Unit 3 Crisis and Disaster Chapter 26

Question 1

Does crisis disrupt equilibrium and homeostasis?]

A. Yes
B. No

Answer 1

A. Yes

The stable state is referred to as homeostasis or equilibrium.

A CRISIS, which is a major disturbance caused by a stressful event or threat, disrupts this homeostasis. In a crisis, normal coping mechanisms fail, resulting in an inability to function as usual. Equilibrium is replaced by disequilibrium.

Question 1

What does Crisis Intervention consist of ?

Answer 1

Crisis intervention involves simple, innovative, accessible, practical, and immediate actions that ensure a person’s safety and mental well-being.

a directive, time-limited and goal-directed strategy designed to assist those experiencing a crisis

*Providing counselors for school students after the sudden death of a classmate or encouraging a person to drive as soon as possible after involvement in a fatal accident that took the life of a friend.

Question 2

You as a nurse is working on a hurricane base and the patients you are assignned to has lost their homes and all their belongings. What is the best action by the nurse according to crisis intervention?

A. Insist that it may take months for them to find stability again.
B. Immediately give them all the resources that they need to find shelter and stability again.
C. Contact the fire department to rescue their items.
D. Call the social worker she’s the only one who can help them with all of their problems.

Answer 2

B. Immediately give them all the resources that they need to find shelter and stability again.

Crisis intervention involves simple, innovative, accessible, practical, and immediate actions that ensure a person’s safety and mental well-being.

a directive, time-limited and goal-directed strategy designed
to assist those experiencing a crisis

OBJECTIVE -helping patients adapt with a traumatic event

Question 3

A successful outcome for a crisis depends on…

Answer 3

A successful outcome for a crisis depends on.

• (1) the realistic perception of the event,
  *(2) adequate situational supports, and
• (3) adequate coping mechanisms.

Question 4

Situational Crisis

Answer 4

A situational crisis arises from events that are unusually dis- tressing and often unanticipated

Question 5

What is example of Situational Crisis?

Answer 5

Examples of situations that may precipitate a crisis include a job loss or change, the death of a loved one, a change in financial status, divorce, and psychiatric or physical illness.

Whether or not these events precipitate a crisis, again, depends on factors such as the degree of support available from friends, family members, and others. General emotional and physical status also impacts our ability to tolerate stressful events.

Question 6

Adventitious Crisis

Answer 6

Not part of everyday life, caused by nature or human-made

The term adventitious comes from the Latin adventicius, mean- ing coming from outside, and advenire, meaning chance hap- pening. An adventitious crisis, then, is a traumatic and external event that happens unexpectedly. This type of crisis may be nat- ural, human, and accidental.

Question 7

What is example of Adventitious Crisis

Answer 7

Natural disasters may be the result of such events as epidemics, floods, fires, and earthquakes. Humans may be the source of adventitious crises through one- on-one violence—such as rape and murder—acts of terrorism, wars, riots, shootings, and bombings. Accidents are another source of adventitious crises and include such events as airline crashes, structural collapses, and nuclear power plant failures.

Question 8

Maturational Crisis

Answer 8

Refer to Erik Erikson 8 stages of development, each stage represents an
internal conflict or crisis
– How the person progresses through each stage, effects the next
– New coping strategies must be developed for each stage

Question 9

Examples of Maturational Crisis

Answer 9

Examples of events that can precipitate a maturational crisis include leaving home for the first time, marriage, the birth of a child, retirement, and the death of a parent.

Question 10

Dysruptions in Maturational Crises

Answer 10

Factors may disrupt individuals’ progression through the maturational stages. For example, alcohol and drug addic- tion disrupts progression through the maturational stages. Unfortunately, this interruption often occurs among adolescents.

ex-
When control over addictive behavior is achieved, the young person’s growth and development may be delayed.

For example, when a 22-year-old recovers from addiction after 8 years of use, he may have limited psychosocial and problem- solving skills for a person his age.

