crisis

Crisis, Loss, Disaster

Boyd Chapter 21

Objectives

  • Define Crisis: Understanding what constitutes a crisis.
  • Identify Types of Crisis: Distinguishing between different types of crises.
  • Discuss Impact of Disasters on Mental Health: Analyzing how disasters affect mental health.
  • Discuss Nursing Care: Strategies for nursing care for individuals experiencing crises, loss, grief, bereavement, and disaster.

Crisis

Definition

  • A crisis is a perceived challenge or threat.
  • It is accompanied by feelings such as:
    • Fear
    • Desperation
    • Feeling out of control
  • Functioning may be severely impaired.
  • Crises are typically time-limited and not chronic in nature.

Types of Crises

Developmental (Maturational)

  • Examples include major life transitions:
    • Leaving home
    • Graduation
    • Marriage

Situational

  • Examples of situational crises include:
    • Loss of a job
    • Illness or divorce

Traumatic (Adventitious)

  • Examples of traumatic crises include:
    • Natural disasters
    • Violent crimes

Question

  • Not all crisis events are "negative."
    • What are some “positive” life events that may lead to a crisis?

Answer

  • Positive life events that may lead to crises include:
    • Marriage
    • Pregnancy
    • Birth of a child
    • Retirement

Factors that Influence Crisis

  • The individual's perception of the event plays a crucial role.
  • Emotional support can either hinder or facilitate coping.
  • Adequate coping mechanisms are essential for handling crises.

The Role of the Nurse in Crisis

Phase 1: Assessment

  • Ask the client to describe the event thoroughly.
  • Assess the client's mental and physical status.
  • Investigate whether the client has experienced similar crises before.
    • Identify previous coping mechanisms.
    • Explore any new coping mechanisms attempted.
    • Evaluate the results of coping mechanisms used.
  • Assess for Suicidal Ideation (SI), Homicidal Ideation (HI), including plans and means to carry them out.
  • Evaluate the support system available to the client.
  • Investigate any substance use.
  • Determine the perception of the event by the client.

Phase 2: Planning & Therapeutic Intervention

  • Establish clear goals for intervention.
  • Assess the individual’s strengths.
  • Consider the available support systems.
  • Identify relevant nursing diagnoses that may aid in treatment.

Phase 3: Interventions

  • Use a reality-orienting approach that focuses on the present situation.
  • Remain with clients experiencing anxiety or panic.
  • Attend to the immediate needs of the client.
  • Acknowledge feelings without judgment, including:
    • Anger
    • Guilt
    • Powerlessness
  • Guide clients through the problem-solving process.

Problem-Solving Process

  • Confront factors contributing to the crisis.
  • Discuss potential changes the client would like to implement.
  • Determine whether these changes are realistic.
  • Assist the client in selecting coping strategies.

Phase 4: Evaluation of Crisis Resolution

  • Evaluate if positive behavioral changes have occurred.
  • Assess whether new coping strategies are effective.
  • Determine if the client has gained insight.
  • Explore the client’s belief in their ability to respond and adapt to crises in the future.
  • Help describe a plan of action for dealing with similar stressors.

Recovery

  • The primary goal is to achieve functioning at the pre-crisis level or at a higher level.
  • Focus primarily on the “here and now,” addressing short-term needs.
  • Work on re-establishing self-care routines.
  • Encourage the use of positive coping strategies.

Guidelines for Crisis Intervention

  • Concentrate on one issue at a time.
  • Avoid providing false reassurance.
  • Offer accurate information, as facts aid recovery.
  • Link clients and families with community resources.

Ways that Crisis is Resolved

  • A positive outcome occurs when a person returns to their pre-crisis level of functioning.
  • An ideal outcome is when a person returns to a higher level of functioning.
  • A negative outcome entails stabilizing at a lower level of functioning.

