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.