Crisis Management In Nursing Education

What Is Crisis
Management

    Crisis management is a series of steps used to intervene
and establish order in situations where events and stressors threaten to
disrupt an equilibrium state. The threat to homeostasis could be at the
individual, group, or community level, but the steps would still apply. The
basic steps according to Elders (2008) are (a) assess the individual. and the
problem, (b) plan the intervention, (or implement the intervention, (d) resolve
the crisis, and (e) anticipatory planning (Elders, 2008).

Implementation of Crisis Management In Nursing

    Incidents of crises can plague students as they progress in
nursing school. Crisis management for students during this time is an apt
approach to decrease stress and allow them to focus on discernible methods to
success. To address the identified crisis, the issue or situation must be
identified and defined. A team approach including faculty and students is
essential; the students describe the problem and the faculty assist with a
planned approach to the crisis management. 

    Aspects of the issue need to be
discovered and explored. While this may seem like a lengthy process, clues to
the severity of the problem will surface, thereby defining and providing
information that can guide a planned intervention. When an intervention is
identified, a plan for implementation can be developed. Measures within the
plan can direct any actions taken when the intervention is initiated. Having
outcome objectives derived from and guided by the intervention plan will allow
the student/faculty to evaluate progress. 

    As the crisis resolves, the expected
outcomes can be evaluated. If no resolution to the crisis is observed, a
reassessment of the problem follows and another approach may be attempted. If
the crisis is resolved, it is important to do anticipatory planning, to prevent
the crisis from reappearing (Reinhardt, Keller, Ochart Summers, & Schultz,
2012) There are a number of situations that can precipitate a crisis for
nursing students; therefore, anticipatory planning by the faculty in schools of
nursing is important.

    The use of standardized high stakes testing such as
standardized entrance and exit examinations in a nursing program can create
crises for all students and especially students identified as at risk. The
licensing examination (NCLEX-RN) is an important consideration in educating
nurses and by itself can precipitate a crisis in some. Clinical testing is
another example where performance is evaluated under the observation of an
instructor and can lead to a perceived crisis in a student. In essence,
learning to be a nurse can be like learning a new language and approach to
life. The student may question all previous learning

Impact of Crisis Management In Nursing

    The literature addresses crisis management in a number of
areas. Apart from management in industry such. as hotels and other business
environments (Elsubbaugh, Fildes, & Rose, 2004; Hamidizadeh, Hosseini,
& Anoosheh, 2011, Lalonde, 2007), theories of crisis manage ment in health
care are primarily devoted to emergency situations where lives are at risk (
Kim, Neilipovitz, Cardinal, Chiu, & Clinch, 2006; Yee et al., 2005). Elder,
Ayala, & Harris (1999) suggest that multiple models used in crisis
management have theoretical bases in behavior modification. 

    The Behavior
Modification Model encourages remediation of coping skills and use of both positive
and negative behaviors to modify behavior. The Health Belief Model addresses a
reduction of environmental barriers to behavior change. Perceptions of skill
use and reinforcement of behavior may direct behavior as suggested by the
social learning theory. Self-changing actions emphasize the use of
self-management models. Of these, social support theories stress the
reinforcement found through social networks. The theory of reasoned action
points out perceptions of social processes. 

    The Trans-theoretical Model requires
action to match intervention in both cognitive and behavioral stages.
Management in a crisis can support behavior change efforts by ensuring that
students: 

(a) have a positive intention

(b) face minimum barriers

(c)
perceive themselves as having the requisite skills or self-efficacy

(d)
believe that positive behavior will be reinforced

(e) believe that there is a
positive pressure to perform and no negativity will follow the behavior change

(f) believe that the behavior is right for their self-image

(g) feel good
about the behavior change

(h) find positive encouragement in the behavior
(Elder et al. 1999)

    Management of a crisis is closely linked to the
precipitating event causing the crisis. Crisis prevention is best approached by
anticipatory planning. Forecasting related to previous events can go a long way
to prevent the development of a crisis event. Disaster planning is an example
of preparedness necessary in any health care setting (Lalonde, 2007, Morrison,
2007). The lessons learned when reviewing such plans can support a nursing
student in developing his or her own plan of crisis prevention.

Outcomes of Crisis Management 

    Nurses, both students and faculty, can be at risk of
crises. Finding an approach to crisis management can be a shared responsibility
and one from which both can gain insight and strength. Although there are a
variety of approaches found in the literature, the most straightforward
approach lies in first identifying the situation in the crisis, developing a
plan of action, implementing that plan, then evaluating the actions taken,
followed by developing any anticipated action if the crisis returns (Elders,
2008). 

    The perceptions of crisis for students are ubiquitous to nursing
education. The profession requires rigorous standards in both education and
practice. Because these demands are inherent in the profession, continued
perception of crisis events may surface. As a profession, nurses must be able
to identify and develop interventions and coping strategies to deal with these
issues as they arise. 

    Research is needed to meet the needs of students
under going a crisis in their education and to prevent untoward outcomes such
as leaving the profession or developing barriers to learning Programs that can
improve student learning in methods that have a broad and current appeal
devised to reduce stress, as well as practice questions for NCLEX-RN, have been
developed and may prove useful. Research-based evaluation of these approaches
will be helpful.