Compare interventions used for psychiatric crises with those used for other crises. What are the similarities? What are the differences? 150 word essay with 2 citation on this subject psych mental health. Adaptation and coping are a natural part of life. If children are protected from experiencing negative events and developing coping skills, they may be unable to cope and adapt to crisis situations in later life. Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. A crisis disrupts the life of the individual experiencing the event. In a crisis, the person’s habits and coping patterns are suspended. Often, unexpected emotional (e.g., depression) and biologic (e.g., nausea, vomiting, diarrhea, headaches) responses occur. Although a person may become extremely anxious, depressed, or elated, feeling states do not determine whether a person is in a crisis. If functioning is severely impaired, a crisis is occurring (Yeager & Roberts, 2003). Image 1 Fig. 1: Crisis A crisis is generally regarded as time limited, lasting no more than 4 to 6 weeks. At the end of that time, the person in crisis should have begun to come to grips with the event and to harness resources to cope with its long-term consequences. By definition, there is no such thing as a chronic crisis. People who live in constant turmoil are not in crisis but in chaos. A crisis can also represent a turning point in a person’s life, with either positive or negative outcomes. It can be an opportunity for growth and change because new ways of coping are learned. Either internal or external demands that are perceived as threats to a person’s physical or emotional functioning can initiate a crisis. The precipitating event is not only stressful, but unusual or rare. Many life events can evoke a crisis, such as pandemics, natural disasters (e.g., floods, tornadoes, earthquakes) and manmade disasters (e.g., wars, bombings, airplane crashes) as well as traumatic experiences (e.g., rape, sexual abuse, assault). In addition, interpersonal events (divorce, marriage, birth of a child) may create a crisis event in the life of any person. A crisis is not the same as a psychiatric emergency that requires immediate intervention. A person in crisis may not need an immediate intervention and should not be viewed as having a mental disorder (Roberts, 2005). However, if the person is significantly distressed or social functioning impaired, an Axis I diagnosis of acute stress disorder should be considered (American Psychiatric Association [APA], 2000). The person with an acute stress disorder has dissociative symptoms and persistently re-experiences the event (APA). A. Historical Perspectives of Crisis The basis of our understanding of the biopsychosocial implications of a crisis began in the 1940s when Eric Lindemann (l944) studied bereavement reactions among the friends and relatives of the victims of the Coconut Grove nightclub fire in Boston in 1942. That fire, in which 493 people died, was the worst single building fire in the country’s history at that time. Lindemann’s goal was to develop prevention approaches at the community level that would maintain good health and prevent emotional disorganization. He described both grief and prolonged reactions as a result of loss of a significant person. From those results, he hypothesized that during the course of one’s life, some situations, such as the birth of a child, marriage, and death, evoke adaptive mechanisms that lead either to mastery of a new situation (psychological growth) or impaired functioning. In 1961, psychiatrist Gerald Caplan defined a crisis as occurring when a person faces a problem that cannot be solved by customary problem-solving methods. When the usual problem-solving methods no longer work, a person’s life balance or equilibrium is upset. During period of disequilibrium, there is a rise in inner tension and anxiety, followed by emotional upset and an inability to function. This conceptualization of phases of a crisis is used today. According to Caplan, during a crisis, a person is open to learning new ways of coping to survive. The outcome of a crisis is governed by the kind of interaction that occurs between the person and available key social support systems. Gerald Caplan’s Four Phases of Crisis Phase 1 A problem arises that contributes to increase in anxiety levels. The anxiety stimulates the implementation of usual problem-solving techniques of the person. Phase 2 The usual problem-solving techniques are ineffective. Anxiety levels continue to rise. Trial-and-error attempts are made to restore balance. Phase 3 The trial-and-error attempts fail. The anxiety escalates to severe or panic levels. The person adopts automatic relief behaviors. Phase 4 When these measures do not reduce anxiety, anxiety can overwhelm the person and lead to serious personality disorganization, which signals the person is in crisis. B.Types of Crises Recent research has focused on categorizing types of crisis events, understanding biopsychosocial responses to crisis, and developing intervention models that support people through crisis (Stone & Conley, 2004). Maturational Crisis – While Lindemann and Caplan were creating their crisis