Crisis, Loss, Grief, Response,

Bereavement, and Disaster

Management
Bisan Mousa RN, MSN
Mental Health
NURS 340
Objectives

 At the end of the session, the student will be able to:

1. Describe the types of crises and responses

2. Differentiate between grief responses and bereavement process
3. Discuss theoretical models explaining grief responses,
uncomplicated bereavement, and complicated bereavement
4. Discuss nursing management for persons experiencing crises, loss,
grief responses, bereavement, and disaster
Crisis
 Crisis occurs when there is a perceived challenge or threat that
overwhelms the capacity of the individual to cope effectively with the
event at any age.
 A crisis occurs when an individual is at a breaking point. It has either
positive or negative outcomes.
 A crisis generally lasts no more than 4-6 weeks.
Phases of Crisis

A problem arises that contributes to increase in anxiety levels. The anxiety

initiates the usual problem-solving techniques of the person

The usual problem-solving techniques are ineffective. Anxiety levels continue

to rise. Trial-and-error attempts are made to restore balance.

The trial-and-error attempts fall. The anxiety escalates to severe or panic levels.
The person adopts automatic relief behaviors.

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
Types of Crises

1. Developmental Crisis: maturational crises are a normal part of growth

and development and successfully resolving a crisis at one stage allows
one to move to the next.(leaving home for the first time, completing
school)
2. Situational Crisis: specific stressful event threatens a person’s physical
and psychosocial integrity and results in some degree of psychological
disequilibrium. Internal : disease or external: job promotion. If a person
enters a new situation without adequate coping skills, a crisis may occur.
3. Traumatic Crisis: is initiated by unexpected, unusual events that can
affect an individual or a multitude of people. National disasters, violent
crimes, and environmental disasters.
 Loss and Bereavement

 Loss can evoke minor to complex thoughts, feelings, and behaviors

depending on the perceived relationship of the person with the lost loved
object or person.
 Grief responses are intense, physical, emotional, cognitive, or social
reactions to the death of a loved one.
 Bereavement or mourning is the process of healing and learning how to
cope with the loss. It begins immediately after the loss, and can last
months or years.
 Theories of Bereavement

 Stage theory: Kubler-Ross, 1969 (denial, anger, bargaining, depression and acceptance)
 Integrated bereavement theory: (Sanders, 1998) shock and disbelief, awareness of loss,
conversation-withdrawal, healing, Renewal.
 Dual Process Model: (Stroebe, Schut, & Boerner, 2010) Offers a nonlinear explanation
of how grieving persons and families come to terms with their loss over time.
 The person adjusts to the loss by oscillating between loss-oriented coping and restoration-
oriented coping. The person is preoccupied between the deceased and the stressful events
as a result of death.
 Oscillation is the process of confronting (loss oriented coping) and avoiding (restoration-
oriented coping) the stresses associated with bereavement.
Exa
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Types of Bereavement

1. Uncomplicated Bereavement: is painful and disruptive, however most bereaved

persons do not need clinical interventions and are able to find meaning and
purpose in their lives. (divorce, empty nest syndrome)
2. Traumatic Grief: external factors influence the reactions and potential long-
term outcomes, like violence, multiple deaths.
3. Complicated Bereavement: The person is frozen or stuck in a state of chronic
mourning which lasts for more than a month to 6 months after a loss. The person
may have trouble accepting the death, an inability to trust others since the death,
and feeling that life is meaningless without the deceased person.
Mental Health Nursing Assessment

 Physical Health: disturbance in sleep, eating, high risk for injury,

which include infection, trauma, and head injuries.

 Emotional and Behavioral Responses: depression, confusion,

uncontrolled weeping or screaming, disorientation, or aggression.

 Social Functioning and Support: disruption of normal daily

activities and routines.
Mental Health Nursing Interventions

 Self Care
 Medication
 Counseling
 Social support Strategies
 Psychoeducation
 Community care
 Conclusion
 A crisis is a time-limited event that occurs when coping mechanisms
fail to provide adaptive skills to address a perceived challenge or
threat.
 Grief responses are intense physical, emotional, social, and cognitive
responses to loss, and bereavement is the process of healing after a
loss.
 Stage theories propose that grief and bereavement follow
stages/phases. Process models explain bereavement as nonlinear.
 Interventions are designed to support people through crises by
helping them understand the process of recovery and identify the
resources they need and how to get them
References

 Boyd, M.A. (2015). Psychiatric Nursing. Contemporary practice (5th

ed.). Philadelphia: Wolters Kluwer.

 American Psychiatric Association (2013). Diagnostic and statistical

manual of mental disorders (DSM-5)(5th ed). Washington, DC:
American Psychiatric Publishing.