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Psych Exam 2 - Ch. 26 (Crisis and Disaster)
Terms in this set (33)
In the United States, which agency has overall responsibility to coordinate responses to disasters?
Department of Homeland Security (DHS)
The DHS has ultimate government responsibility for the safety of United States citizens and territories while assuring adequate preparedness, response, and recovery protocols are immediately available. WHO serves the global community. DHS oversees operations of FEMA. NIMS helps first responders from different disciplines and areas to work together effectively when a community has exhausted its available resources in addressing a large-scale occurrence.
Which government entity is charged with coordinating responses to American disasters, particularly in situations in which local and state resources are inadequate to the presenting challenge?
Department of Homeland Security (DHS)
Following the events of September 11, 2001, the DHS was charged with coordinating responses to US disasters, particularly in situations in which local and state resources are inadequate. The DHHS mission is to enhance and protect the health and well-being of all Americans. The DOD is in charge of US military services. HUD is a cabinet department within the US government with the mission to create strong, sustainable, inclusive communities and quality affordable homes for all.
What are the two initial goals for crisis interventions?
Patient safety and anxiety reduction
The focus of crisis intervention is on the present problem. The two initial goals are to ensure patient safety and take measures to reduce patient anxiety. Anxiety reduction and coping is important; however, safety is a priority need. Crisis resolution and planning are not immediate goals for psychosocial interventions. Assessment and nursing diagnosis are aspects of the nursing process and differ from implementation. Clustering of nursing assessment data will help identify the nursing diagnosis.
Which event leads to the development of a situational crisis in patients?
Loss of a job
A situational crisis arises from external events such as loss of a job or an abortion. An adventitious crisis results from accidental events that are unplanned, which may be human-made or caused by nature. This crisis precipitates from situations such as physical assaults and natural disasters like floods and earthquakes. A maturational crisis arises from developmental changes in a person's life such as the birth of a child or death of parents.
When does a patient have symptoms of self-hatred and depression?
When the patient has chronic low self-esteem
Patients experiencing crisis have chronic low self-esteem, post-trauma syndrome, impaired social interaction, and acute confusion. The symptoms of chronic low self-esteem are self-hatred and depression. The symptoms of post-trauma syndrome are denial, hypervigilance, and panic. Symptoms of impaired social interaction include feelings of isolation and little or no social support. Symptoms of acute confusion include feelings of numbness, confusion, and incoherence.
p. 496, Table 26.1
An individual comes to the crisis clinic for a first visit and reports not sleeping well, anxiety, and excessive crying. These symptoms occurred shortly after a sudden job loss and losing his or her home to a tornado that devastated the town in which the patient lives. Which of the following statements regarding crisis accurately describes the individual's situation?
The patient is experiencing both a situational and an adventitious crisis.
It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. The patient lost his or her job (situational crisis) and also experienced the devastating effects of a tornado (adventitious crisis). The patient may be experiencing low self-esteem, but this doesn't accurately describe the crisis criteria. There is nothing in the scenario suggesting the patient needs acute hospitalization at this time. The patient is experiencing not only a situational crisis but an adventitious one as well. which makes coping more difficult.
During which crisis phase does a patient exhibit serious personality disorganization, depression, and confusion?
Caplan was the first person who conducted an extensive study on individual behavior. He proposed four stages based on the emotional status of a patient during a crisis. Patients with high personality disorganization, depression, and confusion are categorized under phase 4. These patients also exhibit suicidal thoughts. Increased level of anxiety caused by external stimuli is experienced by a patient during phase 1. If the anxiety level grows to a level of extreme discomfort, the patient has reached the phase 2 level of crisis. Phase 3 is characterized by an increased level of panic due to grief and loss.
The nurse is performing crisis intervention for a patient rescued from a bomb blast. What appropriate actions should the nurse take while working with the patient?
-Teach decision-making skills to the patient.
-Consider that a crisis counseling relationship is one between partners.
The nurse should assume that a crisis counseling relationship is one between partners. Both have to work together for an effective outcome. The nurse should teach decision-making skills, relaxation skills, and problem-solving skills to the patient. The nurse should ensure that the patient is in charge of his or her own life and should assume that the patient is able to make decisions. The nurse should avoid giving false reassurances such as, "Everything will be all right" and should focus instead on discussing problems in a more specific way. The nurse should assist the patient in making decisions but should not assume that the patient is unable to make decisions.
A nurse manager instructs a nurse to perform crisis intervention for an acute crisis. Which step should be the priority while conducting secondary care for the patient?
