Chapter 20: Crisis & Mass Disaster

Crisis & Mass Disaster distinguishes between three primary categories of crises: developmental or maturational crises, which correspond to Erikson’s stages of growth where old coping styles become obsolete; situational crises, which are precipitated by unanticipated external events such as job loss, divorce, or severe illness; and adventitious crises, also known as disasters, which include large-scale events like natural catastrophes, violent crimes, or pandemics that overwhelm community resources. The text details the theoretical foundations of crisis care, exploring Caplan’s four phases of crisis progression—moving from initial anxiety and defense mechanism usage to potential personality disorganization and panic—as well as Roberts’s seven-stage model for active intervention. A critical component of the nursing process involves a triad of assessment focusing on the patient's perception of the precipitating event, the availability of situational supports, and the adequacy of personal coping skills. The chapter delineates three levels of intervention: primary care aimed at prevention and resilience building; secondary care focused on acute safety and anxiety reduction to restore pre-crisis functioning; and tertiary care designed for long-term rehabilitation and support for severe mental disruption. Furthermore, it outlines the protocols for disaster nursing, including the principles of triage under the National Incident Management System (NIMS) to allocate finite resources effectively, and the structured group process of Critical Incident Stress Debriefing (CISD) to aid survivors and first responders. Finally, the content emphasizes the critical importance of nurse self-care to prevent compassion fatigue and secondary traumatic stress resulting from vicarious trauma in high-intensity caregiving environments.