WordNet

an unstable situation of extreme danger or difficulty; "they went bankrupt during the economic crisis"
a crucial stage or turning point in the course of something; "after the crisis the patient either dies or gets better"
the act of attacking; "attacks on women increased last year"; "they made an attempt on his life" (同)attempt
(military) an offensive against an enemy (using weapons); "the attack began at dawn" (同)onslaught, onset, onrush
a decisive manner of beginning a musical tone or phrase (同)tone-beginning
an offensive move in a sport or game; "they won the game with a 10-hit attack in the 9th inning"
strong criticism; "he published an unexpected attack on my work"
a sudden occurrence of an uncontrollable condition; "an attack of diarrhea"
begin to injure; "The cancer cells are attacking his liver"; "Rust is attacking the metal"
set to work upon; turn ones energies vigorously to a task; "I attacked the problem as soon as I got out of bed"
the onset of a corrosive or destructive process (as by a chemical agent); "the film was sensitive to attack by acids"; "open to attack by the elements"
attack in speech or writing; "The editors of the left-leaning paper attacked the new House Speaker" (同)round, assail, lash out, snipe, assault
take the initiative and go on the offensive; "The Serbs attacked the village at night"; "The visiting team started to attack" (同)aggress
launch an attack or assault on; begin hostilities or start warfare with; "Hitler attacked Poland on September 1, 1939 and started World War II"; "Serbian forces assailed Bosnian towns all week" (同)assail
rain, hail, or snow hard and be very windy, often with thunder or lightning; "If it storms, well need shelter"
a violent commotion or disturbance; "the storms that had characterized their relationship had died away"; "it was only a tempest in a teapot" (同)tempest
a violent weather condition with winds 64-72 knots (11 on the Beaufort scale) and precipitation and thunder and lightning (同)violent storm
a direct and violent assault on a stronghold
take by force; "Storm the fort" (同)force
attack by storm; attack suddenly (同)surprise
blow hard; "It was storming all night"
a deliberately offensive act or something producing the effect of deliberate disrespect; "turning his back on me was a deliberate insult" (同)affront
a sudden uncontrollable attack; "a paroxysm of giggling"; "a fit of coughing"; "convulsions of laughter" (同)fit, convulsion
distress and disorientation (especially in adolescence) resulting from conflicting pressures and uncertainty about ones self and ones role in society

PrepTutorEJDIC

(社会上・政治上の)『重大な事態』,『難局』,危機 / (人生の)重大な転機(岐路),重大事 / 最悪状態
…'を'『襲う』,『攻撃する』;(ゲームで)…'を'攻める / (演説・文書などで)…'を'『非難する』,攻撃する / 〈病気・不運などが〉…'を'襲う,冒す / 〈仕事など〉‘に'勢いよく取りかかる,着手する / 『攻撃をする』 / 〈U〉〈C〉(…に対する)『攻撃』;(ゲームの)攻め;非難《+『on』(『upon, against』)+『名』》 / 〈C〉発病,発作 / 〈U〉(仕事への)着手,開始
『あらし』,暴風[雨],荒天 / (感情・言動などの)『あらし』,激発《+『of』+『名』》 / (一般に)激動,波乱,騒動 / (弾丸などが)雨あられと飛ぶこと《+『of』+『名』》 / 《itを主語にして》〈天候が〉『荒れる』 / 猛然と突進する;激しく怒る / …‘を'強襲する,急襲する
〈人・物など〉‘を'『侮辱する』,はずかしめる / (…に対する)『侮辱』,侮辱的な言動《+『to』+『名』》
(病気の周期的な)発作《+『of』+『名』》 / (感情・行動などの)激発,発作的行動《+『of』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/12/21 21:40:01」(JST)

wiki en

A crisis (from the Greek κρίσις - krisis;^[1] plural: "crises"; adjectival form: "critical") is any event that is, or is expected to lead to, an unstable and dangerous situation affecting an individual, group, community, or whole society. Crises are deemed to be negative changes in the security, economic, political, societal, or environmental affairs, especially when they occur abruptly, with little or no warning. More loosely, it is a term meaning "a testing time" or an "emergency event".

