Stress, Crisis and Disaster Management

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

4. Primary Appraisal Relevant goal Consistent with values Personal commitment Antecedents to Stress:Cognitive Appraisal • 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.