What is Crisis?
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What are the 3 types of crisis?-Developmental/Maturational -Situational -Disasters or AdventitiousWhat is considered a Maturational Crisis?Normal life events that cause stress. (Based on Erikson's Developmental Stages) -The way maturational crisis' are resolved at one stage, affects the ability to pass through to subsequent stages.What is a Situational Crisis?Arises from events that are extra-ordinary, EXTERNAL rather than internal, and often unanticipated.What are some examples of a situational crisis?- Loss or change of a job - Divorce - Death of a loved one - Severe physical - Change in financial status or mental illnessWhat is an Adventitious Crisis?Not part of everyday life. Results from events that are unplanned and may be accidental, caused by nature, or human- made. (Sandy Hook, Hurricane, Bomb)What is happening in a person's mind during the first phase of crisis?Problem or conflict that threatens self concept---> increased anxiety---> problem solving techniques and defense mechanisms are usedWhat is happening to a patient during phase 2 of a crisis situation?usual defense mechanisms fail and threat persist---> anxiety and extreme discomfort ---> functioning becomes disorganized ---> trial and error attempt at restoring normal balanceWhat is an example of a maladaptive coping mechanism when someone is using trial and error as an attempt to feel normal?Binge drinkingIf a crisis is not resolved during phase 2, what happens during phase 3?trial and error attempts fail ---> severe anxiety and panic ---> withdrawal and flight as a means of relief ---> possible form of resolution, ie compromising needsWhat is an example of compromising needs?Daddy DaycareIf a person does not resolve in phase 3 of crisis, patient will experience phase 4. What goes on during phase 4?Problem is not solve ---> anxiety overwhelms the person ---> serious personality disorganization ---> depression ---> confusion ---> violence against others ---> possible suicidal behaviorWhat is KEY when working with a patient in phase 4 of crisis?SAFETY IS KEY! Assess for suicidal ideation and violence toward others.When performing your general assessment on someone in crisis, what are you assessing? You need to know what the persons needs are before you can come up with an effective plan.-Recent events -Suicidal ideation -Aggression -Self image -Home environment (is it safe)What else are you assessing for when a patient is experiencing crisis?-Assessment Perception of -Perception of Event -Assessing Situational Supports -Assessing Personal Coping *What's your common response to stress? *What helps when you feel stress? -Self AssessmentWhy is a Sad Persons Scale used?Used to assess suicidal potential?How many risk factors does the Sad Persons Scale measure?Measures 10 Major Risk FactorsWhat is the scoring system for Sad Person's Scale?0-2 ; send home w/ f/u 3-4 ; closely follow, consider hospitalization 5-6 ; strongly consider hospitalization 7-10 ; hospitalization requiredWhat other scale is used to assess suicidality?The Columbia Suicide ScaleWhat is Robert's 7 Stage Model of Crisis Intervention?1. Plan and conduct a crisis assessment 2. Establish rapport and relationship 3. Identify major problems 4. Deal with feelings and emotions 5. Generate and explore alternatives 6. Develop and communicate an action plan 7. Follow up plan and agreementWhen is it a very good idea to use Robert's 7?Usually used in Acute Situational Crisis'Guidelines for Nursing Interventions During Crisis-Assess for suicidal or homicidal thoughts or plans -Make the patient feel safe and decrease anxiety -Direct and creative approaches -Identify needed coping skills -Identify social supports -Involve patient in setting realistic goals and interventionIs it important to involve the patient in setting realistic goals and intervention?YES!What are some Nursing Diagnosis for people in crisis-Sleep deprivation -Anxiety -Risk for Suicide -Violence -Isolation -Ineffective coping -Caregiver role strain -Inadequate nutritionWhat are some common problems seen in the nurse/patient relationship caused by the nurse?-The nurse needs to feel needed. -The nurse sets unrealistic goals for the patient. -The nurse has difficulty dealing with a suicidal patient. -The nurse has difficulty terminating after the crisis is resolved.What are the 3 levels of Nursing Care in Crisis Intervention?-Primary Care -Secondary Care -Tertiary CareWhat is carried out on aPrimary Care level of intervention during crisis?Promotes mental health and reduces mental illness to decrease the incidence of crisisWhat is carried out on a Secondary Care level of intervention during crisis?Establishes intervention to prevent prolonged anxiety from diminishing personal effectiveness and personality organizationWhat is carried out on a Tertiary Care level of intervention during crisis?Provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state Rehabilitation centers, sheltered workshops, day hospitals, outpatient clinics Social and community facilities that provide structured environments that can help prevent problem situationsWho needs tertiary care?Ex: hx mental illness, 1st responders, nursesWhat is critical incident stress debriefing?An example of tertiary intervention, directed at a group that has experienced a crisisAt what point in time is critical incident stress debriefing used, and how long does it last?Held 1-10 days post event, and lasts 1-3 hours. It is NOT psychotherapy.Who is debriefed?Debriefing of staff or a group of people following a crisis like a suicide or incident of violence.What are the positive benefits of debriefing?A safe place for them to express feelings and have questions answered by debriefing team members.Disaster Management Continuum-Preparedness - plan to exploring response and risk -Mitigation - attempt to limit damage -Response - implementation of the disaster plan -Recovery - stabilization -Evaluation - for future responses