Crisis

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Crisis
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Crisis

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

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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

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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

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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

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Dissociative Disorders

• Dissociative Amnesia
• Dissociative Fugue
• Depersonalization
• Dissociative Identity Disorder

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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

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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

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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

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Causes

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

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Outcomes

• Arrests
• Unemployment
• Homelessness
• Abusiveness
• Divorce
• Paranoia

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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

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CISM

• 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

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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

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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

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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

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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

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Groups

• Coping Skills
• Relaxation techniques
• Anger management
• Time out to focus
• Bills
• Planning
• Interpersonal Skills
• Take responsibility for ones actions

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Crisis and Pharmacology

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

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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