Definition

Crisis is often linked to the concept of stress. In occidental culture, the term is often used to suggest a negative or fraught experience while in UK as a hazardous event and in oriental cultures like China it means danger and opportunity (Chinese characters used are Wei and Chi). In general crisis is the situation of a complex system (family, economy, society) when the system functions poorly, an immediate decision is necessary, but the causes of the dysfunction are not known.

situation of a complex system

simple systems do not enter crises. We can speak about a crisis of moral values, an economical or political crisis, but not a motor crisis.

poor function

The system still functions, but does not break down.
an immediate decision is necessary to stop the further disintegration of the system.
the causes are so many, or unknown, that it is impossible to take a rational, informed decision to reverse the situation.

Crisis has several defining characteristics. Seeger, Sellnow, and Ulmer^[2] say that crises have four defining characteristics that are "specific, unexpected, and non-routine events or series of events that [create] high levels of uncertainty and threat or perceived threat to an organization's high priority goals." Thus the first three characteristics are that the event is

1. unexpected (i.e., a surprise)

2. creates uncertainty

3. is seen as a threat to important goals

Venette^[3] argues that "crisis is a process of transformation where the old system can no longer be maintained." Therefore the fourth defining quality is the need for change. If change is not needed, the event could more accurately be described as a failure.

Apart from natural crises that are inherently unpredictable (volcanic eruptions, tsunami etc.) most of the crises that we face are created by man. Hence the requirements of their being 'unexpected' depends upon man failing to note the onset of crisis conditions. Some of our inability to recognise crises before they become dangerous is due to denial and other psychological responses ^[4] that provide succour and protection for our emotions.

A different set of reasons for failing to notice the onset of crises is that we allow ourselves to be 'tricked' into believing that we are doing something for reasons that are false. In other words, we are doing the wrong things for the right reasons. For example, we might believe that we are solving the threats of climate change by engaging in economic trading activity that has no real impact on the climate. Mitroff and Silvers ^[5] posit two reasons for these mistakes, which they classify as Type 3 (inadvertent) and Type 4 (deliberate) errors.

The effect of our inability to attend to the likely results of our actions can result in crisis.

From this perspective we might usefully learn that failing to understand the real causes of our difficulties is likely to lead to repeated downstream 'blowback'. Where states are concerned, Michael Brecher, based on case studies of the International Crisis Behavior (ICB) project, suggested a different way of defining crisis as conditions are perceptions held by the highest level decision-makers of the actor concerned:^[6] 1. threat to basic values, with a simultaneous or subsequent 2. high probability of involvement in military hostilities, and the awareness of 3. finite time for response to the external value threat

Political crisis

Economic

Main articles: Economic crisis and Financial crisis

An economic crisis is a sharp transition to a recession. See for example 1994 economic crisis in Mexico, Argentine economic crisis (1999–2002), South American economic crisis of 2002, Economic crisis of Cameroon. Crisis theory is a central achievement in the conclusions of Karl Marx's critique of Capital.

A financial crisis may be a banking crisis or currency crisis.

Environmental

Crises pertaining to the environment include:

Environmental disaster

An environmental disaster is a disaster that is due to human activity and should not be confused with natural disasters (see below). In this case, the impact of humans' alteration of the ecosystem has led to widespread and/or long-lasting consequences. It can include the deaths of animals (including humans) and plant systems, or severe disruption of human life, possibly requiring migration.

Natural disaster

A natural disaster is the consequence of a natural hazard (e.g. volcanic eruption, earthquake, landslide) which moves from potential into an active phase, and as a result affects human activities. Human vulnerability, exacerbated by the lack of planning or lack of appropriate emergency management, leads to financial, structural, and human losses. The resulting loss depends on the capacity of the population to support or resist the disaster, their resilience.^[7] This understanding is concentrated in the formulation: "disasters occur when hazards meet vulnerability".^[8] A natural hazard will hence never result in a natural disaster in areas without vulnerability, e.g. strong earthquakes in uninhabited areas.

For lists of natural disasters, see the list of disasters or the list of deadliest natural disasters.

Endangered species

An endangered species is a population of an organism which is at risk of becoming extinct because it is either few in number, or threatened by changing environmental or predation parameters. An endangered species is usually a taxonomic species, but may be another evolutionary significant unit. The World Conservation Union (IUCN) has classified 38 percent of the 44,837 species assessed by 2008 as threatened.^[9]

International

For information about crises in the field of study in international relations, see crisis management and international crisis. In this context, a crisis can be loosely defined as a situation where there is a perception of threat, heightened anxiety, expectation of possible violence and the belief that any actions will have far-reaching consequences (Lebow, 7–10).

