Ch 26 Crisis & Disaster Flashcards
a short-term therapeutic process that focuses on rapid resolution of an immediate crisis or emergency
Crisis intervention
people vary in the way they absorb, process & use info in from the environment
perception of event
includes nurses & other HCW who use crisis intervention
Situational supports
skills acquired through a variety of sources that promote the adaptive development of new coping responses
coping mechanisms
a critical period of increased vulnerability & at the same time, heightened potential
Erikson’s developmental stages
Maturational Crisis
arises from events that are extraordinary, external rather than internal, & often unanticipated
Situational Crisis
not a part of everyday life; it results from events that are unplanned & that may be accidental, caused by nature or human-made
Adventitious Crisis
Person confronted by conflict or problem that threatens and increases feelings of anxiety
Phases of Crisis
Phase 1
If usual defense responses fail & threat persists, anxiety continues to rise & produces feelings of extreme discomfort.
Functioning becomes disorganized.
Trial & Error to restore balance
Phases of Crisis
Phase 2
If trial & error attempts fail, anxiety can escalate to severe/panic levels.
Person mobilizes automatic relief behaviors such as withdrawal or flight.
Some form of resolution may be made at this stage.
Phases of Crisis
Phase 3
if problem is not solved& new coping skills are ineffective, anxiety can overwhelm the person & lead to serious personality disorganization, depression, confusion, violence against others & suicidal behaviors
Phases of Crisis
Phase 4
Self-limiting & usually resolves in 4-6 wks
At resolution of crisis, pt will emerge at one of three functional levels
1. higher level
2. same level
3. lower level
Goal is to return the pt. to at least the pre-crisis level of functioning
Form of resolution depends on pt. action and others intervention
People are more receptive than usual to outside interventions
Only deals with the pt. present problem & resolution
Nurse must be willing to take an active, even direct role in the intervention
Early intervention increases the changes for a good prognosis
Pt is encouraged to set realistic goals & plan a focus intervention with the nurse
Foundation for Crisis Intervention
- Nurses need to feel needed
- Nurses set unrealistic goals for pt
- Nurse has difficulty with a suicidal pt
- Nurse has difficulty terminating after crisis has resolved
Common problems in the nurse-pt relationship
ID if pt. response warrants psychiatric treatment or hospitalization
ID if pt. is able to identify the precipitating events
Assess pt. understanding of present situational support
ID usual coping styles & determine what coping mechanisms may help present situation
Determine if any religious or cultural beliefs need to be considered during assessment & interventions
Assess if pt. needs primary, secondary or tertiary interventions
Crisis assessment guidelines
promotes mental health & reduces mental illness to decrease the incidence of crisis
- work with pt. to recognize potential problems
- teach pt. specific coping skills
- Assist pt. in evaluating the timing or reduction of life changes to decrease negative effects of stress
Primary Care
interventions during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness & personality organization
Secondary Care
provides support for those who have experienced a severe crisis & are now recovering from a disabling mental state
Tertiary Care
example of tertiary intervention 7 Phases 1. Introductory Phase 2. Fact Phase 3. Thought Phase 4. Reaction Phase 5. Symptom Phase 6. Teaching Phase 7. Reentry Phase
Critical incident stress debriefing (CISD)
Provide atmosphere of support
Avoid giving false reassurance
Provide safe haven
Determine safety risk to self/others
Initiate precautions for safety
Encourage expression of feelings
Assist in identification of the precipitants & dynamics of the crisis
Encourage pt. to focus on one implication at a time
Assist in identification of personal strength & abilities to used in resolving the crisis
Assist in IDing past/present coping skills & effectiveness
Assist in IDing available support systems
Link pt. & family with community resources
Provide guidance in developing & maintain support systems
Intro pt to people/groups who have gone through the same thing
Assist in IDing alternate course of action in solving crisis
Assist in evaulating possible consquences of vaious courses of actions
Assist in deciding course of action & timeframe
Evaluate if crisis has been resolved
Plan with pt how to adaptive coping skills can be used with crisis in the future
Crisis Interventions
protective plan designed before the event of structure the response, assess risk & evaluate damage
Preparedness
attempt to limit a disaster’s impact on human health & community function
Mitigation
actual implementation of the disaster plan
Response
actions focus on stabilizing the community & returning it to its previous state
recovery
evaluating the response effort to prepare for the future
evaluation
