Crisis, loss, grief, bereavement, and disaster management Flashcards
Crisis
Time-limited event that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences
When does a crisis occur?
From stressful events when previous coping mechanisms fail to provide adequate adaptive skills to address the perceived problem. Adaptation to crisis occurs in 6 weeks
Example of positive and negative outcomes of a crisis
Pos: growth, change
Neg: suicide, homelessness, depression
Types of crises
Developmental, situational, traumatic
Developmental crisis
AKA maturational crises; Erikson; successfully resolving crisis at one stage allows one to move to the next stage. Kid develops positive characteristics after crisis is resolved. Leaving home, completing school, accepting adulthood
Situational crisis
Specific stressful event threatens a persons integrity and results in a degree of psychological disequilibrium. Internal (disease) or external (moving cities)
Traumatic crisis
Unexpected, unusual event that can affect the person or multiple people. Riots, war, rape, murder, kidnapping, earthquake, flood
What is the goal for people experiencing a crisis?
To return to precrisis functioning level
Nurses first priority for the patient in a crisis
Determining the extent of the physical injury or trauma
Safety and physical consequences of the crisis are the ____ priority
1st
Nursing a crisis the body reacts in different ways, name a few
Tachycardia, hyperventilation, suicidal ideation, body systems can change (diarrhea, incontinence)
T/F: food, shelter, fear, and extreme distress should be addressed by the nurse
T
Nurses should keep what in mind with therapeutic communications?
Be patient, listen, empathy, don’t give unrealistic or false reassurances of positive outcomes
Immediate goals in a crisis for nurses
Treat life-threatening physical injury, asses for suicide, arrange food and shelter, mobile social support
After the safety needs are met, the nurse can move towards…
Reestabilising self-care routines and using positive coping strategies
T/F medication can’t solve a crisis, they can reduce the emotional intensity
T
The nurse should refer anyone who cannot cope with a crisis to who?
A mental health specialist
Lorazepam (Ativan)
-Benzo
-management of anxiety
- drowsy, sedation, lethargy, hypoTN
Bereavement
Mourning; process of healing after a perceived loss. Begins immediately after loss and can last months to years
What year after a loss is the most difficult?
The 1st due to holidays and birthdays
Grief
A natural, intense, physical, emotional, social, cognitive, or social reaction to the death of a loved one. Crying, sobbing, anger, guilt
Predeath grief
When someone has a terminal illness and mostly occur in caregivers. Dementia for example. This type of grief is associated with depressive symptoms, caregiver burden, and less communication within families
Acute grief
Occurs immediately after the death of a loved one and normally evolves to a permanent state of integrated grief
Integrated grief
Long-term process where there continues to be mild yearning and memories but they aren’t intrusive.
Prolonged grief disorder
PGD; intense longing for or persistent preoccupation w/the deceased that lasts more than 6 months
Dual process model
Explains how grieving people come to terms with their loss over time (coping). People go the the process of confronting (loss-oriented coping) and avoiding ( restoration oriented coping)
In loss-oriented coping, what do the emotions relate to?
The relationship with the deceased
In restoration-oriented coping, what do the emotions relate to?
The stressful events associated with the responsibilities and changes as a result of the loss (paying the dead bills, etc)
Uncomplicated bereavement
Painful and disruptive, but there is always movement. “Why my loved one?”, empty nest syndrome. Don’t need clinical interventions, they move on w/their lives, don’t benefit from therapy, most common
Traumatic grief
Suddenness and lack of anticipation, violence/mutilation/destruction, degree of preventability, multiple deaths, mourners personal encounter with the death, COVID-19
Complicated bereavement
PGD; person is frozen/stuck in a state of chronic mourning and lasts more than a month to 6 months after the loss. No movement in the thought processes. Bitter feelings, lack ability to trust others, feeling meaningless
What do you expect physically with grief?
Sleep difficulty, lack of appetite, weight loss, asses for substance use
The nurse should watch for maladaptive thoughts when assessing cognition, what are some examples
Protesting the death (“its not fair” or could have prevented the death), having a negative view of the world (nobody is safe), and needing the person (life is unbearable w/out them)
The nurse should always consider depression and suicide, as well as access to food/shopping, living arrangements, ADLs
yep
What is the goal of bereavement interventions?
Help with person adapt and re-stabilize biopsychosocial systems as the pain and sadness lessens with time
What medications can be used to aid in bereavement?
Antidepressants or sleep aids; monitor use to prevent long-term use
When is the risk of suicide highest with bereavement?
After the funeral, loneliness sets in and full impact of loss is realized.
What are positive outcomes of bereavement?
Adaption to life w/out the deceased, learning to live w/reminders of deceased, attending to self-care, and enjoying activities again
Disaster
Sudden overwhelming catastrophic even that causes great damage and destruction that may involve mass casualties and human suffering requiring assistance from all available resources
Examples of disasters
Terrorism and pandemics
How has history portrayed disasters?
Fatalistic perspective that humans have little control over catastrophic events. Some cultures say “its an act of God”,
Natural disasters
Hurricane Harvey and Maria highlighted the importance of government preparedness for natural disasters and terrorism.
Terrorism
Before 9/11 govt agencies did not incorporate mental health into overall response plans, now they do
COVID-19 pandemic
WHO declared it a national emergency. ICU was overloaded, lack of prepared health care workers. Time-limited nature disaster. Health care workers are reporting PTSD, depression, insomnia, and anxiety. Patients report mental health probs, isolation, stigma
Phases of disaster
1) prewarning
2) disaster event occurs
3) recuperative effort
3 types of disaster victims that psychiatric nurses encounter
1) may/not survive. If they do, they have severe physical injuries; PTSD
2) professional rescuers; psychological stress, report PTSD
3) everyone else; altered sense of safety, travel less, increase smoking
Primary public health concern during disasters
Drinking clean water, food, shelter, and medical care
Medications to help with psychological consequences of disasters
Anti-anxiety or sedatives
ABCs of psychological aid
A- arousal
B- behavior
C- cognition
When arousal is present, what should you do?
Decrease excitement by providing safety, comfort, and consolation
When cognition disorientation occurs, what should you do?
Reality testing and clear information should be provided
Debriefing
Reconstruction of the traumatic events by the victim. Not useful for everyone
How can the nurse prepare the victim of disaster for recovery?
Teach abt effects of stress and help the person identify strengths and coping skills.
Psychoeducation
Nurse explains anticipated reactions and behaviors to help victims gain control and improve coping. Education on natural recovery process to the public b/c information gaps can increase anxiety and stress.
FEMA
Federal emergency management agency; provides counseling and mental health services
SAMHSA
Substance abuse and mental health services administration assists both victims and responders of the disaster
SAMHSA
Substance abuse and mental health services administration assists both victims and responders of the disaster
Stage theories propose that grief and bereavement follow ___/___ and that process models explain bereavement as ____
- Stages/phases
- nonlinear
