Crisis Management and Characteristics

Crisis/Abuse - Characteristics of a Crisis

• Internal or external forces disrupt a system's balance
• Attempts to restore balance through coping mechanisms
• A specific identifiable event triggers the crisis, becoming too overwhelming for usual problem-solving skills
• People experience occasional overwhelm, but this isn't necessarily a crisis
• Crisis resolution can be positive (adaptive, growth, improved health) or negative (maladaptive, illness, death)

Types of Crises

• Developmental: Periods of disruption at transition points during normal growth and development
• Situational: Stressful disruptive events arising from external circumstances, often sudden and without warning (affecting individuals, groups, aggregates, or communities)
• Multiple: Multiple overlapping crises can worsen experiences for individuals involved

Primary Prevention

• Health promotion and education:
  • Anticipatory guidance
  • Parenting skills
  • Positive coping strategies
  • Social problem-solving skills and assertiveness
  • Social support and resources
• Health protection:
  • Reduce vulnerability factors
  • Reduce hazards in events

Secondary Prevention

• Early diagnosis of crisis/abuse signs/symptoms
• Prompt treatment

Reporting of abuse

• Provide necessary assistance
• Refer to resources
• Set goals with clients
• Ensure client safety

Tertiary Prevention

• Promote adaptation to changed levels of wellness
• Promote independence
• Reinforce newly learned behaviors and lifestyle changes
• Explore learned behaviors in new situations
• Identify and use additional resources
• Continue primary prevention to avert future crises

Specific Abusive Situations

• Shaken Baby Syndrome:
  • Bilateral retinal hemorrhages
  • Subdural or subarachnoid hematomas
  • No other external abuse signs
  • Breathing difficulties, seizures, dilated pupils, lethargy, and unconsciousness
• Munchausen Syndrome by Proxy:
  • Parent or caretaker attempts to bring medical attention to self by injuring or inducing illness in the child
• Internet crimes against children, Child abduction, Crimes against children by babysitters, School violence, Physical abuse
• Bruising, lacerations, abrasions, and fractures associated with physical abuse
• Partner/Spousal Abuse/Dating violence
  • Includes physical, sexual, emotional, economic, or psychological abuse
  • Violence during pregnancy
• Cycle of Violence
  • Tension building
  • Acute battering
  • Loving reconciliation
• Batterer Characteristics
  • Low income, low self-esteem
  • Low academic achievement
  • Involvement in aggressive or delinquent behavior as youth
  • Heavy alcohol and drug use
  • Depression
  • Anger and hostility
  • Personality disorders
  • Prior history of being physically abusive
  • Few friends and isolation from others
  • Unemployment
  • Emotional dependence and insecurity
  • Belief in strict gender roles
  • Desire for power and control
  • Victim of physical or psychological abuse
• Victim Characteristics
  • Prior history of physical violence
  • Young age (especially pregnant)
  • Low income
  • Witnessing/experiencing abuse as a child
  • Low education level
  • Unemployment
  • Single parent with children
  • Different ethnicity than partner (males)
  • Greater education level than partner (women)
  • Being AA/Indian (women)
  • Disabled (women)
  • Verbally abusive or jealous or possessive partner (women)
  • Veterans and active military (women)
• Effects of Violence on Children -Increased risk of abuse victim or perpetrator -Increased risk of substance abuse -Increased risk of depression and anxiety -Hindered health and development -Increased risk of poor school performance

Other Forms of Family Violence

• Suicide (warning signs - IS PATH WARM)
• Homicide
• Rape
• Elder abuse
• IS PATH WARM: Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood change
• Neglect, Physical, Sexual, Emotional, or Fiduciary abuse
• Perpetrator characteristics, Victim characteristics, Risk factors (invisibility, vulnerability)
• Factors contributing to Elder abuse

Human Trafficking

• Elements of trafficking: fraud, force, coercion
• Estimated 14,500 to 17,500 people trafficked into the US yearly
• Risk factors: Primarily female (20% male), transient living, youth, unaccompanied minors, foster system involvement, history of sexual/physical abuse, substance use, LGBTQ+, gang involvement, disability, ESL
• Risk factors & comorbid conditions

Exposure to violence/sexual violence, Psychological violence, Children removed, Abortion, Injury, Mental health issue, STI, Addiction, Suicidal.

