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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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

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.

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.