Crisis and Disaster
Chapter 17
Concept of Crisis
• Crises are universal experiences
• Crisis represents struggle for equilibrium and
adjustment when problems seem unsolvable
– Presents both danger to personality organization as well
as opportunity for personal growth
• Definition of crisis: acute, time-limited event
experienced as overwhelming emotional reaction
• Crisis intervention: assistance in coping for those in
crisis. Interventions used are broad, creative and
flexible
Theory Related to Crisis and
Crisis Intervention
• Crisis is self-limiting (4 to 6 weeks)
• Resolution of crisis: person will emerge at:
– Higher level of functioning
– Same level of functioning
– Lower level of functioning
• Goal of crisis intervention: return individual to
previous level of functioning
– Deal with person’s present problems: “here and now”
– Nurse takes active, directive role when intervening
– Important to set realistic goals
Types of Crisis
• Maturational
– Related to identified developmental stages occurring
throughout life
• Each new stage requires new coping mechanisms
– Examples
• Marriage, birth of a child, retirement
• Situational
– Arises from external rather than internal source;
usually unanticipated
– Examples
• Loss of job, death of loved one, change in financial status,
divorce
Types of Crisis
• Adventitious
– Crisis or disaster not part of everyday life
– Arise from
• Natural disaster (floods, fires, earthquakes)
• National disaster (acts of terrorism, war, riots, airplane
crashes)
• Crime of violence (rape, assault, murder in
workplace/school, bombing in crowded areas, abuse)
– U.S.: 460 major disasters from 1990-2000
Phases of Crisis
• Phase 1: person is confronted by conflict or
problem that threatens self-concept and causes
anxiety
• Phase 2: if usual defensive response fails and threat
persists, anxiety continues to rise
• Phase 3: if trial-and-error attempts fail, anxiety can
escalate to panic levels
• Phase 4: if problem is not solved and new coping
skills are ineffective, anxiety can overwhelm person
– Serious personality disorganization, depression,
confusion, violence against self/other can occur
Nursing Process:
Assessment Guidelines
• Patient’s perception of precipitating event
– Perception critical: one person’s minor irritation
can be another’s major problem
• Assess patient’s situational supports
– Does stressful event also affect patient’s
family/support systems?
• Assess patient’s personal coping skills
– Evaluate patient’s anxiety level and use of defense
mechanisms
Nursing Process: Diagnosis and
Outcomes Identification
• Common nursing diagnoses
– Risk for self- or other-directed violence, Spiritual
distress, Hopelessness, Anxiety (moderate, severe,
panic), Disturbed thought processes, Ineffective
coping, Risk for post-trauma syndrome
• Outcomes identification
– Outcomes need to realistic
– Patient and family need to be involved in
identifying outcomes
– Outcomes need to be congruent with patient’s
values, cultural expectations
Nursing Process:
Planning and Implementation
• Planning
– Nurse plans interventions via variety of modalities
• Disaster nursing, mobile crisis units, group work, health
education and crisis prevention, victim outreach programs,
telephone hotlines
• Implementation
– Nurse can intervene for individual, group, or
community
– Questions important
• How much has crisis affected person’s life?
• How is state of disequilibrium affecting patient’s significant
others?
– Goals of intervention: patient safety, anxiety reduction
Common Nursing Interventions for
Patient in Crisis
• Identify patient support systems and mobilize
these
• Plan with patient interventions acceptable
• Plan regular follow-up to assess patient’s
progress toward established goals
Crisis Intervention
• Primary
– Promote mental health and decrease incidence of
crisis
• Secondary
– Interventions to prevent prolonged anxiety and
personality disorganization
• Tertiary
– Support for those who have experienced severe
crisis and are recovering
– Goal: facilitate optimal level of functioning
Critical Incident Stress Debriefing
(CISD)
• Used to assist a group that has experienced a
crisis
• Consists of seven-step procedure offering
individuals opportunity to share thoughts and
feelings in safe and controlled environment
• CISD used in following situations
– Debrief staff following patient suicide
– Help staff/students following incident of school
violence
– Debrief rescue personnel who responded to disaster
Nursing Process: Evaluation
• Performed 4-8 weeks after initial interview
• Successful intervention characterized by:
– Patient’s anxiety and ability to function has
returned to pre-crisis level
• Questions to ask
– Is patient safe?
– Has patient developed adaptive coping?
– Has patient maintained optimum level of function?