1. Describe a crisis and its characteristics, including crisis responses, types of crises, characteristics of disasters, and crisis intervention. 2. Analyze aspects of the nursing assessment related to crisis and disaster responses. 3. Plan and implement nursing interventions for patients related to their crisis and disaster responses. 4. Develop a patient education plan to cope with crisis. 5. Evaluate nursing care for patients related to their crisis and disaster responses. 6. Describe the settings in which crisis and disaster intervention may be practiced. 1. The anxiety activates the person’s usual methods of coping. If these do not bring relief, anxiety increases because coping mechanisms have failed. 2. New coping mechanisms are tried or the threat is redefined so that old ones can work. Resolution of the problem can occur in this phase. However, if resolution does not occur, the person goes on to the last phase. 3. The continuation of severe or panic levels of anxiety may lead to psychological disorganization. In describing the phases of a crisis, it is important to consider the balancing factors shown in Figure 13-1. These include the individual’s perception of the event, situational supports, and coping mechanisms. Successful resolution of the crisis is more likely if the person has a realistic view of the event; if situational supports are available to help solve the problem; and if effective coping mechanisms are present (Aguilera, 1998). TABLE 13-1 From U.S. Department of Health and Human Services: Training manual for mental health and human service workers in major disasters, ed 2, Washington, DC, 2000, U.S. Government Printing Office. • Precipitating event or stressor • Patient’s perception of the event or stressor • Nature and strength of the patient’s support systems and coping resources 1. Self-esteem needs are achieved when the person attains successful social role experience. 2. Role mastery needs are achieved when the person attains work, sexual, and family role successes. 3. Dependency needs are achieved when a satisfying interdependent relationship with others is attained. 4. Biological function needs are achieved when a person is safe and life is not threatened. TABLE 13-2 PATIENT EDUCATION PLAN
Crisis and Disaster Intervention
Crisis Characteristics
Crisis Responses
Situational Crises
PHASE
RESPONSE
Warning or threat phase
Disasters vary in the amount of warning communities receive before they occur from little or no warning to hours or even days of warning. When no warning is given, survivors may feel more vulnerable, unsafe, and fearful of future unpredicted tragedies.
Impact phase
The impact period of a disaster can vary from the slow, low-threat build-up associated with some types of floods to the violent, dangerous, and destructive outcomes associated with tornadoes and explosions. The greater the scope, community destruction, and personal losses associated with the disaster, the greater the psychosocial effects.
Rescue or heroic phase
In the immediate aftermath, survival, rescuing others, and promoting safety are priorities. For some, postimpact disorientation gives way to adrenaline-induced rescue behavior to save lives and protect property. Although activity level may be high, actual productivity is often low. Altruism is prominent among both survivors and emergency responders.
Remedy or honeymoon phase
During the week to months following a disaster, formal governmental and volunteer assistance may be readily available. Community bonding occurs as a result of sharing the catastrophic experience and the giving and receiving of community support. Survivors may experience a short-lived sense of optimism that the help they will receive will make them whole again. When disaster mental health workers are visible and perceived as helpful during this phase, they are more readily accepted and have a foundation from which to provide assistance in the difficult phases ahead.
Inventory phase
Over time, survivors begin to recognize the limits of available disaster assistance. They become physically exhausted because of enormous multiple demands, financial pressures, and the stress of relocation or living in a damaged home. The unrealistic optimism initially experienced can give way to discouragement and fatigue.
Disillusionment phase
As disaster assistance agencies and volunteer groups begin to pull out, survivors may feel abandoned and resentful. The reality of losses and the limits and terms of the available assistance become apparent. Survivors calculate the gap between the assistance they have received and what they will require to regain their former living conditions and lifestyle. Stressors abound—family discord, financial losses, bureaucratic hassles, time constraints, home reconstruction, relocation, and lack of recreation or leisure time. Health problems and exacerbations of preexisting conditions emerge because of ongoing, unrelenting stress and fatigue.
Reconstruction or recovery phase
The reconstruction of physical property and recovery of emotional well-being may continue for years following the disaster. Survivors have realized that they will need to solve the problems of rebuilding their own homes, businesses, and lives largely by themselves and gradually assume the responsibility for doing so. Survivors are faced with the need to readjust to and integrate new surroundings as they continue to grieve losses. Emotional resources within the family may be exhausted and social support from friends and family may be worn thin.
When people come to see meaning, personal growth, and opportunity from their disaster experience despite their losses and pain, they are well on the road to recovery. Although disasters may cause profound life-changing losses,
they also bring the opportunity to recognize personal strengths and to
reexamine life priorities.
Assessment
Precipitating Event
Planning And Implementation
Coping with Crisis
CONTENT
INSTRUCTIONAL ACTIVITIES
EVALUATION
Describe the crisis event.
Ask about the details of the crisis, including the following:
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Crisis and Disaster Intervention
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