Ch. 26 Crisis and Disaster

A crisis is self-limiting and usually resolves within how many weeks

4 to 6 weeks.

A category 5 hurricane destroys homes and businesses in a community. How would this crisis be classified

Adventitious

Crisis results from a natural disaster (flood, fire, earthquake), a national disaster (act of terrorism, war, riots, etc), a crime or violence (rape, assault, or murder)

Adventitious

Unplanned and accidental: Natural disaster National disaster Crime of violence (Terrorism, bombimngs, lava flow on big island, tsunami, etc)

Adventitious Crisis

Crisis Intervention - Teritary Care:

After the event - provides support to this who have experienced a severe crisis and now recovering from a disabling mental state

Crisi Theory: 7 stage model for crisis intervention

Albert R. Roberts

defined by the struggle for equilibrium and adaptation in its aftermath and not the experience itself

Crisis

normal coping mechanisms fail, profound disruption of normal psychological homeostasis

Crisis

Crisis Theory: 2 nurses - crisis management and interventions for nurses

Donna Aguilera and Janice Mesnick

Crisis Theory: debrief people after crisis and see how coping (1940's)

Erich Lindemann

Evaluating the response effort to prepare for the future

Evaluation

everyone in groups says what did you see happen - what facts are and their invovlement in the incident

Fact

Cries Theory: built on theories to lindemann and improve intervention strategies

Gerald Caplan

Nursing diagnosis for crisis

Ineffective coping

person doing debriefing is leader

Intro

New developmental stage is reached (leaving home, empty nest syndrome, etc) Old coping skills no longer effective Leads to increased tension and anxiety

Maturational Crisis

critical period of increased vulnerability and, at the same time,, heightened potential

Maturational crisis

Attempt to limit a disaster's impact on human health and community function

Mitigation

Two initial goals of crisis intervention:

Patient safety & Anxiety Reduction

Conflict or problem Self-concept threatened Increased anxiety Use of problem-solving techniques and defense mechanisms Resolve conflict or problem Reduce anxiety

Phase of Crisis: Phase 1

Defense mechanisms fail Threat persists Anxiety increases Feelings of extreme discomfort Functioning disorganized Trial-and-error attempt to solve problem and restore normal balance

Phase of Crisis: Phase 2

Trial-and-error attempts fail Anxiety can escalate to severe level or panic Automatic relief behaviors mobilized (i.e., withdrawal and flight) Some form of resolution may be devised(i.e., compromising needs or redefining situation)

Phase of Crisis: Phase 3

Problem is unsolved and coping skills are ineffective Overwhelming anxiety Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior

Phase of Crisis: Phase 4

The protective plan designed before the event to structure the response, assess risk, and evaluate damage

Preparedness

Crisis Intervention - Primary Care:

Prevention - before it happens work with patient to recognize potential problems by evaluating patient's experience of stressful events, teach the patients specific coping skills, could work with patient to plan changes to decrease negative effects of stress.

checking in, how is it working for you, what kind of support do you have, hwo are you going to handle it if symptoms re appear (cope)

Re-entry

- gets into emotions (what is the most painful part of this incident

Reaction

Actions focus on stabilizing the community and returning to its previous status

Recovery

Actual implementation of the disaster plan

Response

Crisis Intervention - Secondary Care:

Screening - establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization

What term is most applicable to crisis?

Self-Limiting

Crisis: loss or change of job, the death of a loved one, an abortion, a change in financial status, divorce, and severe mental or physical illness

Situational Crisis

Type of Crisis: Arise from events that are: Extraordinary External Often unanticipated (Illness, divorce, abortion)

Situational Crisis

describe any symptoms felt after incident (headahce, body aches, passing out, etc) all symptoms are ok nothing is funny/unacceptable in crisis

Symptom

might not be the only symptoms you experience might start to have nightmares, and flashbacks. teach how to cope (support groups, diary, journal, who to talk to when return from incident)

Teaching

what was your first thought?

Thought