Personal

A personal crisis occurs when an individual can no longer cope with a situation.^[10] This is preceded by events of an extraordinary nature triggering extreme tension and stress within an individual, i.e., the crisis, which then requires major decisions or actions to resolve. Crises can be triggered by a wide range of situations including, but not limited to, extreme weather conditions, sudden change in employment/financial state, medical emergencies, long-term illness, and social or familial turmoil. Crises are simply a change in the events that comprise the day-to-day life of a person and those in their close circle, such as the loss of a job, extreme financial hardship, substance addiction/abuse and other situations that are life altering and require action that is outside the "normal" daily routine. A person going through a crisis experiences a state of mental disequilibrium, in which the ego struggles to balance both internal and external demands.^[11] In this case, said person resorts to coping mechanisms to deal with the stress. Various coping mechanisms include:^[12]

High emotions (crying, physical withdrawal)
Defence mechanisms (denial, repression)
Making rash decisions
Acting out
Putting things on hold

In some cases, it is difficult for an individual undergoing a crisis to adapt to the situation. As it is outside of their normal range of functioning, it is common that one endures a struggle to control emotions. This lack of control can lead to suicidal tendencies, substance abuse, trouble with the law and general avoidance of resources available for help. One such resource used to aid an individual in crisis is their social support system, which can come in the form of family, friends, coworkers, or health professionals. It is important that a support system consists of people that the individual trusts. Although these support systems play a crucial role in aiding an individual through a crisis, they are also the underlying cause of two thirds of mental health crises.^[12] The aforementioned mental health crises can include marital issues, abandonment, parental conflict and family struggles.

In order to aid someone in crisis, it is crucial to be able to identify the signs that indicate they are undergoing an internal conflict. These signs, as well as the aforementioned coping mechanisms, include:^[10]^[13]

Irrational and/or narrow thinking
Lowered attention span
Unclear motives
Disorganized approach to problem solving
Resistance to communication
Inability to differ between large and small issues
Change/alteration to social networks

Ways to manage a crisis

As aforementioned, a crisis can be overcome by implementing mechanisms such as: sleep, rejection, physical exercise, meditation and thinking. To assist individuals in regaining emotional equilibrium, intervention can be used. The overall goal of a crisis intervention is to get the individual back to a pre-crisis level of functioning or higher with the help of a social support group. As said by Judith Swan, there's a strong correlation between the client's emotional balance and the trust in their support system in helping them throughout their crisis.^[14] The steps of crisis intervention are: to assess the situation based on behaviour patterns of the individual, decide what type of help is needed (make a plan of action) and finally to take action/intervention, based on the individual's skills to regain equilibrium.^[11]

The Registered Nurses’ Association of Ontario proposed the ABC model for dealing with client’s interventions in crises:^[15]

A - Basic attending skills (making the person comfortable, remaining calm, etc.)

B - Identifying the problem and therapeutic interaction (explore their perceptions, identify sources of emotional distress, identify impairments in behavioural functioning, use therapeutic interactions)

C - Coping (identify coping attempts, present alternative coping strategies, follow up post-crisis)

Benefits of listening in a crisis

Moreover, another method for helping individuals who are suffering in a crisis is active listening; it is defined as seeing circumstances from another perspective and letting the other person know that the negotiator (the helper) understands their perspective. Through this, they establish trust and rapport by demonstrating empathy, understanding and objectivity in a non-judgmental way. It is important for the negotiator to listen to verbal and non-verbal reactions of the person in need, in order to be able to label the emotion that the individual is showing. Thus, this demonstrates that the helper is tuned in emotionally. Furthermore, there are other techniques that can be used to demonstrate actively listening such as: paraphrasing, silence and reflecting or mirroring. The goal in active listening is to keep the person talking about their situation.^[10]

In chaos theory

When the control parameter of a chaotic system is modified, the chaotic attractor touches an unstable periodic orbit inside the basin of attraction inducing a sudden expansion in the attractor. This phenomenon is termed as interior crisis in a chaotic system.

