Week 6 Review
- Created by: Liv.denk
- Created on: 10-04-23 01:51
Types of crisis
Maturation/ developemental crisis
- Critical period of increased vulnerability and heightened potential - turning point
- Each new stage requires new coping mechanisms - previous coping mechanisms will no longer work and lead to increased anxiety and stress
- Person goes without effective defenses for a period of time
- Cant move onto the next stage without developing effective coping and defense mechanisms in current stage
Situational crisis
- Events that are extraordinary, external and unanticipated
- Stressful event that threatens an individuals self-concept, self-esteem and security
- Examples: job loss, unplanned pregnancy, sudden loss in family
Adventitious crisis
- Results from event not part of everyday life - ex) natural disaster, war
- Events that threaten individuals survival and lead to trauma
- Require intervention!
Phases of crisis
Phase One
- Confronted with conflict that threatens self-concept and feelings of anxiety arise
- Stimulates problem solving technique as defense mechanism to lower anxiety
Phase Two
- Defense mechanism (problem solving) fails and threat persists
- Functioning becomes disorganized
- Trial and error solutions are done to restore normal balance
Phase Three
- Trial and error fails, this increasing anxiety to severe or panic level
- Some form of resolution may be reached at this level for some
Phase Four
- Problem remains unresolved and new coping skills are ineffective leading to mental health emergency: overwhelming anxiety that leads to personal disorganization w urgent threat to safety
Nursing Assessment
Equilibrium may be effected by:
- Unrealistic perception of the event
- Inadequate situational supports
- Inadequate coping mechanims
RN interventions:
- Promote sense of safety: risk for suicide/ homicide
- Assess perception of the event
- Assess situational support
- Assess coping skills: do they include drinking and substance use or withdrawing
Acute Stress Disorder
- Time: occurs within 1 month of highly traumatic event (usually 2-4 weeks), resolved within 28 days
- Must display at least 3 of the dissociative symptoms during or after event:
1. Sibjective sense of numbing
2. Detachment
3. Absence of emtional responsiveness
4. Reduction in awareness
5. Derealization (sense of unreality)
6. Depersonalization (self-estrangement)
7. Dissociative amnesia (loss of memory)
Post Traumatic Stress disorder
- Acute emotional repsonse to traumatic event involving severe emotional distress
- Time: symptoms begin within 3 months but can be delayed up to one year, lasting longer than 1 month
1. Persistently re-experiences the event through dreams, flashbacks and intrusive recollections
2. Persistent avoidance of stimuli associatd with trauma causing them to avoid talking about trauma, avoid activities, places, people that rouse memories
3. Persistent numbing of responsiveness avidence by feeling empty inside, feeling disconnected- may blame self or others
4. Persisten symptoms of increased arounsal evidenced by irritability, difficulty sleeping, concentrating, hypervigilance or an exaggerated startle
- Diagnosis: ineffecitive coping
- Requires specialized care and referral
Treatment for acute stress disorder and PTSD
Pharmacology
- Zoloft (sertraline)
- Paxil (paroxetine)
- SSRI
- Decrease SI
- CBD - decrease depression and anxiety
- Psychedelics - under supervision and guided
Trauma focused interventions
- Cognitive behavioural therapy
- Cognitive processing therapy
- Cognitive thrapry
- Exposure therapy
- Brief eclectic therapy - looks at emotion and shame built around PTSD
- Eye moevement desensitization and reprocessing - brings back to emotional state to explore and problem solve controversial
Secondary effects of violence
- Depression
- suicidal ideation
- chronic PTSD
- dissociation
- Substance abuse
- Re-victimization
Cycle of abuse
1. Cyclic
- Internal build of tension as abuser cannot verbalize feelings
2. Tension building
- Minor incidences such as shoving, pushing, verbal abuse
- Vicitim ofen ignores/ accepts
- Tension escalates as both parties try to reduce
- Abuser rationalizs behaviour
3. Acute battering
- Unresolved tension expressed via brutal beatings
- drives victim away and reinforces feelings of abandonment for the abuser
- Abuser promises to never do it again
4. Honeymood phase
- Kindness, loving behaviours, apologetic; cycle evenutally repeats
Epidemiology of abuse
Intimate partner
- Victim is mostly female (79%)
- Increased incidence among indigenous and non-heterosexual relationships
Child abuse
- Victim is exposed to parental violence
- Different forms such as emotional, physical, sexual, neglect
Older adult
- Victim is either living alone or in institution
- Females: family related
- Males: aquaintance or stanger
Abuser in all cases:
- Perceives their own needs as more important
- Poor social skils,
- Pathological jealousy, control, dominance and power
Nursing assessment: Abuse
History
- sexual abuse
- family violence
- drug and alcohol abuse
Assess
- Supports
- Risk for suicide
Nursing inteventions/ considerations
- Ensure private space with only nurse and patient present
- Establish rapport
- Reassure safety
- Non-judgmental
- Open-ended questions, do not interupt
- Provide support
- Safety plan: access to cash, phone, meds, safety bag, code word for children
Reporting Abuse
Adult women
- Choose whether or not to report
- Provide consent prior to RN reporting to authorities
Child abuse
- Suspected or actual MUST be reported
Older adults
- Evaluate competency for consent to report
- If incompetent: help cannot be forced
- Protection of persons in care from HCP - must be reported
Preventing Abuse and RN Interventions
Primary
- Education identifying at risk people
Secondary
- Early intevrvention to prevent long term effects
Tertiary
- Includes health care providers
- Facilitate healing and rehabilitation
- Assist in acheiving safety and optimizing well being
Interventions
- Couselling
- Case management: coordinance of communtiy and social justice
- Milieu management: stable environment
- Promote self-care: empowerment
Sexual Assault
- One of the most undereported crimes
- Level 1: violates sexual integrity of the individual
- Level 2: Done with a weapon or causing bodily harm
- Level 3: Wounds, disfigures and endangers the life of the individual
Aggravated sexual assault
- Life of the survivor is endangered or assult results in injury
- Not about sex for the perpetrator - about control and power
Secondary revicimization
- Survivor experiences trauma or stress from seeking help
- Through stigmatization, minimization, shame, victim blaming, derobing, retelling the experience, treated as just another number
- Contributes to PTSD
At risk populations: women, indigenous, LGBTQ2+, mentally ill
- PTSD rates are 2-3x higher than violence
**** trauma syndrome
Acute phase
- Up to 2 weeks after the event
- Shock, numbness
- Poor cognition (decreased concentration, decision making)
- Emotional response
- Somatic symptoms
Long term
- 2+ weeks later
- Flashbacks/ dreams
- Insomnia
- Anxiety/ mood swings
- Fear, phobia
- Sexual dysfunction
- Interpersonal relationships are effected
Trauma informed Care
- Make connections between the trauma, maladaptive behaviours and coping
- Allow the client to make treatment decisions and have control
- Build trust and rapport to decrease the power imbalance
- Facilitate coping and self-care through empowerment
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