Ch 26 Crisis & Disaster

Question 1

a short-term therapeutic process that focuses on rapid resolution of an immediate crisis or emergency

Answer 1

Crisis intervention

Question 2

people vary in the way they absorb, process & use info in from the environment

Answer 2

perception of event

Question 3

includes nurses & other HCW who use crisis intervention

Answer 3

Situational supports

Question 4

skills acquired through a variety of sources that promote the adaptive development of new coping responses

Answer 4

coping mechanisms

Question 5

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

Erikson’s developmental stages

Answer 5

Maturational Crisis

Question 6

arises from events that are extraordinary, external rather than internal, & often unanticipated

Answer 6

Situational Crisis

Question 7

not a part of everyday life; it results from events that are unplanned & that may be accidental, caused by nature or human-made

Answer 7

Adventitious Crisis

Question 8

Person confronted by conflict or problem that threatens and increases feelings of anxiety

Answer 8

Phases of Crisis

Phase 1

Question 9

If usual defense responses fail & threat persists, anxiety continues to rise & produces feelings of extreme discomfort.
Functioning becomes disorganized.
Trial & Error to restore balance

Answer 9

Phases of Crisis

Phase 2

Question 10

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.

Answer 10

Phases of Crisis

Phase 3

Question 11

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

Answer 11

Phases of Crisis

Phase 4

Question 12

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

Answer 12

Foundation for Crisis Intervention

Question 13

1. Nurses need to feel needed
2. Nurses set unrealistic goals for pt
3. Nurse has difficulty with a suicidal pt
4. Nurse has difficulty terminating after crisis has resolved

Answer 13

Common problems in the nurse-pt relationship

Question 14

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

Answer 14

Crisis assessment guidelines

Question 15

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

Answer 15

Primary Care

Question 16

interventions during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness & personality organization

Answer 16

Secondary Care

Question 17

provides support for those who have experienced a severe crisis & are now recovering from a disabling mental state

Answer 17

Tertiary Care

Question 18

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

Answer 18

Critical incident stress debriefing (CISD)

Question 19

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

Answer 19

Crisis Interventions

Question 20

protective plan designed before the event of structure the response, assess risk & evaluate damage

Answer 20

Preparedness

Question 21

attempt to limit a disaster’s impact on human health & community function

Answer 21

Mitigation

Question 22

actual implementation of the disaster plan

Answer 22

Response

Question 23

actions focus on stabilizing the community & returning it to its previous state

Answer 23

recovery

Question 24

evaluating the response effort to prepare for the future

Answer 24

evaluation