Crisis and disaster

what are examples of a crisis

• hurricanes/ tornadoes

• mass shootings- schools, churches, concerts

• a stressed out student discovers she is pregnant and father abandoned her

• major disturbance caused by a stressful event or threat that disrupts homeostasis

  • failed coping mechanisms

  • inability to function in a usual manner

what is a crisis

• the struggle for equilibrium and adaptation in its aftermath

• the disruption of a persons normal psychological homeostasis

• normal coping mechanisms fail

• results in inability to function as usual

• acute and time- limited

• the individual perceives the event as significantly distressing (perception influences it)

• the individual is unable to resolve the disruption with usual coping mechanisms

• presents an oppertunity for personal growth and development

successful outcomes of crisis depends on:

• realistic perception of the event

• adequate situational supports

• adequate coping mechanisms (how many other stressful life events are going on, unresolved losses, concurrent psychiatric or medical disorders)

_________- use of short term counseling to help pt cope with a crisis and resume a state of functioning comparable to or better than the pre- crisis state

crisis intervention

crisis intervention is. ________, _______, and _________ strategy designed to assist individuals who are experiencing a crisis (have a specific purpose)

directive, time limited, goal directed

crisis intervention is shown to be effective in helping people _________ with stressful events

adaptively cope

which nurses need to be familiar with crisis intervention

ALL nurses

explain a maturational crisis

• a new developmental stage is reached- EXPECTED EVENTS

• r/t developmental transitions in the life cycle (leaving home for college, marriage, midlife, retirement, childbirth, death of parent or pet)

• old coping skills are no longer effective

• leads to increased tension and anxiety

explain a situational crisis:

• r/t sudden, unexpected events (unexpected death, divorce, job problems, witnessing a crime, health, illness)

• arise from extraordinary, external and often unanticipated events

• the way that a situational crisis is handled depends on the persons support system, general emotional physical status coping skills

• successful resolution of the crisis depends on resolution of the grief associated with the loss

explain an adventitous crisis

• a natural or national disaster or crime of violence

• unplanned, may be accidental, violent crimes and natural disasters (caused by nature or humans or accident)

• ex: earthquakes, wild fires, COVID, mass shootings, 9/11, floods, hurricane IDA, airline crashes, riots, wars

• common to have post trauma phenomena:

  • acute stress disorder

  • PTSD

  • depression

• immediate need for crisis intervention and debriefing

what is phase 1 of crisis

• Conflict or problem → Increased anxiety→ Use

of problem-solving techniques and

coping/defense mechanisms to:

-Resolve conflict or problem

-Reduce anxiety

explain phase 2 of a crisis:

• Defense mechanisms fail → Threat persists

- Anxiety increases

- Feelings of extreme discomfort

- Functioning becomes disorganized

• Trial-and-error attempt to solve problem

and restore normal balance

explain phase 3 of crisis

• Trial-and-error attempts fail →→

-Anxiety can escalate to severe level or panic

- Automatic relief behaviors mobilized (i.e.,

withdrawal and flight)

• Some form of resolution may be devised

(i.e., compromising needs or redefining situation)

explain phase 4 of a crisis

• Problem is unsolved and coping skills are ineffective

→→ Overwhelming anxiety

-Possible serious personality disorganization

-Depression

-Confusion

-Violence against others or suicidal behavior

equilibrium is adversely affected by:

1) An unrealistic perception of the precipitating event

• Help improve patients perception

2) Inadequate situational supports

• Assess support and provide resources

3) Inadequate coping mechanisms

• Nurse helps to enhance coping

explain crisis intervention

• Offers immediate help/support to individuals with crisis

needs.

• Crisis occurs in all individuals at one time or another

• Crisis is not necessarily pathological

• Short term approach to care

• Goal is to return to previous level of functioning or

“pre-crisis” state.

• Interventions focus on the “here and now.”

general assessment of a crisis patient

• general assessment

• perception of precipitating event

• situational supports

• coping skills

• self assessment

• suicidal assessment

explain assessment in a crisis patient

• The first step of crisis intervention is assessment

• Establish a positive relationship with the client

• Identify the precipitating event

• Always assess potential for suicide and for safety 1st!

What questions would you ask?

• What is the client’s perception of the event?

• Any support systems?

• Coping resources?

• Self Assessment

• Can environmental manipulation occur?