Factors Affecting Long-Term Recovery

  • Frequent triggers can hinder recovery.
  • Experience of a “2nd assault.”
  • Age is a factor; younger children and the elderly may require additional support.
  • Trauma history and the number of prior losses experienced impact recovery.
  • A lack of support can severely affect recovery.

Loss, Grief, Bereavement

  • Loss and grief are universal human experiences.
  • They can lead to:
    • Improved psychosocial functioning.
    • Maladaptation.

Grief and Bereavement

Definition

  • Grief is defined as a physical, emotional, cognitive, or social reaction to death.
  • Pre-death grief occurs before the death of a loved one.
  • Acute grief surfaces immediately after a loved one's death.
  • Integrated grief is a long-term process characterized by mild yearning with intensity, which
    • Does not interfere with daily life or functioning.

Traumatic Grief

  • Influenced by various external factors such as:
    • Suddenness of the event
    • Lack of anticipation
    • Violence involved
    • The preventability or randomness of the event
    • Occurrence of multiple deaths (referred to as bereavement overload)

Discussion: COVID and Traumatic Grief

  • What factors during the pandemic may contribute to the development of traumatic grief?

Prolonged Grief Disorder (PGD)

  • PGD is characterized by:
    • Intense longing for or preoccupation with the deceased lasting more than 6 months.
    • Clients may remain in a denial stage of grief.
    • This disorder can impact a client’s ability to perform Activities of Daily Living (ADLs).

Nursing Interventions

  • Counseling support.
  • Facilitate social support.
  • Encourage engagement in spiritual or religious practices.
  • Teach and reinforce coping skills.
  • Safety is a priority (e.g., assessing for SI, self-harm).
  • Evaluation of medication effectiveness.

Evaluation of Interventions

  • Clients should learn to adapt to life without the deceased.
  • They should be able to:
    • Live with reminders of the deceased
    • Engage in self-care
    • Attend social and recreational activities again

Disaster

Definition

  • A disaster is defined as a sudden, overwhelming, catastrophic event that causes damage or destruction.
  • Types of disasters include:
    • Terrorism
    • COVID-19 (pandemics)
    • Natural disasters that have sufficient magnitude and require external help to address the psychosocial and physical needs of the victims.

Question: Frequent Needs after a Disaster

  • What are some frequent needs of people following a disaster?
    • Food
    • Shelter
    • Water
    • Immediate medical care
    • Health services for chronic conditions
    • Accurate information about the event
    • Help in contacting loved ones
    • Access to support and resources

Victims of Disaster

Physical and Mental Health Effects

  • Victims may suffer:
    • Physical injuries
    • Mental health repercussions: such as PTSD, depression, anxiety.
  • Psychological stress is not limited to victims; rescuers and others involved may also experience stress, potentially felt worldwide.

Response to a Disaster

  • Initial steps include:
    • Obtaining information
    • Reuniting victims and families
    • Assessing injuries
    • Maintaining a calm demeanor.
    • Assessing the ages and genders of victims, as women and children are at higher risk for distress during a crisis.

Mental Status of Victims

  • Feelings of hopelessness and fear can immobilize victims.
  • Symptoms may include panic attacks, dissociation, and panic can lead to disorders such as PTSD and depression.

Mental Health Nursing Interventions

  • Focus on self-care.
  • Treat injuries using triage.
  • In natural disasters, prioritizing access to clean water, food, and shelter is essential.
  • Medications: - Acute anxiolytics or sedatives may be required.
  • Provide counseling support and community care.

ABCs of Psychological First Aid

  • Arousal Intervention: Decrease excitement through providing safety, comfort, and consolation.
  • Behavior Intervention: Address abnormal or irrational behavior to assist victims in functioning during a disaster.
  • Cognition Intervention: Address cognitive distortions by providing clear and factual information.

Evaluation and Treatment Outcomes

  • Are the victims safe?
  • Are they able to cope with the disaster?
  • Have appropriate supports been given?