Wawrzynski, changing, improving, or integrating oneself and one’s envir-
2005). onment (Shearer, 2009), which can ensure the cultural con-
As presented in Figure 1, this study identified four progres- tinuity and harmonize the mental, spiritual, emotional, and
sive and interactive core elements. The first two elements are physical well-being of the cultural unit and its environment
consistent with the core competencies of the American (Armstrong, 1987; Gauthier & Matteson, 1995; McConaghy,
Association of Colleges of Nursing’s training strategies for inter- 2000).
professional collaborative practices, which emphasize the regu- There is limited evidence regarding the optimal way for trai-
lation of ethical conduct and enriching interprofessional ners to provide training to trainees in mental health disaster
cooperation competencies (Schmitt, Blue, Aschenbrener, & situations. Nevertheless, our model can help researchers form an
Viggiano, 2011). explicit hypothesis regarding how training can support learning
The first step is to build and effectively regulate training that can be empirically investigated. Ultimately, we hope our
content, which includes the quality of teachers, ethical guide- exploratory research can help advance the goal of more humane,
lines, cultural-awareness, and empirical evidence standards integrated, and comprehensive mental health services in the
(Browne et al., 1995). Without well-planned trainings, we future.
can only bring about disorder and negative effects, which In relation to study limitations, our research does not aim to
may even harm survivors. The second step is to enrich inter- build a comprehensive theory to explain global views on disaster
professional cooperation and collaboration. These are impor- mental health education for relief workers in a variety of contexts.
tant due to the huge demand and short supply of In contrast, the information generated from this study provides
interprofessional collaborative practices in China. As a result, an exploratory model (see Figure 1), which evolved in a particular
interprofessional education has lagged dramatically behind its rural remote situational context. As with all qualitative studies,
practice, generating an urgent ‘gap’ in the response of mental the transferability of the findings is limited by the small sample
health teams to earthquakes. Many scholars have stated that size and the uniqueness of the natural disaster setting being
enriching interprofessional cooperation competencies has a studied; therefore, caution must be taken in generalizing this
dynamic relationship with practice needs and practice model to other disaster-related mental health service settings.
improvements and additionally increases trainee’s satisfaction
with learning and the overall training experience (Curran,
Sharpe, Flynn, & Button, 2010; Lumague et al., 2006). These
Concluding comments
improvements lead to better teamwork, relationships with
patients, clinical skills, and professional identity as well as The findings of this study indicate that more attention should be
fewer emotional disturbances and medical errors (Gould, paid to culturally appropriate or worker-informed trainings
Lee, Berkowitz, & Bronstein, 2015; Korner et al., 2016; because the setting for mental health professionals involved in
Roberts & Kumar, 2015). To maintain the efficiency and disaster relief work in rural China is complex and difficult.
expertise of interprofessional cooperation competencies, con- Indeed, consistent with our model, to build deeper connections
tinuous training and supervision is a key element of systema- and understanding, future trainers must fully respect the world
tic interprofessional education, which helps ensure that of the trainees while being committed to the needs of workers.
knowledge becomes practice through long-term training and Additionally, role-modelling is a primary method through
clinical supervision. This approach can help students better which experienced trainers can teach relief workers humanistic
obtain professional skills, offer more effective services, and aspects of disaster relief work. Moreover, issues surrounding the
reduce clinical mistakes (Begat, Ellefsen, & Severinsson, 2005; regulation of training, clinical supervision, empowerment, inten-
Watkins Jr, 2011). tional and strategic training of mental health relief workers
The final and most important step is to empower students using interprofessional concepts and strategies, and the roles
to take proper actions based on their local situations rather and responsibilities of different professions must be addressed
than apply knowledge mechanically. Providing this service is in future studies.
JOURNAL OF INTERPROFESSIONAL CARE 7

Acknowledgements physicians and patients. Health Care Management Review, 33(1), 29–
39. doi:10.1097/01.HMR.0000304493.87898.72
We want to take this opportunity to thank our friends Professor Alvin Jia, X., Ying, L., Zhou, X., Wu, X., & Lin, C. (2015). The effects of
Dueck and Professor Chow Lam. They nurture our understanding of extraversion, social support on the posttraumatic stress disorder and
human suffering and culture psychology. posttraumatic growth of adolescent survivors of the Wenchuan earth-
quake. PLoS One, 10(3), e0121480. doi:10.1371/journal.pone.0121480
Keats, D., & Wang, S. (2013). The background to the research: Cultural,
Declaration of interest theoretical and methodological issues. In Y. Kashima, E. S. Kashima, &
R. Beatson (Eds.), Steering the Cultural Dynamics, Selected papers from
The authors report no conflicts of interest. The authors alone are the 2010 Congress of the international association for cross-cultural psy-
responsible for the content and writing of this article. chology, (pp. 9–14). Melbourne, Australia: International Association for
Cross-Cultural Psychology.
