1. Chapter 26 Crisis and Disaster
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Crisis Profound disruption of normal psychological homeostasis
Normal coping mechanisms fail
Results in inability to function as usual
Acute and time-limited
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Outcomes of Crisis Depend on Realistic perception of the event
Adequate situational supports
Crisis intervention
Adequate coping mechanisms
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Crisis Theory Erich Lindemann Gerald Caplan
Donna Aguilera and Janice Mesnick
Albert R. Roberts
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Types of Crisis Maturational New developmental stage is reached
Old coping skills no longer effective
Leads to increased tension and anxiety
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Types of Crisis (Cont.) Situational Arise from events that are
Extraordinary
External
Often unanticipated
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Types of Crisis (Cont.) Adventitious Unplanned and accidental
Natural disaster
National disaster
Crime of violence
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Phases of Crisis Phase 1 Conflict or problem Self-concept threatened
Increased anxiety
Use of problem-solving techniques and defense mechanisms
Resolve conflict or problem
Reduce anxiety
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Phases of Crisis Phase 2 Defense mechanisms fail Threat persists
Anxiety increases
Feelings of extreme discomfort
Functioning disorganized
Trial-and-error attempt to solve problem and restore normal balance
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Phases of Crisis Phase 3 Trial-and-error attempts fail
Anxiety can escalate to severe level or panic
Automatic relief behaviors mobilized (i.e., withdrawal and flight)
Some form of resolution may be devised (i.e., compromising needs or redefining situation)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Phases of Crisis Phase 4
Problem is unsolved and coping skills are ineffective
Overwhelming anxiety
Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Application of the Nursing Process
Assessment
General assessment
Assessment of perception of precipitating event
Assessment of situational supports
Assessment of personal coping skills
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13. Nursing Process (Cont.)
Diagnosis (Table 25-2)
Ineffective coping
Outcomes identification (Table 25-3)
Implementation
Basic level
Patient safety
Anxiety reduction
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Nursing Process (Cont.)
Crisis intervention
Primary care
Secondary care
Tertiary care
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Critical Incident Stress Debriefing (CISD)
Seven phases
Introductory phase
Fact phase
Thought phase
Reaction phase
Symptom phase
Teaching phase
Re-entry phase
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Disasters Disaster management continuum Preparedness Mitigation
Response
Recovery
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. Audience Response Questions
Which term is most applicable to crisis?
Self-limiting
Boundaries
Amnesia
Chronic
ANS: A
A crisis is self-limiting and usually resolves within 4 to 6 weeks.
REF: 41
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. Audience Response Questions
A category 5 hurricane destroys homes and businesses in a community. How would this crisis be classified?
Disequilibrium
Adventitious
Maturational
Situational
ANS: B
An adventitious crisis results from events that are unplanned and may be accidental, caused by nature, or human made. This type of crisis results from a natural disaster, a national disaster, or a crime of violence.
REF: 8
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.