Question 11

Phase 1 - Crisis

Answer 11

-ANXIETY

– Person confronted by conflict/problem
– Anxiety rises – problem solving techniques engaged
– Defense mechanism

A person is exposed to a serious stressor or problem, which results in increased anxiety. The increase in anxiety stimulates the use of usual coping methods and defense mechanisms in an effort to address the problem and decrease anxiety.

Question 12

Phase 2 - Crisis

Answer 12

(when usual defense response fails
– Anxiety rises accompanied by increase in discomfort
– Functioning disorganized
– Trial and error to restore balanc
If the usual coping methods and defense mechanisms fail and the threat persists, anxiety will continue to rise, producing increased discomfort. Individual functioning becomes disorga- nized. Trial-and-error attempts at problem-solving and restor- ing balance begin.

Question 13

Phase 3 - Crisis

Answer 13

Phase 3 (Trial and Error fails)
– Anxiety escalates to severe or panic
– Fight or flight

If the trial-and-error attempts fail, anxiety can escalate to severe and panic levels. The person mobilizes automatic relief behav- iors, such as withdrawal and flight. Resolution may occur at this stage. Resolution may be achieved by compromising needs or redefining the situation to reach an acceptable solution.

Question 14

Phase 4 - Crisis

Answer 14

– Ineffective coping
– Overwhelming anxiety
– Personality disorganization – depression, confusion, violence, suicidal ideations

If the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person and lead to serious person- ality disorganization, depression, confusion, violence against others, or suicidal behavior.

Question 15

Crisis intervention

Answer 15

Assess for suicidal or homicidal thoughts
■ Take steps to make patient feel safe and decrease anxiety
■ Listen to your patient (verbal and nonverbal)
■ Identify needs
– Support
– Coping mechanisms

Question 16

General Assessment

Answer 16

Self-harm is a possibility. Crises may result in such serious disorganization and discomfort that ending the pain may seem a reasonable solution. The nurse’s initial task is to assess the patient’s potential for suicide. Sample questions to ask include: * Have you thought about hurting yourself ?
* Have you thought of how you would do this?
* Do you feel you can keep yourself safe?

Question 17

Assessing Perception of the Precipitating Event

Answer 17

• What leads you to seek help now?
• Has anything upsetting happened to you within the past few
  days or weeks?
• Describe how you are feeling right now.
• How does this situation affect your life?
• How do you see this event affecting your future? * What do you hope to get out of this treatment?

Question 18

Assessing Situational Supports

Answer 18

• Is there anyone—family or friends—you would like to have
  involved in your care?
• Have you ever used a community agency for support?
• Do you have a religious affiliation?
• Are you active in a religious group?

Question 19

Assessing coping skills

Answer 19

• What have you been doing to relieve the anxiety you have been feeling?
• What has helped in the past to relieve stress?
• Did you try it this time? If so, what was different?
• What helped you through difficult times in the past?

Question 20

Levels of care

Answer 20

Primary Care (prevent crisis)
– Promote mental health, identify potential problems
– Teach coping skills, problem solving
■ Secondary Care (stabilize, lessen time of mental disability during a crisis)
– Establish interventions during an acute crisis
– Identify the crisis, get help, utilize support and coping mechanisms
■ Tertiary Care
– Support for those who have experienced crisis and are recovering
– Goal = promote optimal level of functioning and prevent further emotional
disruptions
– Critical incident stress debriefing – example of tertiary intervention

Question 21

Foundations of Crisis Interventions

Answer 21

• A crisis has a limited duration and usually resolves within 4–6 weeks.
• Once a crisis is resolved, individuals will emerge at one of three different
  functional levels:
• A higher level of functioning.
• The same level of functioning.
• A lower level of functioning.
• The goal of crisis intervention is to return the patient to at least the pre- crisis level of functioning.
• The form of crisis resolution depends on the person’s perceptions, actions, and the support of others.
• During a crisis, people are often more receptive than usual to outside intervention. With intervention, new and adaptive means of problem solving may be adopted.
• Crisis intervention is here-and-now oriented, with a focus on the person’s present problem and resolution of the immediate crisis.
• Due to the disequilibrium of crisis and accompanying anxiety, the nurse takes a more active and directive role in intervention than during non-crisis states.
• Early intervention increases the chance for a positive outcome.