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Crisis

Crisis. Crisis. Source: any stressful event hazardous situation Maturational Situational Adjustment Disorder Can effect The individual Family Community Nation. Crisis vs. Stress. Period of severe disorganization Failure of Coping Mechanisms Lack of usual resources

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Crisis

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  1. Crisis

  2. Crisis • Source: • any stressful event • hazardous situation • Maturational Situational • Adjustment Disorder • Can effect • The individual • Family • Community • Nation

  3. Crisis vs. Stress • Period of severe disorganization • Failure of Coping Mechanisms • Lack of usual resources • Feels totally out of control • Unable to function • Extremely frightening • Motivates to escape the situation or pain

  4. Crisis • Panic Level Anxiety • Feel hopeless and helpless • Can not be tolerated for more than 4 to 6 weeks • Need and accept help • Trust is less of an issue • Crisis has growth potential • Learn new coping skills • Improve relationships

  5. Help: Unavailable • Exhaustion and illness • Dysfunctional coping patterns (behaviors) • Persist without intensive counseling for a prolonged period • Less time and more effective if intervention occurs quickly and during the crisis • Emotionally ill • Suicidal

  6. Dissociative Disorders • Dissociative Amnesia • Dissociative Fugue • Depersonalization • Dissociative Identity Disorder

  7. ASD vs. PTSD • Acute Stress Disorder • Dissociative symptoms immediately after the event • Post Traumatic Stress Disorder • Characteristic Symptoms one month after the trauma • May go unrecognized for years • Major Characteristics of Both: • Numbing of responsiveness • Reduced involvement • Defense mechanisms • Regression • Denial • Repression • Suppression

  8. Intrussive Thoughts and Feelings • Re-experiencing the trauma • Thoughts • Memories • Nightmares • Illusions • triggers • Sudden Feeling the event is recurring • Abreaction: process by which repressed material is brought back to the consciousness and re-experienced affectively

  9. ASD and PTSD • Arousal • Anxiety • Restlessness • Irritability • Disturbances in Sleep • Impaired memory or concentration • Anger or Rage • Survivor guilt: perceive they did not help or are responsible for the trauma

  10. Causes • Previous trauma • Rape • Childhood Abuse • War (Iraq and Afghanistan) • Bombings (World Trade Center)

  11. Outcomes • Arrests • Unemployment • Homelessness • Abusiveness • Divorce • Paranoia

  12. Sensitization • Fear Conditioning • Auditory and visual stimuli • Emotional and visceral memories • Response continues even when the traumatic event is no longer present • Cross sensitization • Over-reaction to stimuli that resembles the trauma • Hyper arousal

  13. Critical Incident Stress Management Used when the development of posttraumatic symptoms are likely Provides a range of services for victims Seven Core Elements Pre-crisis preparation Large-Scale demobilization Individual acute crisis counseling Brief small group discussions (defusings) Longer small group discussions (critical Incident stress debriefings Family crisis intervention techniques Follow-up procedures CISM

  14. Crisis Intervention • Identify the point at which the crisis began • Identify how the victims life is being effected • Immediate action to prevent harm and further decompensation • The Nurse can be active and directive

  15. Crisis Intervention • Focus on Survival safety and security (physical and emotional) • Re-establish equilibrium and stabilization • Focus on strengths and adaptive coping • Offer suggestion for concrete specific problem-solving • Make provisions for follow-up care

  16. Nurse-Patient Relationship • Trust: Depends on the Crisis • May be difficult to establish • Acknowledge the injustice • Address concerns about safety and security • The patient needs to be able to talk about injuries destruction and atrocities and changes that have occurred in their lives • Nurses need help to avoid secondary PTSD

  17. Nurse-Patient Relationship • Safe verbalization of anger • Facilitate externalization of painful emotions (difficult to verbalize) • Write in a journal • Write a letter • Art Music and Poetry • Developing a new perspective

  18. Groups • Coping Skills • Relaxation techniques • Anger management • Time out to focus • Bills • Planning • Interpersonal Skills • Take responsibility for one’s actions

  19. Crisis and Pharmacology • Benzodiazepines • Clonazepam • Lorazepam • reduce anxiety and help to rest • Clonidine • Peripheral autonomic response • Reduces fear anxiety and nightmares

  20. Crisis and Pharmacology • Valporic Acid or Carbamazepine • Help with mood swings; explosive outbursts; feelings of being out of control • SSRIs • May decrease sensitization; disturbing images • Tricyclic Antidepressants • Antipsychotics • Acute crisis • Resperidone or quetiapine can decrease flashbacks and nightmares

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