Korner, M., Butof, S., Muller, C., Zimmermann, L., Becker, S., & Bengel,
References J. (2016). Interprofessional teamwork and team interventions in
chronic care: A systematic review. Journal of Interprofessional Care,
Armstrong, J. C. (1987). Traditional indigenous education: A natural 30, 15–28. doi:10.3109/13561820.2015.1051616
process. Canadian Journal of Native Education, 14(3), 14–19. Levine, M. P. (2015). Role models’ influence on medical students’ profes-
Backman, K., & Kyngas, H. A. (1999). Challenges of the grounded theory sional development. Virtual Mentor, 17(2), 144–148. doi:10.1001/vir-
approach to a novice researcher. Nursing & Health Sciences, 1(3), 147– tualmentor.2015.17.02.jdsc1-1502
153. doi:10.1046/j.1442-2018.1999.00019.x Liu, C., Chen, L., Xie, B., Yan, J., Jin, T., & Wu, Z. (2013). Number and
Begat, I., Ellefsen, B., & Severinsson, E. (2005). Nurses’ satisfaction with characteristics of medical professionals working in Chinese mental
their work environment and the outcomes of clinical nursing super- health facilities. Shanghai Archives of Psychiatry, 25(5), 277–285.
vision on nurses’ experiences of well-being – a Norwegian study. doi:10.3969/j.issn.1002-0829.2013.05.003
Journal of Nursing Management, 13(3), 221–230. doi:10.1111/j.1365- Lumague, M., Morgan, A., Mak, D., Hanna, M., Kwong, J., Cameron, C.,
2834.2004.00527.x . . . Sinclair, L. (2006). Interprofessional education: The student per-
Browne, A., Carpenter, C., Cooledge, C., Drover, G., Ericksen, J., spective. Journal of Interprofessional Care, 20, 246–253. doi:10.1080/
Fielding, D., et al. (1995). Bridging the professions: An integrated 13561820600717891
and interdisciplinary approach to teaching health care ethics. Marcus, E. R. (1999). Empathy, humanism, and the professionalization
Academic Medicine: Journal of the Association of American Medical process of medical education. Academic Medicine: Journal of the
Colleges, 70(11), 1002–1005. doi:10.1097/00001888-199511000-00018 Association of American Medical Colleges, 74(11), 1211–1215.
Byszewski, A., Hendelman, W., McGuinty, C., & Moineau, G. (2011). doi:10.1097/00001888-199911000-00014
Wanted: Role models–medical students’ perceptions of professional- Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications
ism. BMC Medical Education, 12, 115–115. doi:10.1186/1472-6920-12- for cognition, emotion, and motivation. Psychological Review, 98(2),
115 224–253. doi:10.1037/0033-295X.98.2.224
Chan, E. Y. (2008). The untold stories of the Sichuan earthquake. The Mathers, C., Fat, D. M., & Boerma, J. (2008). The global burden of disease:
Lancet, 372(9636), 359–362. doi:10.1016/S0140-6736(08)61141-1 2004 update. Geneva, Switzerland: World Health Organization.
Chastonay, P., Moretti, R., Cremaschini, M., Bailey, R., Wheeler, E., Mattig, McClean, D. (2010). World disasters report 2010: Focus on urban risk world
T., . . . Mpinga, E. K. (2015). A public health e-learning master? s disasters Report 2010: Focus on urban risk. Geneva, Switzerland:
programme with a focus on health workforce development targeting International Federation of Red Cross and Red Crescent Societies (IFRC).
francophone Africa: The University of Geneva experience. Human McConaghy, C. (2000). Rethinking Indigenous education:
Resources for Health, 13, 68–68. doi:10.1186/s12960-015-0065-8 Culturalism, colonialism and the politics of knowing. Flaxton,
Chiang, H. H., Lu, Z. Y., & Wear, S. E. (2005). To have or to be: Ways of Australia: Post Pressed.
caregiving identified during recovery from the earthquake disaster in Moody, K., Kramer, D., Santizo, R. O., Magro, L., Wyshogrod, D.,
Taiwan. Journal of Medical Ethics, 31(3), 154–158. doi:10.1136/ Ambrosio, J., . . . Stein, J. (2013). Helping the helpers: Mindfulness
jme.2003.004101 training for burnout in pediatric oncology–a pilot program. Journal of
Corbin, J. M., & Strauss, A. (1990). Grounded theory research: Pediatric Oncology Nursing, 30(5), 275–284. doi:10.1177/
Procedures, canons, and evaluative criteria. Qualitative Sociology, 1043454213504497
13(1), 3–21. doi:10.1007/BF00988593 Nancarrow, S. (2004). Dynamic role boundaries in intermediate care
Curran, V. R., Sharpe, D., Flynn, K., & Button, P. (2010). A longitudinal services. Journal of Interprofessional Care, 18, 141–151. doi:10.1080/
study of the effect of an interprofessional education curriculum on 13561820410001686909
student satisfaction and attitudes towards interprofessional teamwork Ng, C., Ma, H., Raphael, B., Yu, X., Fraser, J., & Tang, D. (2009). China-
and education. Journal of Interprofessional Care, 24, 41–52. Australia training on psychosocial crisis intervention: Response to the
doi:10.3109/13561820903011927 earthquake disaster in Sichuan. Australas Psychiatry, 17(1), 51–55.
