Crisis, loss, grief, bereavement, and disaster management

Question 1

Crisis

Answer 1

Time-limited event that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences

Question 2

When does a crisis occur?

Answer 2

From stressful events when previous coping mechanisms fail to provide adequate adaptive skills to address the perceived problem. Adaptation to crisis occurs in 6 weeks

Question 3

Example of positive and negative outcomes of a crisis

Answer 3

Pos: growth, change
Neg: suicide, homelessness, depression

Question 4

Types of crises

Answer 4

Developmental, situational, traumatic

Question 5

Developmental crisis

Answer 5

AKA maturational crises; Erikson; successfully resolving crisis at one stage allows one to move to the next stage. Kid develops positive characteristics after crisis is resolved. Leaving home, completing school, accepting adulthood

Question 6

Situational crisis

Answer 6

Specific stressful event threatens a persons integrity and results in a degree of psychological disequilibrium. Internal (disease) or external (moving cities)

Question 7

Traumatic crisis

Answer 7

Unexpected, unusual event that can affect the person or multiple people. Riots, war, rape, murder, kidnapping, earthquake, flood

Question 8

What is the goal for people experiencing a crisis?

Answer 8

To return to precrisis functioning level

Question 9

Nurses first priority for the patient in a crisis

Answer 9

Determining the extent of the physical injury or trauma

Question 10

Safety and physical consequences of the crisis are the ____ priority

Answer 10

1st

Question 11

Nursing a crisis the body reacts in different ways, name a few

Answer 11

Tachycardia, hyperventilation, suicidal ideation, body systems can change (diarrhea, incontinence)

Question 12

T/F: food, shelter, fear, and extreme distress should be addressed by the nurse

Answer 12

T

Question 13

Nurses should keep what in mind with therapeutic communications?

Answer 13

Be patient, listen, empathy, don’t give unrealistic or false reassurances of positive outcomes

Question 14

Immediate goals in a crisis for nurses

Answer 14

Treat life-threatening physical injury, asses for suicide, arrange food and shelter, mobile social support

Question 15

After the safety needs are met, the nurse can move towards…

Answer 15

Reestabilising self-care routines and using positive coping strategies

Question 16

T/F medication can’t solve a crisis, they can reduce the emotional intensity

Answer 16

T

Question 17

The nurse should refer anyone who cannot cope with a crisis to who?

Answer 17

A mental health specialist

Question 18

Lorazepam (Ativan)

Answer 18

-Benzo
-management of anxiety
- drowsy, sedation, lethargy, hypoTN

Question 19

Bereavement

Answer 19

Mourning; process of healing after a perceived loss. Begins immediately after loss and can last months to years

Question 20

What year after a loss is the most difficult?

Answer 20

The 1st due to holidays and birthdays

Question 21

Grief

Answer 21

A natural, intense, physical, emotional, social, cognitive, or social reaction to the death of a loved one. Crying, sobbing, anger, guilt

Question 22

Predeath grief

Answer 22

When someone has a terminal illness and mostly occur in caregivers. Dementia for example. This type of grief is associated with depressive symptoms, caregiver burden, and less communication within families

Question 23

Acute grief

Answer 23

Occurs immediately after the death of a loved one and normally evolves to a permanent state of integrated grief

Question 24

Integrated grief

Answer 24

Long-term process where there continues to be mild yearning and memories but they aren’t intrusive.

Question 25

Prolonged grief disorder

Answer 25

PGD; intense longing for or persistent preoccupation w/the deceased that lasts more than 6 months

Question 26

Dual process model

Answer 26

Explains how grieving people come to terms with their loss over time (coping). People go the the process of confronting (loss-oriented coping) and avoiding ( restoration oriented coping)

Question 27

In loss-oriented coping, what do the emotions relate to?

Answer 27

The relationship with the deceased

Question 28

In restoration-oriented coping, what do the emotions relate to?

