TOPIC 8 - crisis nursing Flashcards
what is a crisis
acute, time limited occurrences experienced as overwhelming emotional reactions to a stressful situational event, developmental event, or the persons perception of an event
crisis will result in which two responses from the person experiencing crisis
fall apart and decompensate or problem solve and grow through the process
what impacts the outcomes of crises
individual, family, and community perception of the response
coping abilities and resiliency
availability and outside supports
factors that limit coping and problem solving abilities
mental illness, substance abuse, history of poor coping, diminished cognitive ability, preexisting physical health problems, limited social supports, developmental and or physical changes
clients with the best outcomes …
feel safe, connected, calm and hopeful
have access to social, physical, and emotional supports
find ways to help themselves
developmental crisis
have to do with the predictable transitions that individuals experience as they move from one stage to another
examples of developmental crises
getting married, starting college, retirement, becoming a parent
situational crisis
arise suddenly and unexpectedly from an external source and are events or circumstances that threaten the physical, social, and psychological integrity of individuals , frequently involving grief or loss
examples of situational crises
being forced to retire, financial distress, illness, death of a loved ones, going through divorce
adventitious or social crisis
rare, unexpected events that affect a group or community
not part of everyday life
examples of adventitious crises
natural disaster, terrorism, pandemics, flood, earthquake, active shooter
existential crisis
inner conflicts, often centered around life’s purpose and spirituality
examples of existential crises
what is my calling in life? midlife crisis, am i making a difference? does god really exist?
phase 1 of psychological crisis
Person confronted by conflict; responds with increased anxiety.
phase 2 of psychological crisis
If usual defensive responses fail and threat persists, anxiety escalates. Trial-and-error begins.
phase 3 of psychological crisis
If trial-and-error attempts fail, anxiety can escalate to severe & panic levels.
phase 4 of psychological crisis
If the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person & lead to serious illness; assess for suicidal thoughts.
crisis interventions need to be …
bold, creative, flexible
strategies of primary level of care
Promote mental health before crisis strikesProvide education, information & resource listings
goals of primary level of care
Improve clients’ coping ability &Decrease incidence of crises
strategies of secondary level of care
Prevent prolonged anxiety during acute crisis
goals of secondary level of care
Ensure client safety & Shorten duration of client distress
strategies of tertiary level of care
Provide support during recovery from crisis
goals of tertiary level of care
Facilitate optimal client functioning & prevent further emotional disruption
example of tertiary care
critical incident stress debriefing
objectives of CISD
-lessen the impact of the traumatic event
-facilitate recovery process and restore adaptive functioning in psychologically healthy people in distress by the crisis event
-screen for and identify community members who might benefit from additional support services/provide referrals for those who need it
best effects of CISD happen when
there is enhanced group cohesion and unity performance
CISD should be part of a broader crisis support system
who benefits from CISD
staff members and clients after an incident of violence or trauma
crisis hotline volunteers
rescue and health care workers who respond to traumatic situations
phase 1 - introduction
the team members introduce themselves and describe the process. They present guidelines for the conduct of the CISD and they motivate the participants to engage actively in the process.
set the tone of the session
phase 2 - facts
Only extremely brief overviews of the facts are requested. Excessive detail is discouraged. This phase helps the participants to begin talking. It is easier to speak of what happened before they describe how the event impacted them.
overall view point of what happened
phase 3 - thoughts
The thought phase is a transition from the cognitive domain toward the affective domain. It is easier to speak of what one’s thoughts than to focus immediately on the most painful aspects of the event. The typical question addressed in this phase is “What was your first thought or your most prominent thought once you realized you were thinking?
phase 4 - reactions
The reaction phase is the heart of a Critical Incident Stress Debriefing. It focuses on the impact on the participants. Anger, frustration, sadness, loss, confusion, and other emotions may emerge. The trigger question is “What is the very worst thing about this event for you personally?”
phase 5 - symptoms
Team members ask, “How has this tragic experience shown up in your life?” or “What cognitive, physical, emotional, or behavioral symptoms have you been dealing with since this event?” The team members listen carefully for common symptoms associated with exposure to traumatic events. The CISM team will use the signs and symptoms of distress presented by the participants as a kicking off point for the teaching phase.
phase 6 - teaching
provide explanations of the participants’ reactions and provide stress management information. Other pertinent topics may be addressed during the teaching phase as required.
phase 7 - re entry
The participants may ask questions or make final statements. The CISD team summarizes what has been discussed in the CISD. Final explanations, information, action directives, guidance, and thoughts are presented to the group. Handouts maybe distributed.
4 primary categories of abuse and neglect
emotional
physical
sexual
neglect
among who is abuse and neglect prevalent
all social divisions : ethnic, religious, age, social, and socioeconomic groups
what does the intergenerational theory of family violence believe ?
It is most likely the interaction of societal, cultural, psychologic, and neurobiological factors. Child learns violence as a behavioral norm through Role modeling, Identification and human interaction within the family unit.
However, not all abused children become abusers.
what societal or cultural factors play a role in family violence
- Poverty or unemployment
- Communities with inadequate resources
- Overcrowding
- Social isolation of families
what is the classic frustration aggression hypothesis
frustration is high in response to societal situations and aggression follows
what is the patriarchal theory
AKA feminist theory
male dominence enforces the differential status of men and women - women are kept relatively powerless
signs that may indicative abuse or neglect
recurrent ED visits
hyperventilation
anxiety
depression
GI disturbance
hypertension
physical injuries
insomnia
extreme fatigue
cachexia
loss of hair
what happens in the tension phase in the cycle of violence?
small offenses start to accumulate, avoidance of trouble, hindered communication
what happens in the confrontation phase in the cycle of violence?
acting out, abuse, intimidation, threats
what happens in the reconciliation phase in the cycle of violence?
apologies, denial, rationalization, “it wasn’t that bad”
what happens in the honeymoon phase in the cycle of violence?
past offenses have been forgotten
what is child abuse ?
