Terms in this set (27)
Important step for staff in coming to terms with overwhelming violent or otherwise disastrous situations once they are over.Helps staff place the crisis in perspective and begin healing themselves.
The early Crisis theory
Lindemann was convinced that even though acute grief is a normal reaction to distressing situation, preventative interventions could eliminate or decrease serious personality disorganization.
Donna Aguilera and Janice Mesnick provided what?
a framework for nurses for crisis assessment and intervention
Roberts Seven stage model
bottom to top of triangle.
1.plan and conduct crisis assessment (lethality measures)
2. Establish rapport and rapidly establish relationship
3. Identify major problems ("last straw" or crisis precipitants)
4. deal with feelings and emotions(active listening and validation)
5. Generate and explore alternatives
6.Develop and formulate an action plan
7. Follow-up plan and agreement
Crisis interventions deals with
the present problem "here and now"
Understanding what three areas or the crisis theory enable the application of the nursing process
1.types of crisis
2.phases of crisis
3.aspects of crisis that have relevance for nurses
After determining the need for external controls because of suicidal or homicidal ideation, the nurse assesses what three main areas?
1. patients perception of the precipitating event
2. the patients situational supports
3. the patients coping skills
Common coping mechanisms may be ...
overeating, drinking, smoking, withdrawing, seeking out someone to talk to, yelling, fighting, or engaging in other physical activity
Crisis assessment guidelines 6
1. identify whether the patient's response to the crisis warrants psychiatric treatment or hospitalization to minimize decompensation
2.Id if patient can identify preciptating event
3.assess patient understanding of situational supports
4.Id patient's coping skills
5. Determine if certain religious or cultural beliefs need to be considered when intervening
6. assess to see if the situation is one in which the patient needs primary intervention (education, environmental manipulation), secondary intervention(crisis intervention), tertiary intervention( rehabilitation).
Crisis intervention modalties
disaster nursing, mobile crisis units, group work, health education and crisis prevention, victim outreach programs, and telephone hotlines
In dealing with crisis intervention, what are the two basic goals?
patient safety and anxiety reduction
3 Levels of nursing care
promotes mental health and reduces mental illness
-work with pt to ID problems
-teach individual specific coping skills
-assist pt in evaluating the timing and reduction of life changes to decrease the negative effects of stress as much as possible.
intervention during acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. Primary focus is to ensure safety of the pt. Occurs in the hospital units, ER, or mental health centers, usually daytime hours.
provides support for those who have experienced a severe crisis and are now recovering from disabling mental state. EX: rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. Primary goal is to facilitate optimal level of fxning and prevent further emotional disruptions
Critical incident stress debriefing (CISD)
is an example of tertiary intervention directed toward a group that has experienced a crisis.
Seven phases to CISD
1.Introductory phase-overview of debriefing process- participants are motivated
2.Fact phase-discuss facts of the incident and tell how they were involved in the incident
3. Thought phase- discuss their 1st thoughts of the incident
4.Reaction phase- engage in freewilling discussion and talk about the worst thing about the incident
5.Symptom phase-pt decribes cognitive, physical, emotional, or behavioral experiences that they had at the scent of the incident.
6.Teaching phase-anticipatory guidance is offered regarding future symptoms that may be experienced by participants, stress management techniques.
7.Reentry phase- participants review old material discussed; introduce new topics tey want to discuss and how they want to bring closure to the debriefing.
crisis is self limiting and normally lasts how long?
Three basic types of crises
each stage of development in adulthood is affected. Professional intervention may be needed.EX: alcohol and drug addiction can interrupt an individuals progression through the maturational stages.
arisess from an external rather than an internal source. often unanticipated. EX: loss of job, change in financial status, divorce.
not part of everyday life; it si unplanned and accidental. EX: natural disaster (flood, fire, earthquake, national disaster(acts of terrorism, war, riots),crime of violence (rape, assault, murder,bombing in crowded areas, child abuse)
460 major disaster declared higher than any other decade on record
Underlying principle of a triage is to?
seperate out those with more minor injuries, thus reducing the urgent burden on medical facilities and organizations and making the most efficient use of available resources.
During a disaster often the first needs are what?
rescue efforts, evacuation plans and execution, food and shelter, medical attention, and physical safety.
Caplan identified four distinct phases of crisis
Phase 1: person confronted by a conflict has increased feelings of anxiety
phase 2: usual defensive response fails, if threats persist, anxiety continues to rise and produce feelings of extreme discomfort. Individual fxning becomes disorganized. Trial and error attempts for solving problem
phase 3: trial and error attempts fail, anxiety can escalate to severe and panic levels.May react with withdrawl and flight. May compromise.
phase 4: problem is not resolved and new coping skills are ineffective. Leads to depression, confusion, violence and suicide.
CISD is used in the following situations...
-Debrief staff following pt suicide
-help staff/students following incident of school violence
-debrief rescue personnel who responded to disaster
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