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Chapter 10 Crisis Intervention
Terms in this set (70)
Any stressful situation can precipitate a?
problem solving; growth with resolution.
Assistance with ________ during the crisis period preserves self-esteem and promotes ?
requires problem solving skills that are often diminished by the level of anxiety accompanying disequilibrium
as a sudden event in one's life, during which usual coping mechanisms cannot resolve the problem; the crisis disturbs homeostasis
Crisis occurs in all individuals at one time or another and is not necessarily equated with ??.
Crises are precipitated by specific ?
Crises are ?? by nature.
acute, not chronic
Crises are _______, and are resolved in one way or another within a brief period.
psychological growth or deterioration.
A crisis situation contains the potential for ?
helpless to change
individuals in crisis feel ?
- thoughts become obsessional
- all behavior is aimed at relief of the anxiety being experienced
characteristics of a person in crisis
Phase 1 (acute crisis)
The individual is exposed to a precipitating stressor. Anxiety increases; previous problem solving techniques are employed
Phase 2 (acute crisis)
When previous problem-solving techniques do not relieve the stressor, anxiety increases further.
The individual begins to feel a great deal of discomfort at this point. Coping techniques used in the past are attempted but only create a feeling of helplessness. Confusion and disorganization prevail
Phase 3 (acute crisis)
All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort.
the individual may try to view the problem from a different perspective or overlook certain aspects of it. New problem solving techniques may be used and resolution may occur.
Phase 4 (acute crisis)
If resolution does not occur in previous phases, the tension mounts beyond a further threshold or its burden increases over time to a breaking point. Major disorganization of the individual occurs, often with drastic results.
anxiety might reach panic levels. cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking
1. The individual's perception of the event
2. The availability of situational supports
3. The availability of adequate coping mechanisms
Whether individuals experience a crisis in response to a stressful situation depends on three factors:
The individual's perception of the event
if the event is perceived realistically, the individual is more likely to draw upon adequate resources to restore equilibrium. If the perception is distorted, attempts at problem solving are likely ineffective
the availability of supports
without adequate situational supports during a stressful situation, an individual is most likely to feel overwhelmed and alone
the availability of adequate coping mechanisms
drawing upon behavioral strategies that have been successful for them in the past. without coping strategies, a crisis may be diverted
Class 1-Dispositional crisis
(example: 2 instances of domestic violence within the past 6 months; wife who was abused is in crisis)
An acute response to an external situational stressor
Class 2-Crisis of anticipated life transitions
(ex. student placed on probationary status due to low grades, wife has baby and quits job, increases work from part time to full time)
Normal life-cycle transition that may be anticipated but over which the individual may feel a lack of control
Class 3- Crisis resulting from traumatic stress
(ex. woman is abducted, raped and beaten; cannot be alone, fearful, flashback and dreams, unable to eat, sleep or work at her job)
Precipitated by an unexpected, external stressor over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated
Class 4 Maturational/developmental crisis
(ex. Jill jas a 4 month old, mother is diagnosed with cancer. Jill feels incapable of being a parent, getting in fights with husband)
Occurs in response to a situation that triggers emotions related to unresolved conflicts in one's life
Class 5- Crisis reflecting psychopathology
(ex. Sonja has borderline personality due to fear of abandonment. Therapist says she is moving away ; Sonja is distraught and found wandering out in traffic)
An emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution
Class 6- Psychiatric emergency
A crisis situation in which general functioning has been severely impaired and the individual is rendered incompetent or unable to assume personal responsibility
suicidal, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger, alcohol intoxication
- Clenched fists
- Low-pitched voice
- Yelling and shouting
Anger can be identified by a cluster of characteristics that include:
secondary emotion (response to grief, depression, fear, anxiety, or unresolved postraumatic stress)
anger is often described as a ?
- Pacing; restlessness
- Verbal/physical threats
- Threats of homicide or suicide
- Loud voice; argumentative
- Tense facial expression and body language
Aggression can be identified by a cluster of characteristics that include:
can arise from a number of feeling states, including anger, anxiety, guilt, frustration or suspicious
threats of physical violence against others
physical acts of violence against others
behavior that is intended to inflict harm or destruction; a requisite of aggression
the key issue in management of aggressive or violent behavior.
the individual who becomes violent usually feels an underlying ?