model, Erik Erikson was formulating his ideas about crisis and development. He proposed that maturational crises are a normal part of growth and development, and that successfully resolving a crisis at one stage allows the child to move to the next. According to this model, the child develops positive characteristics after experiencing a crisis. If he or she develops less desirable traits, the crisis is not resolved. This concept of maturational crisis assumes that psychosocial development progresses by an easily identifiable, orderly process. The concept of developmental crisis continues to be used today to describe unfavorable person-environment relationships that relate to maturational events, such as leaving home for the first time, completing school, or accepting the responsibility of adulthood. The accomplishment of developmental tasks throughout the life cycle will impact the interpretation of crisis events during the transition of an individual from one stage of life to another. Situational Crisis – A situational crisis occurs whenever a specific stressful event threatens a person’s biopsychosocial integrity and results in some degree of psychological disequilibrium. The event can be an internal one, such as a disease process or any number of external threats. A move to another city, a job promotion, or graduation from high school can initiate a crisis even though they are positive events. For example, graduation from high school marks the end of an established routine of going to school, participating in school activities, and doing homework assignments. When starting a new job after graduation, the former student must learn an entirely different routine and acquire new knowledge and skills. If a person enters a new situation without adequate coping skills, a crisis may develop, resulting in dissonance (inconsistency between attitude and behavior). Situational Crises Top 12 Items on The Holmes - Rahe Life Stress Inventory The Social Readjustment Rating Scale Death of spouse Divorce Marital Separation from mate Detention in jail or other institution Death of a close family member Major personal injury or illness COVID-19 Marriage Being fired at work Marital reconciliation with mate Retirement from work Major change health/behavior of a family member Pregnancy/Abortion Image 3 Fig. 2: The World Trade Center on 9/11 Adventitious Crisis – An adventitious crisis is initiated by unexpected unusual events that can affect an individual or a multitude of people. In such situations, people face overwhelmingly hazardous events that may entail injury, trauma, destruction, or sacrifice. Such an event involves a physically aggressive and forced act by a person, a group, or an environment. National disasters (e.g., racial persecutions, kidnappings, riots, war); violent crimes (e.g., rape, murder, and assault and battery); and natural disasters (e.g., earthquakes, floods, forest fires, hurricanes) are examples of events that precipitate this type of crisis (Hazelwood & Burgess, 2001). 9/11 is an example of an adventitious crisis. C. Advanced Practice Psychiatric/Mental Health Nursing Management of Crisis The goal for people experiencing a crisis is to return to the pre-crisis level of functioning. The role of the PMH-APRN is to provide a framework of support systems that guide the client through the crisis and facilitate the development and use of positive coping skills. The PMH-APRN must be acutely aware that a person in crisis may be at high risk for suicide or homicide. To determine the level of effectiveness of coping capabilities of the person, the PMH-APRN should complete a careful assessment for suicidal or homicidal risk. If a person is at high risk for either, the PMH-APRN should consider the possible need for the person to be referred for admission to the hospital. When assessing the coping mechanisms and ability of the client to use those mechanisms for adaptation, the PMH-APRN should assess for unusual behaviors and determine the level of involvement of the person with the crisis. In addition, assess for evidence of self-mutilation activities that may indicate the use of self-preservation measures to avoid suicide. It is critical to assess the client’s perception of the problem and the availability of support mechanisms (emotional and financial) for use by the person (Litz, Gray, Bryant, & Adler, 2002). During an adventitious crisis (e.g., flood, hurricane, forest fire) that affects the well-being of many people, the interventions of the PMH-APRNwill be a part of the community’s efforts to respond to the event. On the other hand, when a personal crisis occurs, the person in crisis may have only the PMH-APRN to respond to his or her needs. After the assessment, the PMH-APRN must decide whether to provide the care needed or to refer the person to a psychiatrist. Biologic Domain/Assessment – Biologic assessment focuses on areas that usually undergo initial changes. Eliciting information about changes in health practices provide important data that the PMH-APRN can use to determine the severity of the disruption in functioning. Biologic functioning is important because a crisis can be physically exhausting. Disturbances in