• Signs/symptoms: Scripted/inconsistent story, History of physical/sexual abuse, Unable to provide address, unable to provide emergency contact, No social network, Cash pay, Anxious, Refusal to be without phone, No ID, Not allowed to speak for themselves, Avoids eye contact, Hostile behavior
• Physical Exam, Constitutional, Well groomed, Sex Trafficking Language, Dermatological, GU, Obstetrics, HEENT, Pharyngeal trauma, Broken teeth, Hearing loss, Vision issues, Substance abuse

Pathological caregivers

• Learned hopelessness, living in violent neighborhoods

Preventing Elder Abuse

• Awareness/education through media campaigns
• Increase care attention directed at unique needs of elders
• Training for caregivers
• Statutory requirements for reporting abuse
• Crisis hotline, World elder abuse awareness day

Epidemiology/Outbreak Surveillance

• Science of PH- distribution and determinants in specified populations
• Epidemiology- focus on patterns, causes, and effects of health & disease in populations. Provides foundation for understanding spread, risk factors, and prevention strategies
• Role of epidemiology: Data collection to identify trends, identify risk factors of specific populations, assess and implement interventions targeted at high-risk groups

Wheel Model of Human-Environment

• Host- genetic, personality, environmental- social, biological, physical
• Frequency rates- measuring birth, death, and morbidity for health and disease
• Incidence- occurrence of new cases
• Prevalence- total with the disease

Communicating Disease- Principles

• Principles of infection: Multicausation (host, agent, environment), Spectrum of infection (stages of infection), Latency, Communicable, Incubation period, Spectrum of disease occurrence (incidence)
• Endemic, Outbreak, Epidemic, Pandemic, Chain of transmission (pathologic agent, reservoir, portal of exit, transmission, portal of entry, host susceptibility)
• Breaking Chain of Transmission
  • Inactivating the agent
  • Eliminating the non-human reservoir
  • Controlling human reservoir (and ports of entry/exit)

Immunity

• Natural: protecting body develops after fighting off an infection -Active: body actively produces own antibodies -Passive: person receives antibodies from an outside source, like breastfeeding
• Artificial -Active: vaccination with weakened or inactive pathogen (e.g., flu, MMR) -Passive: direct antibody receiving (e.g., immune globulin)

Infection (new or latent)

• Treatment: Isoniazid for 6-9 months for all new/latent infections, Treat HIV patients with Isoniazid in conjunction with antiretrovirals

Care of Family

• Defining family, Many ways to define, Examples, a Gang is a Family

Kinship, Relations & Residence

• Important individuals, Conceptual frameworks (interactional, Structural-functional, developmental)

Purpose of the Family

• Meets needs of individuals (economic, protective, emotional support)
• Meets needs of society (socializing children)

Characteristics of a Healthy Family

• Facilitative interactions, healthy development, effective relationships, strong home environment, links with the community
• Characteristics of a changing family -Marriage: Increased later marriage, rising rates of cohabitation -Children: Later having children, fewer children, more childless couples -Household: Increased multigenerational households

Nursing Process

• Assessment (Family interview), Methods (Genogram, Eco-map), Diagnosis (Health promotion, Role relationships, Coping/stress tolerance), Planning, Implementation (Nurses help families), Evaluation

Barriers to Healthcare

• Family apathy/indecision, nurse imposed ideas, labeling, overlooking strengths, cultural/gender implications, perceptions of hopelessness, fear of failure, limited access to resources, limited finances, fear/distrust of healthcare systems

Case Management

• Variety of pt care programs (acute hospitals, community settings)
• Case managers work in various settings (medical homes, occupational health, geriatrics, ambulatory care clinics)
• Case management is a service approach (cost-effective, access to care, alternatives to institutionalization, coordination of services)

Case Management essential activities

• looks at individuals, populations
• Improve coordination of services for elderly, low income families with chronic illness

Transitional care management

• Face-to-face visits with high-risk patients post-hospitalization to prevent readmission and improve pt outcomes

Occupational Health

• Work environment is not risk free
• Preventative and restorative care
• OSHA (Occupational Safety and Health Administration) is the regulatory agency for occupational health
• Code of Federal Regulations (29CFR1910) for health standards
• Focus on illness and injury, and physical/chemical/biological/ergonomic/psychosocial factors affecting workers
• Supervising care, counseling for health risks, following up on workers' compensation claims.

Home Health

• Service is aimed at helping patients regain independence and increase health outcomes
• Physician authorization is required, Patients must be eligible, and regularly reviewed, as well as needing skilled nursing, therapy (in home care) and homebound.
• Home visits, initial phone call, improving communication, relationship building, specific interventions, assessments, diagnosis, care plan development, evaluation.

Performing periodic health assessments,Evaluating health status of employees returning to work, Disaster planning, Safety in work place

• Focus on effectiveness of primary care delivery, health promotion, workplace stress, and effects of stressors