Crisis, Grief, and Disaster Management Flashcards
Crisis
time-limited challenge/threat that overwhelmed the person’s ability to cope
–> turning point w/positive or negative outcomes
- time limited: 4-6 weeks
- when we reach dysequilibium from stressful situaton a crisis will occur if any of these following balancing factors are absent
Crisis Balancing Factors
- realistic perception
- adequate situational support
- adequate coping skills
Types of Crises
Developmental
Situational
Traumatic
Developmental Crisis
significant events that are a normal part of growth/require role changes
ex: marriage, leaving for college
* developmental crisis and situational crisis may be very similar
Situational Crisis
occur when a specific life even upsets and individuals psychological equilibrium
*situational crisis and developmental crisis may be very similar
Traumatic Crisis
unexpected/unusual events affecting a person/group
Assessment
support systems
physical condition
- emotions/strengths
- mental status
- suicide/homicide ideation
Diagnosis
- ineffective coping
- powerlessness
- impaired communication
- risk for violence/self harm
Psychological First Aid
ABCs of first aid focus on:
A: arousal
B: behavior
C: cognition
Intervention
- may need to be directive if problem-solving abilities are strained
- first arrange for safety/to meet basic needs (treat life-threatening injuries, arrange food/shelter, provide care for suicidal/homicidal ideation or plans)
- do not give unrealistic or false reassurance of positive outcomes
- Lorazepam (Ativan): benzo, anti-anxiety may be used
- mobilize social support
Grief
an intense, biopsychosocial reaction to loss of loved one, spontaneous expression of pain, sadness, and desolation
Bereavement
process of mourning and coping
begins immediately, but can last months/years
*anniversary reactions may occur (emotions and grief may reappear on anniversary of death…etc.)
Phases of Bereavement
- Shock/Disbelieve
- hours to weeks
- varying degrees - Acute Mourning
- becomes gradually aware of loss (intense feeling, social withdrawal, identification w/deceased)
- -includes crying - Resolution
- the return of feelings of well-being
- acceptance of loss
Dual Process Model of Grieving
another explanation of how people deal w/loss is between loss-oriented coping (preoccupation w/deceased) and restoration-oriented copying (preoccupation w/other life events)
Uncomplicated Grief
- physical responses
- feeling of unreality (upset stomach, headaches, feeling of unreality…)
- Intense preoccupation with deceased
- Exaggerated guilt for any small negligence
- Yearnings disbelief
- 6 months may have signs of limited impairment in new situations
- May grieve more over other situations like “empty nest”
- Self esteem & competency intact & do NOT need counseling
Traumatic Grief
-More difficult & prolonged grief, benefits from treatment
Worse if it’s sudden (lack of anticipation)
External factors influence reactions & outcomes:
1) Suddenness and lack of anticipation
2) Violence, mutilation, and destruction
3) Preventability and/or randomness of the death
4) Multiple deaths (bereavement overload)
5) Mourner experienced significant threat to personal survival, or a massive and shocking confrontation with the deaths (and/or mutilation) of others
- Reliving the traumatic death of the loved one
- Suicide survivors may feel stigma, blame, shame, guilt & rejection
- Women are more likely to confront & express negative emotions
Complicated Grief
- Occurs in 10-20% of people when the grieving person is stuck in a chronic state of mourning.
- Intense longing & grieving for a person who died over 6 months ago.
- Feelings of bitterness, lack of trust, life is meaningless without the deceased person.
Nursing Management
Assess for suicide/self-harm
assess level of coping
listen –> intervene/link support systems
refer to therapist/psychiatrist
facilitate the development of positive coping skills
Outcomes
return to previous/higher level of functioning
Disaster/Terrorism
Disaster: sudden, overwhelming, catastrophic even that causes GREAT damage/destruction
may involve mass casualties/human suffering
requires assistance from all available resources
Phases of Disaster
- Prewarning of Disaster
- Disaster event occurs
- Recuperative effort
Prewarning of the Disaster
preparing victims for possible evacuation of environment, mobilization of resources, and review of disaster plans
Disaster Event Occurs
rescuers provide resources, assistance, and support as needed to preserve the biopsychosocial functioning/survival of victims
Recuperative Effort
implement strategies for healing sick
prevent complications
repair damage
reconstructing the community
Types of Disaster Victims
- severe physical trauma
- professional rescuers
- everyone else
Nursing Management of Disaster
- mental status and panic reactions
- physical condition
- suicidal and homicidal ideation/plans
- unexplained physical symptoms
Diagnosis of Disaster
could be almost any Dx depending on situation/person’s reaction
- insomnia
- risk for self harm
- relocation stress syndrome
- fear
Disaster Crisis Intervention
Similar to crisis interventions strategies w/following additions:
-help victims prioritize and match available resources with their needs
-the type/severity of the disaster will affect needs/resources
When balancing factors are absent, what occurs?
- Distorted perception
- Inadequate support
- Inadequate coping skills
ABC’s of psychological first aid: A
Arousal
when arousal is present, decrease excitement by providing safety, comfort, and consolation
ABC’s of psychological first aid: B
Behavior
when irrational behavior is present, assist survivors to function more effectively in the disaster
ABC’s of psychological first aid: C
Cognition
when cognitive disorientation occurs, reality testing and clear information should be provided