sleep and eating patterns and the reappearance of physical or psychiatric symptoms are common. Changes in body function may include tachycardia, tachypnea, profuse perspiration, nausea, vomiting, dilated pupils, and extreme shakiness. Some victims may exhibit loss of control and have total disregard for their personal safety. The victims are at high risk for injury, which may include infection, trauma, and head injuries (France, 2002). If the victim’s sleep patterns are disturbed or nutrition is inadequate, the victim will not have the physical resources to deal with the crisis. Any negative physiological responses should be treated immediately. Triage the victims according to the level of care needed. If the crisis involves a life-threatening physical injury, those types of injuries should be treated immediately. Throughout the triage process, the victims should be reassured that the caregiver is concerned and committed to providing quality nursing care. Be careful not to give unrealistic or false reassurances of positive outcomes over which you have no control. Make referrals as appropriate. Ideally, a PMH-APRN would be an integral part of the triage team. Pharmacologic interventions may be needed to help maintain a high level of psychophysical functioning. While medication cannot resolve a crisis, the judicious use of psychopharmacologic agents can help reduce its emotional intensity. Psychological Domain/Assessment – Psychological assessment focuses on the victim’s emotions and coping strengths. In the beginning of the crisis, the victim may report the feeling of numbness and shock. Responses to psychological distress should be differentiated from symptoms of psychiatric illnesses of the victim. Later, as the reality of the crisis sinks in, the victim will be able to recognize and describe the felt emotions. The PMH-APRN should expect those emotions to be intense and will need to provide some support during their expression by that victim. At the beginning of a crisis, assess the victim for behaviors that indicate a depressed state, the presence of confusion, uncontrolled weeping or screaming, disorientation, or aggression. The victim may be suffering from loss of feelings of well-being and safety. In addition, panic responses, anxiety, and fear may be present (Hall, Norwood, Ursano, & Fullerton, 2003). The ability to cope by problem-solving may be disrupted. By assessing the victim’s ability to solve problems, the PMH-APRN can evaluate whether the victim can cognitively cope with the crisis situation and determine the kind and amount of support needed. The survivor of a disaster may experience traumatic bereavement because of feelings of guilt for survival of the crisis. Safety interventions to protect the person in crisis from harm should include preventing the person from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Once the person’s safety needs are met, the PMH-APRN can address the psychosocial aspects of the crisis. Prepare the victims for recovery. Victims should be encouraged to report any depression, anxiety, or interpersonal difficulties during the recovery period. There may be a need for support groups to be established to help victims and their families deal with the psychological effects of the phenomenon (Dattilio & Freeman, 2007). Counseling reinforces healthy coping behaviors and interaction patterns. Counseling focuses on identifying the victim’s emotions and positive coping strategies. Responses to crisis differ with individuals. Some victims may present with behaviors that indicate transient disruptions in their ability to cope. Others may be totally devastated (Bonanno, 2004). At times, telephone counseling may provide the victim with enough help that face-to-face counseling is not necessary. If counseling strategies do not work, other stress reduction and coping enhancement interventions can be used. For anyone who cannot cope with a crisis, the PMH-APRN should make referral to short-term psychiatric inpatient treatment. Social Domain/Assessment – Assessment of the impact of the crisis on the victim’s social functioning is essential because a crisis usually severely disrupts social proficiencies. The PMH-APRN should assess the severity of the crisis to determine the capability of the individual or the community to respond in a supportive way. Assist the victims to maintain a calm demeanor, obtain and distribute information about the crisis and the victims of the crisis. Initiate attempts to reunite victims and their families. Shelter, food, and other resources may not be available. In a crisis, the first priority is to meet the basic human needs of the victims. The nursing interventions for the social domain include the individual, the family, and the community. A crisis often disrupts a victim’s social network leading to changes in available social support. Development of a new social support network may help the victim cope more effectively with the crisis. Supporting the development of new support contacts within the context of available social networks can be done by contacting available local and state agencies for assistance as well as specific private support groups and religious groups.