Answer 28

The stressful events associated with the responsibilities and changes as a result of the loss (paying the dead bills, etc)

Question 29

Uncomplicated bereavement

Answer 29

Painful and disruptive, but there is always movement. "Why my loved one?", empty nest syndrome. Don't need clinical interventions, they move on w/their lives, don't benefit from therapy, most common

Question 30

Traumatic grief

Answer 30

Suddenness and lack of anticipation, violence/mutilation/destruction, degree of preventability, multiple deaths, mourners personal encounter with the death, COVID-19

Question 31

Complicated bereavement

Answer 31

PGD; person is frozen/stuck in a state of chronic mourning and lasts more than a month to 6 months after the loss. No movement in the thought processes. Bitter feelings, lack ability to trust others, feeling meaningless

Question 32

What do you expect physically with grief?

Answer 32

Sleep difficulty, lack of appetite, weight loss, asses for substance use

Question 33

The nurse should watch for maladaptive thoughts when assessing cognition, what are some examples

Answer 33

Protesting the death ("its not fair" or could have prevented the death), having a negative view of the world (nobody is safe), and needing the person (life is unbearable w/out them)

Question 34

The nurse should always consider depression and suicide, as well as access to food/shopping, living arrangements, ADLs

Answer 34

yep

Question 35

What is the goal of bereavement interventions?

Answer 35

Help with person adapt and re-stabilize biopsychosocial systems as the pain and sadness lessens with time

Question 36

What medications can be used to aid in bereavement?

Answer 36

Antidepressants or sleep aids; monitor use to prevent long-term use

Question 37

When is the risk of suicide highest with bereavement?

Answer 37

After the funeral, loneliness sets in and full impact of loss is realized.

Question 38

What are positive outcomes of bereavement?

Answer 38

Adaption to life w/out the deceased, learning to live w/reminders of deceased, attending to self-care, and enjoying activities again

Question 39

Disaster

Answer 39

Sudden overwhelming catastrophic even that causes great damage and destruction that may involve mass casualties and human suffering requiring assistance from all available resources

Question 40

Examples of disasters

Answer 40

Terrorism and pandemics

Question 41

How has history portrayed disasters?

Answer 41

Fatalistic perspective that humans have little control over catastrophic events. Some cultures say "its an act of God",

Question 42

Natural disasters

Answer 42

Hurricane Harvey and Maria highlighted the importance of government preparedness for natural disasters and terrorism.

Question 43

Terrorism

Answer 43

Before 9/11 govt agencies did not incorporate mental health into overall response plans, now they do

Question 44

COVID-19 pandemic

Answer 44

WHO declared it a national emergency. ICU was overloaded, lack of prepared health care workers. Time-limited nature disaster. Health care workers are reporting PTSD, depression, insomnia, and anxiety. Patients report mental health probs, isolation, stigma

Question 45

Phases of disaster

Answer 45

1) prewarning 2) disaster event occurs 3) recuperative effort

Question 46

3 types of disaster victims that psychiatric nurses encounter

Answer 46

1) may/not survive. If they do, they have severe physical injuries; PTSD 2) professional rescuers; psychological stress, report PTSD 3) everyone else; altered sense of safety, travel less, increase smoking

Question 47

Primary public health concern during disasters

Answer 47

Drinking clean water, food, shelter, and medical care

Question 48

Medications to help with psychological consequences of disasters

Answer 48

Anti-anxiety or sedatives

Question 49

ABCs of psychological aid

Answer 49

A- arousal B- behavior C- cognition

Question 50

When arousal is present, what should you do?

Answer 50

Decrease excitement by providing safety, comfort, and consolation

Question 51

When cognition disorientation occurs, what should you do?

Answer 51

Reality testing and clear information should be provided

Question 52

Debriefing

Answer 52

Reconstruction of the traumatic events by the victim. Not useful for everyone

Question 53

How can the nurse prepare the victim of disaster for recovery?

Answer 53

Teach abt effects of stress and help the person identify strengths and coping skills.

Question 54

Psychoeducation

Answer 54

Nurse explains anticipated reactions and behaviors to help victims gain control and improve coping. Education on natural recovery process to the public b/c information gaps can increase anxiety and stress.

Question 55

FEMA

Answer 55

Federal emergency management agency; provides counseling and mental health services

Question 56

SAMHSA

Answer 56

Substance abuse and mental health services administration assists both victims and responders of the disaster

Question 57

SAMHSA

Answer 57

Substance abuse and mental health services administration assists both victims and responders of the disaster

Question 58

Stage theories propose that grief and bereavement follow ___/___ and that process models explain bereavement as ____

Answer 58

- Stages/phases - nonlinear