Focus on the safety of the patient
Ensuring the patient's safety is of the utmost importance while planning crisis intervention for a patient with acute crisis. The nurse should constantly assess for suicidal or homicidal thoughts in the patient. While giving tertiary care the nurse tries to prevent emotional disruption by suggesting support groups and rehabilitation centers. The nurse should discuss the facts of incidents with patients during tertiary care. Primary care involves the demonstration of assertiveness skills to the patient.
A nurse is conducting crisis intervention for a patient who is a victim of physical assault and learns that the patient is confused and overwhelmed. Which strategy does the nurse implement while interacting with the patient to make the patient feel comfortable?
The nurse summarizes the information given by the patient.
The patient who is a victim of physical assault often feels confused and overwhelmed. The nurse should make the patient feel comfortable by listening attentively to the patient during their interaction. After listening to the patient, the nurse should summarize the information given by the patient. It makes the patient feel that the nurse is concerned and is actively listening. Making firm eye contact with the patient during an interaction indicates active listening. The nurse should give frequent feedback to the patient to clearly understand what the patient is trying to say. Once the patient feels comfortable and starts expressing feelings, then the nurse can advise the patient to come for regular follow-up visits.
p. 497, Table 26.2
Which interventions are associated with primary crisis care?
-Discussing impact of crisis on the patient
-Assisting the patient with learning new problem solving techniques
-Helping the patient to identify environmental changes necessary to reduce stress
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. On this level the nurse can work with a patient to recognize potential problems by evaluating the patient's experience of stressful life events, teach the patient specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills, and assist the patient in evaluating the timing or reduction of life changes to decrease the negative effects of stress as much as possible. This may involve working with a patient to plan environmental changes, make important interpersonal decisions, and rethink changes in occupational roles. Administering antidepressant medication and planning for discharge are examples of secondary care.
What is the term for crises that occur as an individual moves from one developmental level to another?
Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective. A situational crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. An adventitious crisis is not a part of everyday life; it results from events that are unplanned and may be accidental, caused by nature, or human made. Reactive is not a term used to identify a type of crisis.
The student nurse is providing examples of adventitious crisis to a peer. Which examples of adventitious crisis listed by the student nurse requires correction?
-The birth of a child
-Death of a loved one
-A change in financial status
-Leaving home for the first time
The death of a loved one is a situational crisis, and the birth of a child is a maturational crisis. A change in financial status is also situational, while leaving home for the first time is maturational. Adventitious crises are caused by events that are unplanned and may be accidental, caused by nature, or human-made. Examples of adventitious crises are natural disasters and a crimes of violence.
A crisis intervention nurse knows that crisis victims need assistance with many aspects of getting through the crisis. What is the highest priority of care for such patients?
Promoting patient safety
The nurse's initial task is to promote safety by assessing the patient's potential for suicide or homicide. Reduction of anxiety, development of new coping skills, and prevention of boundary blurring are all important components of the care plan, but safety of the patient takes the highest priority.
Which type of crisis arises from events that are extraordinary, external rather than internal, and often unanticipated?
A situational crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. A maturational crisis occurs in response to changes in developmental stages. An adventitious crisis results from a natural disaster, a national disaster, or a crime of violence. A crisis may cause posttraumatic stress, but it is not a crisis itself.
What are the signs and symptoms of rape-trauma syndrome?
Due to the physical and psychological trauma of rape, some rape victims have rape-trauma syndrome. The patient becomes very alert and gets startled even by a minor stimulus. The patient also becomes numb occasionally. The patient is constantly involved in thoughts that may interfere with their day-to-day activities. These are the symptoms suggestive of rape-trauma syndrome. Lack of social support is a sign of impaired social interaction. Showing impaired problem-solving skills is a symptom of ineffective coping.
p. 496, Table 26.1
The nurse is caring for a patient with rape-trauma syndrome. What outcome shown by the patient after 8 weeks indicates effective crisis intervention?
The patient concentrates on the given task.
Patients with rape-trauma syndrome have symptoms of denial, horror, hypervigilance, and panic. Following effective treatment, patients may be able to develop concentration and are able to effectively concentrate on a given task. They exhibit impulse control and exhibit a nonlabile mood. Patients usually report having adequate sleep. They don't sleep for long hours or for a short span. Patients with rape trauma usually maintain hygiene, so maintaining hygiene is not an indication of effective treatment. Patients in trauma usually express their emotions nonverbally. Good verbal communication indicates recovery.
p. 496, Table 26.1
Mason and Charlie, both 16 years old, were involved in a bad car accident in which they were both passengers. Mason spoke with a counselor about the incident once and has been able to move forward with little dysfunction. Charlie has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. What is the most likely reason that accounts for the difference in the way individuals who experience the same event are affected emotionally by that event?
