View
218
Download
0
Embed Size (px)
Citation preview
Stress, Crisis and Disaster Management
Chapter 33
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
Antecedents to Stress
Person
• Values
• Commitment
• Personality behavior patterns
Environment• Social network• Social support• Demands• Constraints• Sociocultural
factors• Life events
Person-Environment Relationship
Antecedents to Stress:Cognitive Appraisal
Primary Appraisal• Relevant goal
• Consistent with values
• Personal commitment
•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
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.
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 (-)
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
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
Adaptation
• Capacity of a person to survive and flourish
• Affects three areas:
– Health
– Psychological well-being
– Social functioning
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
Nursing Management
• Biological
– Review of systems
– Physical functioning
– Pharmacologic assessment
Nursing Management
• Psychological
– Emotions
– Severity of responses
• Social– Recent life changes
– Social network and support• Size
• Functions
• Reciprocity
• Interconnectedness
Nursing Diagnosis• Anxiety
• Powerlessness
• Fear
• Fatigue
• Low self-esteem
• Ineffective coping
• Family coping
• Altered role performance
Interventions
• Biologic
– Nutrition
– Exercise
• Psychological
– NIC
• Social
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”
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
Types of Crises• Developmental
• Situational
– Bereavement
• Shock and disbelief
• Acute mourning
– Intense feeling
– Social withdrawal
– Identification with the deceased
• Resolution
– Dysfunctional Grieving
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.
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
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)
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
Nursing Management:Biologic Domain
Assessment
• Physical reactions – tachycardia, etc.
• Panic without regard to personal safety
Interventions
• Treat physical reactions.
• Provide reassurance.
• Maintain safety.
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.
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.