CRISIS

Crisis is an internal disturbance caused by a stressful event

(or perceived threat) that moentarily renders the person's

normal coping mechanisms inadequate

Self limiting within 4 to 6 weeks.

Resolved in 3 ways: return to precrisis level of functioning,

begins to function at a higher level, or functioning stabilizes

at a lower level than precrisis functioning.

Maturational or Developmental Situational Adventitious
Crisis Crisis Crisis
Associated with expected normal and Unexpected crisis that originates Sometimes called social crisis, include natural
predictable growth and development, from environmental, personal, disasters like floods, earthquakes, or hurricanes;
requiring role changes in these physical, or psychosocial terrorist attacks; riots; and violent crimes (rape or
transitional periods murder)
Primary appraisal - initial response to stressor and the ultimate goal of prevailing over a situation, or effectivity
Coping managing a given situation.
Mechanism Secondary appraisal - emerging response (if primary appraisal is ineffective) with the goal to assess
coping resources, options and choices.
Pre-crisis | Impact | Crisis | Resolution | Post Crisis
Phase | Phase | Phase | Phase | Phase
State of equilibrium HIgh level of stress Ineffective and Acknowledges, and Achieve higher level of
with confusion and disorganized behavior; attempts to solve maturity and new coping
possible panic avoids or withdraws problem sucesully skills
or denies problem leading to ess anxiety
crisis InterventionActive but temporary entry into the life situation during crisis with the goals to be a PARE:
Protect client from Assists clients in Return to pre-crisis Eliminate
additional stress organizing state or higher level emotional stress.
and other harm. mobilizing of functioning.
resources or
support system.
Directive interventions: to assess the Supportive interventions: deals with
individual's health status and promote person's needs for empathic
problem solving (offering new understanding (encouraging to
information, raising self-esteem identify and discuss feelings, and
through positive feedback) affiring self-worth)
 Is an encompassing response (physical,

GRIEF psychological, cognitive and behavioral) that a

person experiences after the loss of significant
person, object, belief or relationship.

is the state of desolation

BEREAVEMENT resulting from a loss.

MOURNING is a socially conventional bereavement behavior after the

death of a significant other.

ANTICIPATORY is the characteristic pattern of responses a

person makes to the impending (real or
GRIEF imagined) loss.
STAGES OF DEATH & DYING BY: KUBLER ROSS

DENIAL - "No! Not me! I'm healthy"

ANGER - "Why me? I'm a good person. What did I

do wrong?"

BARGAINING - "Yes me, but..."

DEPRESSION - "Yes me! I want to be alone"

ACCEPTANCE - "My time has come!"

 MODELS OF GRIEF

Engel's Kubler-Ross Parkes' Model Grief Cycle

Model Stages of Dying (4 stages of Grief) Model
1. Shock (a drop to lower
1. Shock and disbelief 1. Denial (from complete 1. Numbness (brief denial
level of functioning-
(refuses to accept denial of the illness and as a psychological
blocking of thoughts and
the loss or shows impending death to defense)
emotions, becomes
intellectual denial of the effect that 2. Yearning (last several
passive and feels numb)
acceptance but dying will have on self months with intense 2. Protest (intense physical
denies emotional and others) psychological distress and psychological
impact) 2. Anger (may be directed with thoughts focused on dependence on others.
2. Developing toward fate, God, the deceased) may start during the
Awareness (when family members, 3. Disorganization first week through the
reality and meaning health care providers (characterized by severe third month.)
of the loss surfaces or others) depression, social 3. Disorganization ( Where
into the 3. Bargaining (seeks to withdrawal, lack of the person has the
consciousness) delay the dreaded interest in people and lowest level of
3. Restitution (involves event, bargains with activities) functioning with feelings
work of mourning God as promise is made of depression and social
that includes rituals) to repay for more time) withdrawal,
 MODELS OF GRIEF

Engel's Kubler-Ross Parkes' Model Grief Cycle

Model Stages of Dying (4 stages of Grief) Model
4. Resolving the Loss meaninglessness and loss
(focus is on thoughts 4. Reorganization (begins 6-9 of interest in people and
4. Depression
of the deceased) months with gradual work, starting on third to six
(acknowledges the reality
5. Idealization renewal of interest in people months.
and inevitability of the
(repressing all the and activities) 4. Reorganization
impending death)
negative feelings (comfortable remembering
5. Acceptance (comes to
toward the decease) Progression through the the decease, renews life
terms with loss and detach
6. Outcome stages of grief normally meaning and vigor, and
from supportive people resumes social relationship.
(psychological takes 2 years or longer
and loss interest in worldly starts on the sixth month to
dependence on the activities) a year.)
deceased reduces as
interest in new Pioneering work that Grieving persons may go
relationship resumes) prompted for increased through the stages at
attention to the needs of varying rates, go back and
Resolution of grief the dying and the forth between stages, or
takes 1year or longer. bereaved skip stages)
 AGE GROUP | CONSIDERATION RE : Death, Grieving and Dying