Perception of the event
People vary in the way they absorb, process, and use information from the environment. Some people may respond to a minor event as if it were life-threatening. Conversely, others may experience a major event and look at it in a calmer fashion. Individual personality, previous trauma, and the type of counseling provided may be true, but are not the primary reasons two people respond differently to the same event.
A nurse is caring for a group of patients in a rehabilitation center who were rescued from a tornado. The nurse identifies a patient with disturbed identity who is isolated from the other patients. What does the nurse interpret from the patient's behavior?
The patient is in a depressed state.
A patient who does not interact with others after a trauma is showing signs of depression. Several factors such as grief and loss cause depression in patients. The antisocial behavior of the patient does not indicate that the patient is refusing care or is incapable of meeting his or her basic needs. These behaviors are more indicative of ineffective coping strategies than of depression. Similarly, this antisocial behavior does not necessarily indicate a personality disorder, as it may be a temporary reaction to the trauma.
p. 496, Table 26.1
In the event of an adventitious crisis, which age group would be least in need of crisis intervention?
A distinction cannot be made
It is known that there is a need for psychological first aid (crisis intervention) and debriefing after any crisis situation that cannot be overstressed for all age groups (children, adolescents, adults, and the elderly).
The nurse is performing crisis intervention for a patient who recently lost a spouse. The patient shows depressive and impulsive behavior, and sometimes gets aggressive. Which assessment tool should the nurse use to evaluate the effectiveness of crisis intervention?
The Likert scale is used to assess the effectiveness of the crisis intervention. It contains five points, and based on the patient's symptoms, a rating is given. The SAD PERSONS scale is used to assess the suicidal behavior of a patient. The rating is given on 10 points based on 10 different criteria. Hamilton rating scale is used to rate the anxiety and depression in a patient and contains 17 items on which the rating is given. Cognition rating scale is used to evaluate the functioning ability in schizophrenic patients.
Following an assessment, the nurse concludes that the patient is in phase 2 crisis. What signs and symptoms does the nurse find in the patient?
Feelings of extreme discomfort
Crisis is categorized into four distinct phases based on the behavior of the patient. A patient in phase 2 crisis has feelings of extreme discomfort, threat, and anxiety. Patients in phase 4 have suicidal ideation and/or intention to harm others. Patients who exhibit severe panic and withdrawal are included in phase 3.
After the bomb explosions at the Boston Marathon in 2013, members of the community donned t-shirts that said, "Boston Strong." Which phase of the disaster management continuum is evident by this behavior?
Each catastrophic event will set in operation a five-phase disaster management continuum that includes preparedness, mitigation, response, recovery, and evaluation. The recovery phase includes actions focused on stabilizing the community and returning it to its functional status. The t-shirts promoted the message that the community was resilient and intact, which represents recovery.
Which statement concerning a crisis is true?
-Adaptation to the results of the crisis is vital to recovery.
-A crisis involves a struggle to regain one's emotional equilibrium.
Crisis is defined by the struggle for equilibrium and adaptation in its aftermath. Crisis is not defined by the experience itself. Normal coping mechanisms fail to deal with this distress, resulting in an inability to function as usual. Crises are acute and time limited, usually lasting 4 to 6 weeks.
Which are foundational theory concepts for crisis intervention?
-A crisis intervention deals only with the patient's present problem.
-A crisis is self-limiting and usually resolves within four to six weeks.
-Early intervention probably increases the chances for a good prognosis.
Crisis theory defines aspects of crisis that are basic to crisis intervention and relevant for nurses. Foundational concepts are that a crisis is self-limiting and usually resolves within four to six weeks; a crisis intervention deals only with the patient's present problem ("here and now"); and early intervention probably increases the chances for a good prognosis. A crisis usually does not resolve in two to three weeks. During a crisis, people are usually more receptive (not less receptive) to outside intervention. Crisis intervention deals only with the patient's present problem and does not go back to historic issues.
Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.
What is the best description of a psychiatric advance directive plan?
Proactive method of addressing a crisis situation before it occurs
A psychiatric advance directive plan is a proactive method of addressing a crisis situation before it occurs. In psychiatry, these plans take the form of a document that is developed by the consumer to be used in crisis situations during which the consumer is unable to make decisions. Outpatient care with the goal of preventing hospitalization may be provided by a mobile crisis service. It is proactive, but this description does not address the psychiatric aspect. A legal, written statement regarding a person's wishes regarding medical treatment is any advance directive.
A patient comes to the crisis intervention clinic and tearfully tells the nurse, "It is so painful! I have thought about it, and I cannot see how I can go on without my partner." The nurse states, "You have resilience and will look back on this as a crisis you were able to manage." Analysis of this interaction reveals what about the nurse?
