1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 13Crisis and Disaster Intervention

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Any serious interruption in the steady state or equilibrium of a person, family, or group is considered a crisis. A crisis is a state of emotional turmoil. It is also considered an emotionally significant event which acts as a turning point for better or worse in a person’s life. Mitchell & Resnik, 1981

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Understand the terms crisis and disaster Discuss the characteristics of a crisis Recognize the phases of a crisis Distinguish the five periods of the disaster recovery process Articulate how the following balancing factors can influence the development of a crisis: realistic perception of the event, adequate situational support, and adequate defense and/or coping mechanisms

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Compare and contrast crisis intervention and disaster mental health nursing Interpret the goals of crisis intervention Analyze the role of the psychiatric–mental health nurse in crisis intervention and disaster nursing Apply the steps of crisis intervention Explain the issue of legal immunity for the crisis worker

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Crises Types of crises – Situational – Maturational

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Phases of a Crisis Precrisis Impact Crisis Resolution Postcrisis

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Paradigm of Balancing Factors Realistic perception Situational supports Defense mechanisms

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Crisis Intervention The goals of crisis intervention are as follows: To decrease emotional stress and protect the client from additional stress To assist the client in organizing and mobilizing resources or support systems to meet unique needs and reach a solution for the particular situation or circumstance that precipitated the crisis To return the client to a precrisis or higher level of functioning

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Crisis Intervention (cont.) The role of the psychiatric–mental health nurse or nurse practitioner during a crisis is as follows: Provide emotional support while assessing the individual’s emotional and physical needs and enlisting his or her cooperation – Crisis response teams – Disaster response teams

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps in Crisis Intervention Assessment Planning of therapeutic intervention Implementation of therapeutic intervention Resolution of the crisis with anticipatory planning and evaluation

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Determining crisis severity Assessing the client’s perception Formulating nursing diagnoses

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning of Therapeutic Intervention Individuals must learn to ask for help and realize the potential for growth during a crisis situation. They should be involved in the choice of alternate coping methods and encouraged to make as many arrangements as possible by themselves. If significant others are involved, their needs and reactions must also be considered. The nurse should identify strengths and resources of all persons providing support. Connoly and Chandler, 1997

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Intellectual understanding of the crisis Exploring coping mechanisms Reducing immobility Encouraging verbalization of feelings Establishing new supportive and meaningful relationships Using therapeutic techniques

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Resolution Reassessment Reinforcement Realistic plans Discuss how present experiences may help in coping with future crises.

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Aspects of Crisis Intervention Police officers, firefighters, and emergency medical personnel are legally responsible to provide help. In certain states, doctors and nurses are also expected to intervene during an emergency or a crisis situation. Generally, these individuals are legally protected as long as they provide reasonable and prudent care.

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Crisis Intervention for Children Assessment of a child in crisis – Common reactions of a child in crisis Interventions for a child in crisis Resolution of a child’s crisis

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Functions of Crisis Intervention for a Child Provide safety and security Provide an opportunity for bonding Provide stabilization services Assist the child and family members in resolving issues that may have precipitated the crisis Provide linkages with community services

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Crisis Crisis forensics Crisis intervention Crisis response team Crisis situations Disaster Disaster mental health nursing Disaster response team Maturational crisis Paradigm of balancing factors Situational crisis

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Crisis can be a turning point for better or for worse in a person’s life. ? What are the three ways divorce can be a turning point in the life of a middle-aged woman who has been physically and emotionally abused by her husband for several years? What is the rationale for your answer(s)?