Chapter26/Exam2
Characteristics of a Crisis
A crisis is defined as a disturbance caused by a stressful event or a threat.
It disrupts an individual’s state of homeostasis or equilibrium.
In a crisis, an individual's normal coping mechanisms fail to resolve the stressor.
This leads to an inability to function as usual.
The state of equilibrium is displaced and replaced with a state of disequilibrium.
Factors for a Successful Crisis Outcome
The degree to which a crisis is resolved successfully depends on several factors:
Realistic perception of the event: The individual's ability to view the stressor accurately rather than in a distorted manner.
Adequate situational supports: The availability of people or resources the individual can rely on during the event.
Adequate coping mechanisms: The repertoire of skills and strategies the individual possesses to manage stress and anxiety.
Foundations of Crisis Theory
Behavior responses to crisis are considered normal reactions to abnormal situations.
Erich Lindemann: Asserted that behavioral responses to crisis are normal.
Gerald Caplan: Outlined specific intervention strategies that are grounded in the principles of homeostasis and equilibrium.
Albert R. Roberts: Created a prominent -stage model of crisis interventions used to guide practitioners.
Classifications and Types of Crisis
Maturational Crisis:
Occurs when a new developmental stage is reached.
During these transitions, old coping skills may no longer be effective.
This mismatch leads to increased tension and anxiety as the individual adjusts to new roles or biological changes.
Situational Crisis:
Arises from events that are extraordinary, external, and often unanticipated.
Examples include:
Job loss or a sudden change in employment.
The death of a loved one.
Significant changes in financial or marital status.
Onset of a psychiatric or physical illness.
Adventitious Crisis:
Natural Disasters: Includes events such as epidemics, floods, fires, and earthquakes.
Human-Made Disasters: Includes one-on-one violence, acts of terrorism, wars, riots, mass shootings, and bombings.
Accidental Disasters: Includes airline crashes, structural collapses (e.g., buildings or bridges), and failures at nuclear power plants.
The Four Phases of Crisis
Phase :
A serious stressor or problem results in increased anxiety.
This anxiety stimulates the individual’s usual coping methods and defense mechanisms in an effort to address the problem and restore comfort.
Phase :
This phase occurs when defense mechanisms fail.
The threat persists and anxiety continues to increase, producing feelings of extreme discomfort.
Individual functioning becomes disorganized.
The individual begins trial-and-error attempts at problem-solving to find a solution.
Phase :
Trial-and-error attempts fail to resolve the issue.
Anxiety can escalate further to a severe or panic level.
Automatic relief behaviors are mobilized, such as withdrawal and flight.
Some form of resolution may be devised, such as compromising needs or redefining the situation to make it more acceptable.
Phase :
The problem remains unsolved and coping skills prove ineffective.
Anxiety overwhelms the person.
This phase can lead to serious outcomes, including:
Serious personality disorganization.
Depression.
Confusion.
Violence against others.
Suicidal behavior.
Application of the Nursing Process in Crisis
Assessment:
General assessment of the patient.
Assessing the individual’s perception of the precipitating event.
Identifying situational supports (friends, family, resources).
Evaluating existing coping skills.
Self-assessment of the nurse's own feelings and reactions.
Nursing Diagnosis:
Risk for impaired coping.
Impaired coping.
Risk for (or actual) impaired family coping.
Risk for (or actual) impaired community coping.
Anxiety.
Outcomes Identification:
Establishing clear, measurable goals for the patient's recovery and stabilization.
Planning:
Designing interventions tailored to the specific type of crisis and the individual's needs.
Implementation:
Prioritizing patient safety.
Implementing anxiety reduction techniques.
Determining the appropriate level of prevention or debriefing required.
Evaluation:
Assessing the effectiveness of interventions and determining if the individual has returned to their pre-crisis level of functioning.
Levels of Prevention in Crisis Intervention
Primary Prevention:
Focuses on promoting mental health and reducing mental illness to decrease the incidence of crisis events.
Secondary Prevention:
Involves intervention during an acute crisis phase to prevent the development of prolonged anxiety.
Tertiary Prevention:
Focuses on providing long-term support for individuals who have already experienced a crisis, aiming to facilitate recovery and prevent further complications.
Critical Incident Stress Debriefing (CISD)
CISD is a specific tertiary prevention tool.
It consists of a -phase group meeting designed to help people process traumatic events.
Examples of applications for CISD:
Debriefing nursing and medical staff on an inpatient unit following a patient suicide.
Debriefing schoolchildren and school personnel after a school shooting.
Debriefing rescue workers and health care professionals who have responded to a natural disaster.
Treatment Modalities and Crisis Care Services
Emergency Rooms: Often used for crisis but are noted as not being ideal for behavioral health stabilization.
Behavioral Crisis Care Services:
Crisis call lines: Immediate telephone support.
Warm lines: Peer-run support lines for individuals who are not in immediate crisis but need someone to talk to.
Crisis intervention teams: Mobile units that respond to crises in the community.
Crisis stabilization facilities: Short-term residential facilities for acute stabilization.
Psychiatric Advance Directive Plan
This involves proactively addressing a crisis situation before it occurs.
It stipulates the individual's wishes when they are unable to make decisions during a crisis, including:
Specific treatment choices.
Preferred treatment facilities.
Specific providers.
Identification of a designated support person to be involved in the decision-making process.
Global Disasters and Management
Global disasters are large-scale crises.
Examples include tsunamis, hurricanes, wildfires, large-scale depletion of natural resources, international stock exchange collapses, and pandemics.
Disaster Preparedness encompasses:
Developing resilient communities.
Assessing disaster risks on a local level.
Extending networking to neighboring communities.
Extending efforts to larger societal and national programs.
Disaster Management Frameworks
FEMA's Four-Phase Disaster Management Continuum:
Mitigation
Preparedness
Response
Recovery
Department of Homeland Security (DHS):
Coordinates the United States' responses to U.S. disasters.
Holds ultimate responsibility for the safety of the United States.
Assures the immediate availability of preparedness, response, and recovery protocols.
Utilizes civilian first response professionals (local emergency response professionals).
Created the National Incident Management System (NIMS).
National Incident Management System (NIMS):
Coordinates efforts between various responder agencies.
Provides Incident Command System (ICS) training.
Questions & Discussion
Question: A single parent has just lost her job and calls a warm line in her community. This is an example of:
Choice A: Tertiary prevention
Choice B: Primary prevention
Choice C: Secondary prevention
Choice D: Critical incident stress debriefing
Answer: C. Secondary prevention (Intervention during an acute crisis).
Question: A category hurricane destroys homes and businesses in a community. How would this crisis be classified?
Choice A: Accidental crisis
Choice B: Situational crisis
Choice C: Adventitious crisis
Choice D: Maturational crisis
Answer: C. Adventitious crisis (Natural disaster).