Fothergill, A., Edwards, D., & Burnard, P. (2004). Stress, burnout, coping doi:10.1080/10398560802444069
and stress management in psychiatrists: Findings from a systematic Palm, K. M., Polusny, M. A., & Follette, V. M. (2004). Vicarious trau-
review. The International Journal of Social Psychiatry, 50(1), 54–65. matization: Potential hazards and interventions for disaster and
doi:10.1177/0020764004040953 trauma workers. Prehospital and Disaster Medicine, 19(1), 73–78.
Gao, X., Jackson, T., Chen, H., Liu, Y., Wang, R., Qian, M., & Huang, X. doi:10.1017/S1049023X00001503
(2010). There is a long way to go: A nationwide survey of professional Pechacek, J., Shanedling, J., Lutfiyya, M. N., Brandt, B. F., Cerra, F. B., &
training for mental health practitioners in China. Health Policy, 95(1), Delaney, C. W. (2015). The national united states center data reposi-
74–81. doi:10.1016/j.healthpol.2009.11.004 tory: Core essential interprofessional practice & education data
Gauthier, M. A., & Matteson, P. (1995). The role of empowerment in enabling triple aim analytics. Journal of Interprofessional Care, 29,
neighborhood-based nursing education. The Journal of Nursing 587–591. doi:10.3109/13561820.2015.1075474
Education, 34(8), 390–395. Ren, Z. (2009). On being a volunteer at the Sichuan earthquake disaster
Gould, P. R., Lee, Y., Berkowitz, S., & Bronstein, L. (2015). Impact of a area (translated version). Hong Kong Journal of Psychiatry, 19(3), 123.
collaborative interprofessional learning experience upon medical and Roberts, C., & Kumar, K. (2015). Student learning in interprofessional
social work students in geriatric health care. Journal of Interprofessional practice-based environments: What does theory say? BMC Medical
Care, 29, 372–373. doi:10.3109/13561820.2014.962128 Education, 15(1), 211. doi:10.1186/s12909-015-0492-1
Halbesleben, J. R., & Rathert, C. (2008). Linking physician burnout and Rudman, A., & Gustavsson, J. P. (2012). Burnout during nursing educa-
patient outcomes: Exploring the dyadic relationship between tion predicts lower occupational preparedness and future clinical
8 Z. REN ET AL.

performance: A longitudinal study. International Journal of Nursing Thai, M. T., Chong, L.-C., & Agrawal, N. M. (2012). Straussian grounded-
Studies, 49(8), 988–1001. doi:10.1016/j.ijnurstu.2012.03.010 theory method: An illustration. The Qualitative Report, 17(52), 1–55.
Schmitt, M., Blue, A., Aschenbrener, C., & Viggiano, T. (2011). Core Tierney, A. J., & Vallis, J. (1999). Multidisciplinary teamworking in the
competencies for interprofessional collaborative practice: Reforming care of elderly patients with hip fracture. Journal of Interprofessional
health care by transforming health professionalsʼ education. Academic Care, 13, 41–52. doi:10.3109/13561829909025534
Medicine: Journal of the Association of American Medical Colleges, Umbach, P. D., & Wawrzynski, M. R. (2005). Faculty do matter: The role
86(11), 1351–1351. doi:10.1097/ACM.0b013e3182308e39 of college faculty in student learning and engagement. Research in
Selle, K. M., Salamon, K., Boarman, R., & Sauer, J. (2008). Providing Higher Education, 46(2), 153–184. doi:10.1007/s11162-004-1598-1
interprofessional learning through interdisciplinary collaboration: The Watkins, C. E., Jr. (2011). Does psychotherapy supervision contribute to
role of “modelling”. Journal of Interprofessional Care, 22, 85–92. patient outcomes? Considering thirty years of research. The Clinical
doi:10.1080/13561820701714755 Supervisor, 30(2), 235–256. doi:10.1080/07325223.2011.619417
Shanafelt, T. D. (2009). Enhancing meaning in work: A prescription for Wilters, J. H. (1998). Stress, burnout and physician productivity. Medical
preventing physician burnout and promoting patient-centered care. Group Management Journal, 45(3), 32-34, 36-37.
The Journal of the American Medical Association, 302(12), 1338–1340. Wright, S., Wong, A., & Newill, C. (1997). The impact of role models on
doi:10.1001/jama.2009.1385 medical students. Journal of General Internal Medicine, 12(1), 53–56.
Shearer, N. B. C. (2009). Health empowerment theory as a guide for practice. doi:10.1007/s11606-006-0007-1
Geriatric Nursing, 30(2), 4–10. doi:10.1016/j.gerinurse.2009.02.003 Yan, Y. E., Turale, S., Stone, T., & Petrini, M. (2015). Disaster nursing skills,
Skodova, Z., & Lajciakova, P. (2013). The effect of personality traits and knowledge and attitudes required in earthquake relief: Implications for
psychosocial training on burnout syndrome among healthcare students. nursing education. International Nursing Review, 62(3), 351–359.
Nurse Education Today, 33(11), 1311–1315. doi:10.1016/j.nedt.2013.02.023 doi:10.1111/inr.12175