The nurse has not followed up on the patient's verbal clues to suicidal thoughts.
Nurses who are uncomfortable with the idea of suicide may fail to pick up on a patient's clues. This patient clearly was open to discussing suicidal thoughts, or the patient would not have said, "I cannot see how I can go on."
p. 497, Table 26.2
Which question best assesses an individual's ability to cope with the potential emotional crisis resulting from the death of a parent?
"Have you ever lost a loved one before?"
The question "Have you ever lost a loved one before?" will help determine how the individual has dealt with similar losses in the past, which will assist in evaluating his or her coping abilities. The question about coping well assesses the individual's self-perception, which may be skewed. Although informative, the question concerning supportive people does not assess the individual's ability to cope effectively with the loss. The question regarding fond memories assesses the individual's perception of the relationship but provides no insight into his or her coping abilities.
Whose model does a nurse follow while conducting crisis intervention for a patient with acute stress disorder?
Albert R. Roberts
Several theories have been proposed for treating individuals diagnosed with acute stress disorder. Roberts's model of crisis interventions is especially useful for patients who have suffered from an acute situational crisis and those who are diagnosed with acute stress disorder. It is a seven-step process that includes planning, establishing relations, identifying cause, active listening, searching for alternatives, formulating, and implementation. Caplan's advanced crisis theory provides an outline of the knowledge of crisis and disaster management. Lindemann was the first person to propose the concept of crisis theory. He conducted a study of relatives of the 492 victims of the Cocoanut Grove nightclub fire accident. Aguilera and Mesnick's theory explains the framework of planning strategies for effective crisis management. Unlike Roberts's model of crisis interventions, these other models do not specifically focus on interventions for acute stress disorder.
p. 492, Figure 26.2
Which stage of critical incident stress debriefing includes acknowledgement of expressed symptoms?
Critical incident stress debriefing is a form of tertiary intervention for crisis and disaster management. It is a type of group therapy that consists of seven phases in which the patients share their thoughts, feelings, and ideas. In the teaching phase the patients acknowledge the normality of their symptoms. They are also taught about the symptoms of stress that they may anticipate in the future. The thought phase includes the sharing of ideas and thoughts between the patients of the group. In the reaction phase the participants talk about the painful events associated with the crisis incident. In the symptom phase participants describe their cognitive, physical, emotional, or behavioral experiences of the incident.
The nurse is performing crisis intervention for a patient who has been sexually assaulted. What appropriate action does the nurse take first?
Assess the patient for any suicidal intentions
A patient experiencing crisis can develop suicidal behavior to escape from the situation. The nurse should first asses the suicidal intentions of the patient to promote the safety of the patient. The vital signs of the patient are assessed after admission in the hospital, and not during crisis intervention. The patient's perception of the situation and coping skills are assessed after assessing the suicidal intentions of the patient, as the safety of the patient is of greater importance.
p. 497, Table 26.2
According to Caplan, crisis occurs in four phases. Which patient behavior is an example of phase 3 of a crisis?
Following the death of a spouse, the patient progresses from mild anxiety to a panic state. The patient tells the nurse, "I cannot live alone! I will need to move in with my children."
During phase 3 of a crisis, trial-and-error attempts to deal with the crisis fail, and the threat persists, causing anxiety to escalate to severe and panic levels. As such, the patient displaying anxiety escalating to panic is demonstrating phase 3. Phase 1 occurs when the person is confronted by a conflict and responds with increased anxiety and use of defense mechanisms such as denial to lower anxiety. A patient denying a serious diagnosis such as myocardial infarction is displaying a phase 1 behavior during a crisis. Phase 2 occurs when usual defense mechanisms fail and the threat persists, resulting in high levels of anxiety and disorganized thinking. Following a motor vehicle accident, the patient relates the inability to "think straight" and desire to sit down to "clear" his head. Phase 4 occurs when the problem becomes overwhelming and coping skills are ineffective. Suicidal behavior may ensue, as demonstrated by the parent who lost a child.
Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect.
A nurse manager instructed the nurse to conduct crisis intervention for a patient who is depressed due to the death of a partner. The nurse manager gives instructions to the nurse for conducting effective crisis intervention. Which statement made by the nurse manager is appropriate?
"Remember that crisis counseling is the relationship between the nurse and patient."
The nurse should always know that crisis counseling is the relationship between two partners (the nurse and the patient). It helps to understand the feelings and perceptions of the patient. The nurse should not give false assurance to the patient by saying, "Do not to worry, everything will be alright." The patient may lose trust due to false assurance. The nurse should encourage the patient to solve problems and make decisions independently. During crisis intervention the nurse should be a good role model and give helpful advice to the patient.
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