Any recent act or failure to act on the part of a parent or caregiver that results in death, serious physical harm, sexual abuse, or exploitation, or any act or failure to act that presents an immediate risk of serious harm
which act provides states with federal funding, guidance, and support for abuse prevention
CAPTA act of 1974
overindulgence abuse
in developed countries is considered a type of neglect (appease a child or keep a child “happy” / “busy” by providing whatever the child wants: unhealthy snacks, unlimited screen time. This leads to serious adjustment issues and social impairments, as well as obesity and medical conditions as a result of obesity
who are typically perpetrators of physical abuse and deaths of children
parents and siblings
the most underreported type of abuse
neglect
sexual abuse includes what other type of abuse
emotional
interventions for child abuse
Remain nonjudgmental
Play therapy, dolls
Medical treatment as needed
Report suspected abuse to proper authorities
short term goals for medical care
should be received within 1 hour for injuries
most immediate concern
ensure child’s safety and well being
primary interventions for TIC
Child abuse prevention initiatives
Recognize increased risk factors for abuse
secondary interventions for TIC
Provide appropriate, non-judgmental care to child survivors of abuse and abusers
tertiary interventions for TIC
Education and supports to prevent recurrence of abuse
reporting obligations
Nurses, other health care providers, teachers, spiritual leaders, coaches, counselors, child care providers all MUST legally report suspicion of abuse to the appropriate child protective agency
the person reporting does not have to have proof (authorities will perform investigation)
what is intimate partner violence
A pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current or former partners of an intimate relationship, regardless of gender or marital status
what is intimate partner violence all about ?
instilling fear and wanting to have power or control in the relationship
types of abuse in intimate partner violence relationships
denial and blame, emotional abuse, control through isolation, control through intimidation, control through economic abuse, control through power
IPV during pregnancy
IVP is the leading cause of injury-related female deaths
Birth defects and infant deaths are frequent outcomes
questions to revel IPV
Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
before taking pictures of evidence for abuse …
ask for consent
follow laws and facility policies
physical examination includes assessing :
Internal injuries—concussions, perforated eardrums, abdominal injuries, eye injuries, and strangulation marks on the neck
Broken (fractured) bones—arms, pelvis, ribs, clavicle, legs, or jaw
Examination might reveal burns from cigarettes, acids, scalding liquids, or appliances.
primary interventions incorporated into TIC
Abuse prevention education and programs
secondary interventions incorporated into TIC
Facilitate physical and emotional healing for survivors of IPV (physical and emotional)
Facilitate treatment for abusers
tertiary interventions incorporated into TIC
Promote safety plans and healthy relationship choices to mitigate future occurrences of abuse
if the patient is interested in pressing charges :
give verbal or written information on:
Local attorneys who handle spouse abuse cases
Legal clinics and/or battered persons advocates
if the patient is not interested in pressing charges :
provide a list of community resources:
Hotlines, shelters, battered women’s groups
Battered persons advocates
Aid to Families with Dependent Children (AFDC)
when are reporting obligations mandated for IPV
only if the victim meets criteria (minor or vulnerable adult or if in state mandates)
your role as a nurse in identifying if the patient want to press charges
do not attempt to convince the victim to pursue legal action
remain nonjudgmental regardless of their decision
types of elder abuse
Physical
Emotional
Financial (exploitation)
Sexual
Neglect
Self-neglect
who is at highest risk for elder abuse
those above the age of 80
indications that there may be elder abuse occurring
Fear of being alone with caregiver
Obvious malnutrition
Bedsores or skin lesions
Begging for food
Needs medical and/or dental care
Left unattended for long periods
Reports of abuse and neglect
Passive, withdrawn, and emotionless
Concern over finances and missing valuables
primary interventions that involve TIC
Provide education and support to those at high risk for elder abuse
Respite care for family caregivers may be available/Senior Daycare
Visiting Nurse Services
Meals on Wheels
secondary interventions that involve TIC
Provide treatment and support for victims of elder abuse
Facilitate treatment for perpetrators of elder abuse
tertiary interventions that involve TIC
Ongoing promotion of safe environment for previously victimized elder to reduce possibility of recurrence of abuse or neglect
how many states is elderly abuse reporting mandated in
44
what is sexual assault
an act of violence, power, and control
common date rape drugs
gamma-hydroxybutyric acid
flunitrazepam
ketamine
which date rape drugs cause anterograde amnesia
GHB and ketamine
how quickly does GHB clear from your system
within hours
therefore, it is hard to detect by testing
GHB is therapeutically used for what
type 1 narcolepsy
what is dangerous to mix GHB with
alcohol or other CNS depressants
likely to cause respiratory depression
what does GHB affect
the central nervous system
what is the most frequently used date rape drug
alcohol
what type of drug is flunitrazepam
a potent benzo
the “forget” drug, roofies
FDA approval of flunitrazepam
NOT FDA approved for any use
flunitrazepam causes which type of amnesia
both retrograde and anterograde amnesia
what type of drug is ketamine
an anesthetic, hallucinogenic, psychedelic, dissociate drug (derived from PCP)
what is ketamine therapeutically used for
treatment resistant depression
procedural sedation in medical settings or veterinary practice
acute phase goals
Typical reactions to a crisis often reflect cognitive, affective, and behavioral disruptions. The most common responses are shock, numbness, and disbelief.
long term phase goals
Teach the individual to know what to expect during this phase to enable her or him to be prepared and not feel like they are going crazy. Understanding that all assault survivors will deal with the event in their own manner is also important.
