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Mental Health: Crisis and Disaster

Terms in this set (41)

Crisis Intervention
Is what nurses and other health professionals do to assist those in crisis to cope. Interventions are broad, creative, and flexible.
Crises
are acute, time-limited occurances experienced as overwhelming emotional reactions to: a stressful situational event, a developmental event, a societal event, a cultural event, and the perception of an event.
Prevalence and comorbidity
Many factors may limit a person's ability to problem solve or cope wit stressful life events or situations.
Prevalence and comorbidity
Factors that can cause inability to cope: presence of other stessfull life events, mental illness, substance avuse, history of poor coping skills, preexisting physical health problems, limited social support network, and developmental or physical challenges.
Theory
Erich Lindemann-formed the foundation of crisis theory and clinical intervention. He believed that even though avute grief is a normal reaction to a distressing situation, preventive interventions could eliminate or decrease serious personality disorganization and devastation psychological consequence from the sustained effects of severity anxiety. same interventions for breavement would be just as helpful for other stressful situations.
Theory
Gerald Caplan further elaborated crisis theory and outlined crisis intervention strategies.
Theory
Donna Aguilera and Janice Mesnick proveded the framework for nurses for crisis assessment and intereventions, which has grown in scope and practice.
Robert's seven-stages model of crisis interventions
1. plan and conduct crisis assessment
2. establish rapport and rapidly establish relationship
3. Identify major problems
4. deal with feelings and emotions
5. generate and explore alternatives
6. develop and formulate an action plan
7.Follow-up plan and agreement
Foundation for crisis intervention
box 17-1 pg 365
Three areas of crisis
Type of crisis, phases of crisis, and aspects of crises that have relecance for nurses.
Types of Crises
maturational crisis, situational crisis, and adventitious crisis
Maturational crisis
A process of maturation occurs throughout life. Erikson identified eight stages of G&D in which specific maturational tasks must be mastered. Each developmental stage can be reffered to as a maturational crisis. When a person arrives at a new stage, new coping skills need to be developed. Ex. Marriage, birth of child, and retirement. The ability to resovle a crisis at one stage affects how you move through the next stage.
Situational Crisis
Arises from an external rather than an internal source. Crisis is often unanticipated. Ex. loss of job, change in financial status, death of a loved one, ect. Referred to as "critical life problems", because they are encountered by most people during the course of their lives.
Adventitious Crisis
AKA crisis of disaster. Is not part of everyday life, it is unplanned and accidental. Adventitous crises result from a natural disaster, national disaster, or a crime of violence.
Phases of crisis
phase 1 phase 2 phase 3 phase 4
Phase 1 of a crisis
A person confronted by a conflict or problem that threatens the self-concept resoponds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety.
Phase 2 of a crisis
If the usual defensive response fails, and if the threat persists, anxiety continues to rise and produce feelings extreme discomfort. Individual functioning becomes disorganixed. Trial-and-error attempts at solving the problem and restoring a normal balance begins.
Phase 3 of a crisis
If the trail-and-error attempts fail, anxiety can escalate to severe and panic levels, and the person mobilizes automatic relief behaviors, suvh as withdrawal and flight. Some form of resolution may be made in this stage.
Phase 4 of a crisis
If the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person and lead to serious personality disorganization, depression, confusion, violence against others, or suicidal behavior
Assessment
A person's equilibrium may be adversely affected by one or more of the following: An unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms.
Assessing the Pts perception of the precipitating event
It is important to see the event through the eyes of the patient. The nurse's initial task is to assess the individual or family's perception of the problem. The more clearly the problem can be defined, the better the chance that an effective solution will be found.
Assessing the Pts situational supports
The Pts support systems are assessed to determine the resources available. Family and friends may be called on to aid the individual by offering material or emotional support. If these resourses aren't available the nurse or counselor acts as a temoporary support system while relationships with individuals or groups in the community are established.
Assessing the Pts personal coping skills
In crises situations it is important to evaluate the person's level of anxiety. Common coping mechanisms may be overeacting, drinking, smoking, withdrawing, seeking out someone to talk to , yelling, fighting, or engaging in other physical activity. The potential for suicide or homicide must be assessed. If the patient is suicidal, homicidal, or unavle to take care of personal needs, hospitalization should be considered.
Assessment Guildlines
Pg 369
Diagnosis
Refer to table 17-1
Outcome identification
The planning of realistic patient outcomes is done together with the patient or family. Realistic outcomes are made to fit within the person's cultural and personal values. The nurse will document the outcomes as measureable goals that are realistic and include a time estimate. Without the patients involvement, the outcome criteria may be irrelevant or unacceptavle solutions to that person's criteria.
Planning
Nurses are called upon to plan and intervene through a variety of crisis intervention modalities such as disaster nursing, mobile crisis units, group work, health edu and crisis intervention, victim outreach programs, and telephone hotlines. The nurse may be involved in planning and intervention for an individual. Answers to certain questions guides the nurse in the determines what immediate actions to take.
Implementation
Crisis intervertion is considered to be a function of the basic level nurse and has two basic goals: 1. patient safety and 2. anxiety reduction. A person in crisis first needs to gain a feeling of safety. Solutions to crisis maybe offered, so Pt is aware of other options. Feelings of support and hope will temporarily diminish anxiety. Role of nurse is to indicate that help is availble. The nurse may act as an educator, advisor, and model, always keeping in mind that it is the patient that solves the problem . The nurse helps the patient refocus to gain new perspectives on the situation. The nurse supports the patient through this process. See table 17-2
Levels of nursing care
Primary, Secondary, and Tertiary
Primary
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. Nurse can work with an individual to recognize potential problems by evaluating stressful life events the person is experiencing. Teach individual specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills, to handle stressful events. Assist an individual in evaluating the timing or reduction of life changes to decrease the negative effects of stress as much as possible.
Secondary
Secondary care establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurses primary goal is to ensure the patient's safety. Assess Pt. Desired goals are explored and interventions planned. Secondary care lessens the amount of time a person is mentally disabled during a crisis.
Tertiary
Tertiary care provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruption.
Critical incident stress debriefing
is an example of a tertiary intervention directed toward a group that has experienced a crisis. Consists of a 7 phase group meeting that offers individuals the opportunity to share their thoughts and feelings in a safe controlled environment.
Introductory phase
the purpose of the meeting is explained; an overview of the debriefing process is provided; participants are motivated; confidentiality is assured; guidelines are explained; team members are identified and questions are answered
Fact phase
Participants are assisted in discussing the facts of the incident; participants are asked to introduce themselves and tell how they were involved in the incident and what happened from their perspective
thought phase
all participants are asked to discuss their first thoughts of the incident
reaction phase
participants engage in freewheeling discussion and talk about the work thing about the incident-what they would like to forget and what was most painful
symptom phase
participants describe cognitive, physical, emotional, or behavioral experiences that they had at the scene of the incident and describe any symptoms they felt following the initial experience.
teaching phase
the normality of the symptoms that have been expressed is acknowledged and affirmed; anticipatory guidance is offered regarding future symptoms that may be experienced by paricipants; the group is involved in stress management techniques.
reentry phase
participants review old material discussed; introduce new topics they want to discuss; ask questons and discuss how they would like to bring closure to the debriefing. debriefing team members answer questions, inform, and reassure; provide handouts and other written material; provide information on referral sources for additional help; and summarize the debriefing experience with encouragement, support, and appreciation.
Evaluation
the evaluation of a person in crisis is usually done in 4-8 wks after initial interview. follow-ups!
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