1. Stress, Crisis and Disaster Management Chapter 33

2. Stress Selye - oversimplified concept of stress Richard Lazarus - new approach for understanding stress –Stress: relationship between the person and environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well- being. –Components: Antecedents Stress Coping Adaptation

3. Antecedents to Stress Person Values Commitment Personality behavior patterns Environment Social network Social support Demands Constraints Sociocultural factors Life events Person-Environment Relationship

4. Antecedents to Stress: Cognitive Appraisal Primary Appraisal Relevant goal Consistent with values Personal commitment Importance of the event An event may be extremely stressful to one and not another. Meaning: depends on the risk-benefits (Text Box 35-2) Secondary Appraisal Blame or credit Coping potential Future expectations

5. Stress Stress is initiated by an unfavorable person-environment relationship that is meaningful in terms of risks or benefits to that person’s well-being. The more committed to the goal, the greater the vulnerability to stress.

6. Stress Response Physiological –Sympathetic response –Immune system functioning affected negatively –Over time, biologic responses to stress compromise a person’s health status. Emotional –Emotions - psychophysiologic reactions –Intense emotions - disturbance in intellectual functioning –Challenged (+) or threatened (-)

7. Emotions Negative emotions - occur when there is a threat –Anger, fright, anxiety, guilt, shame –Sadness, envy, jealousy, disgust Positive emotions - movement toward an attainment of goal –Happiness, pride, relief, love Borderline emotions - ambiguous –Hope, compassion, empathy, –Sympathy, contentment Nonemotions - don’t fit into category –Confidence, awe, confusion, excitement

8. Coping Process - managing demands and emotion Problem-focused coping –Changes the relationship between the environment and person Emotion-focused coping –Changes the meaning of the situation

9. Adaptation Capacity of a person to survive and flourish Affects three areas: –Health –Psychological well-being –Social functioning

10. Nursing Management May not have a DSM-IV dx or may be an adjustment disorder Goals: –To recognize stressful events –To strengthen positive coping skills

11. Nursing Management Biological –Review of systems –Physical functioning –Pharmacologic assessment

12. Nursing Management Psychological –Emotions –Severity of responses Social –Recent life changes –Social network and support Size Functions Reciprocity Interconnectedness

13. Nursing Diagnosis Anxiety Powerlessness Fear Fatigue Low self-esteem Ineffective coping Family coping Altered role performance

14. Interventions Biologic –Nutrition –Exercise Psychological –NIC Social

15. Crisis Stressful experience for which coping mechanisms fail Precipitating event is unusual or rare Time limited 4-6 weeks No such thing as a chronic crisis A turning point is life Can develop “Acute Stress Disorder”

16. Crisis Process An event is perceived as a threat, and usual coping mechanisms do not work. Tension builds. Attempts to cope are: Successful or Unsuccessful

17. Types of Crises Developmental Situational –Bereavement Shock and disbelief Acute mourning –Intense feeling –Social withdrawal –Identification with the deceased Resolution –Dysfunctional Grieving

18. Nursing Management Assessment Nursing Diagnosis –Grieving –Post-traumatic response –Relocation stress Interventions (Table 33-14) –Assist in confronting reality. –Encourage expressions of feelings. –Encourage person to focus on one thing at a time.

19. Nursing Management Interventions (cont.) –Avoid false reassurance. –Clarify fantasies with facts. –Link with community resources. –Psychopharmacologic –Help re-establish support network. Community Interventions –Telephone hot lines –Residential crisis services

20. Disaster Sudden, overwhelming, catastrophic event that causes great damage, destruction, mass casualties and human suffering Caused by nature (i.e., earthquake) or humans (i.e., chemical spill, terrorist attack)

21. Types of Victims Victims who may or may not survive –Victims who survive with injuries are more likely to experience depression and PTSD. Rescuers – often suffer psychological effects Everyone else

22. Nursing Management: Biologic Domain Assessment Physical reactions – tachycardia, etc. Panic without regard to personal safety Interventions Treat physical reactions. Provide reassurance. Maintain safety.

23. Nursing Management: Psychological Domain Assessment Observe for depression, confusion or uncontrolled weeping. Determine how patient normally responds to stress. Interventions Therapeutic communication Apply principles of stress and coping model. Refer to mental health clinic.

24. Nursing Management: Social Domain Assessment Capability of individuals and community to respond in a supportive way Interactions of the news media Women exhibit higher levels of distress. Violence may become a problem. Interventions Teach individual about community resources. Support family systems. Refer to community resources.