No concept of death
Separation anxiety
Newborn and Infant
Reacts more to pain and discomfort of illness and immobilization
Perceive death as reversible, and avoidable
Toddler and Preschooler Cannot grasp yet death's universality, and finality
Perceive death as long sleep
Early school age child perceives death as unnatural, reversible, and avoidable
Personifies death
Fear of mutilation and punishment
School-Age
At a 9 yrs old, a child has realistic concept of death as irreversible, universal (no
one escapes), inevitable and natural

Begins to develop philosophy of life and death

Adolescents Thought of one's death is overwhelming, hence suppressed
May have strong emotions about death
May have poorer outcomes than adults because of other stressors
Grieve more intensely and continuously, but relatively shorter period
Adults Middle-age adults perceive death as out of normal sequence of events
 Seven Tasks of Dying (Rolando) HOSPICE CARE
1. Controlling pain and other symptoms Focus: Support and Care of the Dying
2. Managing stress related to treatment person and family, with the goal of
3. Developing and maintaining relationship with FACILITATING A PEACEFUL & DIGNIFIED
professional caregivers
DEATH
4. Preserving emotional balance
Improve QUALITY OF LIFE, rather than
5. Preserving self image
6. Managing relationships with family and friends CURE GOALS
7. Preparing for the culture - Control and Relieve Pain and Symptoms of
illness
PREPARING clients through grief - Provide physical comfort for the terminally ill
Protect and provide for physiologic needs (sleep, food) and safety - Provide social, emotional, spiritual comfort for
Role modeling by those who have successfully coped the client, family and friend
Establish coping behavior that was successful in the past - Meet spiritual support
Pull support systems by mobilizing existing and identifying new
Final Stage of Disease Phase
Allow expression of diverse feelings and emotions
Time of Dying Phase
Refer to self-help groups
Bereavement Period Phase
Expand coping behaviors by introducing new mechanics
Phases of Separation Anxiety in Infants and Children
1. PROTEST - cries and screams, inconsolable by others
2. DESPAIR - child becomes quiet, does not cry, and less active. Does not want to eat nor play identifies with object for security
3. DENIAL - appears adjusted and resumes interest in environment, but actually has resigned.
 Clinical Death
Clinical signs of Impending Death Death Imminent
(World Medical Assembly)
Loss of muscle tone (bladder and bowel Fixed dilated pupils Total lack of response to external
incontinence, decrease GI motility) Loss of reflexes and movement stimuli
Slowed circulation (mottling of skin, cool skin) Faster, weak pulse No muscular movement,
Vital Signs Changes (weak pulse; hypotension; Cheyne-Stokes respirations especially breathing
rapid shallow, irregular mouth breathing) (progression in the depth of No reflexes
Sensory impairment (hearing is the last to breathing with periods of apnea) Flat EEG
disappear) Death rattle (noise breathing due to
collection of mucous in the
pharynx)
Definitions and Signs of Death
Traditional clinical Cerebral death Somatic death Molecular death Indications of death
signs of death adopted by the World
Medical Assembly

heart-lung death higher brain death determined by the determined by the Total lack of response to
cessation of the apical occurs when the absence of cardiac cessation of cullular external stimuli
pulse, respirations, and higher brain center, and pulmonary function No muscular movement,
blood pressure the cerebral cortex is functions No reflexes
irreversibly Flat EEG
destroyed
 Postmortem Care
Physician certify death
Option for organ donation
Check for specimen orders (autopsy)
Remove all equipment, tubes, etc. according to protocol
Clean body thoroughly
Position according to protocol
Shroud wrap
Apply name tag, document

Postmortem Changes
Rigor Mortis Algor Mortis Livor Mortis

stiffening of the body that occurs 2-
4 hrs after death. It resukts from the
lack of adenosine triphosphate
(ATP) > muscle contract > stiffening
joints
gradual decrease of the the discoloration of surrounding tissues by
body's temperature after hemoglobin (released by the breakdown of
death. (1℃ /hr until room RBCs when circulation stops). This appears
temperature) in the lowermost or dependent portions of
the body.