• What needs to be done to resolve this conflict?

• How does this situation affect your life?

• Who do you live with?

• Who can you trust?

• Who is most helpful?

• What would you usually do to help you feel better?

implementation for a crisis patient

– Patient safety

– Anxiety reduction

– Appropriate level of prevention/debriefing

what to ask patient when planning crisis intervention

• How much has the crisis affected their lives?

– Attend work?

– School?

– Care for their own kids?

• How is the state of disequilibrium affecting

significant people in the patient’s life?

– Husband/wife/children/family/boss

guidelines for interventions for crisis patients

• Assess for suicidal or homicidal ideations

• Take steps to make patient feel less anxious

• Listen carefully, make eye contact, summarize

• Identify needed social supports

• Id needed coping skills

• Involve patient in identifying realistic interventions

• Plan regular f/u to assess progress

• Clarification (debriefing) – helps process the feelings and

concerns related to a witnessed intervention or traumatic event

• Suggesting, provide information

• Restore psychological safety

• Reinforcing positive behaviors

• Support of previous adaptive defenses (self-efficacy)

• Raising self-esteem

• Exploration of solutions

• Ensure social support

2 main implementations for crisis patients

1. Patient Safety

2. Anxiety Reduction

nurse may act as an _____________

educator, advisor, role model

always remember that the ______ is the one to solve the problem not the nurse

patient

in a crisis situation never give ______

false reassurance “everything will be okay”

which crisis intervention level promotes mental health and reduce mental illness to decrease the incidence of crisis

primary

nurses role in the primary level of crisis intervention

• working on coping skills

• recognizing stressful events

• teaching relaxation skills, meditation, problem solving, assertiveness skills

• assist pt to evaluate life changes to decrease the negative effects of stress, rethink occupational roles, etc.

which level of crisis intervention is establishing intervention during an acute crisis to prevent prolonged anxiety

• primary focus is to ensure the safety o the patient

  • goal is to lessen the time that the pt is mentally disabled during a crisis

  • ex: hospital units, EDs, mental health centers

secondary

which crisis intervention level is when the nurse provides support for those who have experience severe crisis and now recovering from a disabling mental state (had crisis already)

• ex rehab centers, shelter workshops, day hospitals

• goals are to facilitate optimal levels of functioning and prevent further emotions disruptions

tertiary

what are the 7 phases of critical incident stress debriefing (CISD)

• A tertiary intervention directed toward a group that has

experienced a crisis. Individuals are offered an

opportunity to share their thoughts and feelings in a safe

and controlled environment (used after school shootings,

a patient suicide, to debrief rescue health workers etc)

• Introductory phase

• Fact phase

• Thought phase

• Reaction phase

• Symptom phase

• Teaching phase

• Re-entry phase

treatment modalities for crisis patients

• Crisis call lines 24/7-– professionals and trained volunteers

– 988

• Warm lines- prevents escalation of stress, provided by consumers

• Crisis Intervention Teams- partnership with law enforcement

and licensed/credentialed clinicians.

• Crisis Stabilization Facilities

– <24hrs.

• Psychiatric Advance Directive Plan

• Disaster Response

• Short Term crisis residential services

• Mobile crisis service- counselor, psychiatrist, Psych NP go to patients home etc.

• Peer Crisis Services

• Disaster Response

psychiatric advance directive plan

• Proactively addressing a crisis situation

before it occurs

• Stipulates wishes such as—

– Treatment choices

– Treatment facilities

– Providers

– Designated support person to be involved

in decision making

explain global disasters:

Large-scale crisis

• Examples: tsunamis, hurricanes, wildfires, large-scale

depletion of natural resources; international stock exchange

collapses; pandemics

Disaster preparedness

• Develop resilient communities

• Assess disaster risks on a local level

• Extend to networking communities

• Extend to larger societal and national programs

FEMA’s four phase disaster management continuum

mitigation

preparedness

response

recovery

explain department of homeland security

• civilian first responders: local emergency response professionals

• created the national incident management system

• – Coordinate United States responses to US

  disasters

  – Ultimate responsibility for US safety

  – Assure immediate availability of preparedness,

  response, and recovery protocols

  – Uses civilian first response professionals

  – Created National Incident Management System

  (NIMS) to coordinate efforts between responder

  agencies

explain national incident management system (NIMS)

• coordinates first responders

• incident command system training (ICS)