References

^ κρίσις, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
^ Seeger, M. W.; Sellnow, T. L.; Ulmer, R. R. (1998). "Communication, organization, and crisis". Communication Yearbook. 21: 231–275.
^ Venette, S. J. (2003). Risk communication in a High Reliability Organization: APHIS PPQ's inclusion of risk in decision making. Ann Arbor, MI: UMI Proquest Information and Learning.
^ Mitroff.I. (2005) Why some companies emerge stronger and better from a crisis, p36
^ Mitroff & Silvers, (2009) Dirty rotten strategies
^ Shlaim, Avi, The United States and the Berlin Blockade, 1948–1949: a study in crisis decision-making, University of California Press, Berkeley, 1983, p.5
^ G. Bankoff, G. Frerks, D. Hilhorst (eds.) (2003). Mapping Vulnerability: Disasters, Development and People. ISBN 1-85383-964-7.
^ B. Wisner; P. Blaikie; T. Cannon; I. Davis (2004). At Risk – Natural hazards, people's vulnerability and disasters. Wiltshire: Routledge. ISBN 0-415-25216-4.
^ Factsheet: The IUCN Red List a key conservation tool (2008)
^ ^a ^b ^c Lanceley, F. J. (2003). On-Scene Guide for Crisis Negotiators, Second Edition (2nd ed.). London: CRC Press.
^ ^a ^b Woolley, N. (1990). Crisis theory: A paradigm of effective intervention with families of critically ill people. Journal of Advanced Nursing, 15(12), 1402-1408. doi:10.1111/1365-2648.ep8529911
^ ^a ^b Nursing Best Practice Guideline: Shaping the future of Nursing. (Electronic book). Appendix C - Assessment of coping skills and support systems. (Page 53). Executive Director: Doris Grispun, RN, MScN, PhD. Date: August 2002.
^ Vecchi, G. M. (2009). Conflict and crisis communication. Annals of the American Psychotherapy Association, 12(2), 32-29.
^ Swan, J., & Hamilton, P.M. (2014). Mental health crisis management. Wild Iris Medical Education, Inc.
^ Registered Nurses’ Association of Ontario. (2006). Crisis intervention. Toronto, ON: Registered Nurses’ Association of Ontario.

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Related Pictures

★リンクテーブル★

国試過去問	「108C013」
リンク元	「100Cases 71」「attack」「insult」「paroxysm」「crises」

「108C013」

　　[★]

問題指向型医療記録〈POMR〉の要素はどれか。

a　assessment
b　bias
c　crisis
d　dimension
e　elimination

[正答]

※国試ナビ4※　［108C012］←［国試_108］→［108C014］

「100Cases 71」

　　[★]

■症例

72歳　女性

現病歴：胸部の感染症にドキシサイクリンをGPに処方された。関節リウマチに長期間罹患しており、9年間、1日7mgのプレドニゾロンを服用している。関節痛のため時々パラセタモールを服用。GPが測定した血圧は138/82mmHgであった。抗菌薬を服用し始める2日前からはじまって5日間熱っぽく、食欲不振であり、ベットから動けないでいる。水は十分に飲ませている。5日目に傾眠傾向となり、起こすことが困難になったため、救急車で救急部に連れてきた。

主訴：傾眠

生活歴：単身。退職した娘が世話をするために引っ越してきている。

家族歴：なし。

身体所見 examination

　小柄である(50kgと評価された)が、最近になって体重が減少したということはない。体温38.8℃。眠たそうであり、命令には応じる。簡単な質問にしか答えない。全身性に筋緊張低下。局所神経症状無し。脈拍：118/min。血圧：104/68mmHg。頚静脈圧上昇せず。足首に腫脹無し。肺底部にcrackles(ラ音)とwheezes(笛音)を認める。関節にわずかに活動性の炎症と変形が認められる。これは関節リウマチの既往と合う所見である。

検査　 investigation

　ヘモグロビン：軽度低下。MCV：正常。白血球増多。ナトリウム低下。カリウム正常。尿素上昇。クレアチニン上昇。

問題0. □と○に入る言葉を述べよ

　1) 傾眠とは□□障害に含まれる

　2) 傾眠とは、刺激を与えなければ□□が低下するが、刺激を与えれば○○する状態である。

問題1. 患者に関連する以下の事項のうち何が傾眠と関係あるのだろうか？2つ選べ。

　1) ドキシサイクリンの副作用

　2) 関節リウマチの重症化

　3) プレドニゾロンの服用歴

　4) パラセタモールの服用歴

　5) 胸部感染症

問題2. 異常な検査所見をどう説明しますか？口頭で述べてください。ぶっちゃけ、やや低血圧であることと、ナトリウム低値が着目点です。腎機能低下は二次的なものです。