- Past history of violence
- Client diagnosis
- Current behaviors
Three factors are important considerations in identifying extent of risks for potential violence
diagnosis (such as schizophrenia, major depressive disorder, BPD, and substance use disorders; antisocial, borderline, intermittent explosive personality disorders) (diagnoses that have strong association with violence both self and other directed)
also highly correlated with assaultive behavior is ??
prodromal syndrome of aggression
characterized by anxiety and tension, verbal abuse and profanity and increasing hyperactivity
grim, defiant affect
talking in a rapid raised voice
arguing and demanding
agitation and pacing
pounding and slamming
behaviors included in prodromal syndrome of aggression
- ineffective coming related to negative role modeling and dysfunctional family system evidenced by yelling, name calling, hitting others, and temper tantrums as expressions of anger
- risk for self directed or other directed violence related to inadequate anger management
diagnoses for Anger and Aggression management on the Inpatient unit
harm to self or others
anger is a normal response that only becomes unhealthy when accompanied by ?
1. the client recognizes when he or she is angry and seeks out staff to talk about his or her feeling
2. takes responsibility for his or her feelings of anger
3. demonstrates the ability to exert self control over anger
4. demonstrates ability to diffuse anger before losing control
5. uses tension generated by the anger in a constructive manner
6. causes no harm to self or others
7. uses steps of the problem solving process rather than becoming violent as a means of seeking solutions
outcome identification for the patient with anger or aggression
- remain calm
- set verbal limits on behavior
- have client keep a diary
- avoid touching the client when they are angry
- help determine true source of anger
- ignore derogatory remarks to give lack of feedback, when applicable
- help client identify ways to release tension
- role model appropriate ways to express anger assertively
nursing interventions for the client to recognize anger and take responsibility
1. observe for escalation
2. ensure sufficient staff when observed escalation behaviors to help with a potentially violent situation
3. talk down, provide physical outlets, medicate, call for assistance, seclude/restrain
nursing intervention to prevent client from harming self or others, and verbalize anger
Correct answer: C
Adequate coping mechanisms can influence the development of a crisis. If a person can draw on past successful coping strategies, a crisis may be diverted. The second student had a lack of adequate coping mechanisms.
Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis?
a. The time of year in which the event occurred
b. The presence of support systems
c. A lack of adequate coping mechanisms
d. The individual's family birth order
psychological resolution of the individual's immediate crisis and restoration to at least the level of functioning that existed before the crisis period.
The minimum therapeutic goal of crisis intervention is ?
improvement in functioning above the pre-crisis level.
A maximum goal in crisis intervention is ?
virtually any setting
Nurses may be called on to function as crisis helpers in ??committed to the practice of nursing.
Phase 1 (crisis intervention) - Assessment
Information is gathered regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help.
1. ask the individual to describe the event that precipitated the crisis.
2. determine when it occurred.
3. assess the individual's mental and physical status.
4. determine if the individual has experienced this stressor before and what coping mechanisms they used.
5. if the previous coping methods were tried what was the result?
6. if new coping methods were tried what was the result?
7. assess suicide or homicide potential, plan, and means
8. assess the adequacy of support systems
9. determine level of pre crisis functioning
10. assess the individuals perceptions of personal strengths and limitations
11. assess the individuals use of substances
what might the nurse assess in phase 1 of crisis intervention?
phase 2 (crisis intervention) Planning of therapeutic intervention
From the assessment data, the nurse selects appropriate nursing diagnoses that reflect the immediacy of the crisis situation.
Desired outcome criteria are established.
Appropriate nursing actions are selected, taking into consideration the type of crisis as well as the individual's strengths and available resources for support.
when are goals established in crisis intervention?
phase 3 (crisis intervention) - Intervention
The actions identified in the planning phase are implemented.
reality orientation approach
approach used in Phase 3 of crisis intervention
unconditional acceptance, active listening, and attending to immediate needs.
during phase 3 of crisis intervention, A rapid working relationship is established by showing ?
problem solving model
becomes the basis for change in phase 3 intervention
set firm limits
what should you do when a client displays aggressive or destructive behaviors because of anxiety ?
Phase 4 (crisis intervention) - Evaluation of crisis resolution and anticipatory planning
A reassessment is conducted to determine whether the stated objectives were achieved.
A plan of action is developed for the individual to deal with the stressor should it recur.
plan of action
during phase 4 of crisis intervention, A________ is developed for the individual to deal with the stressor should it recur.
For the past 3 days, a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions?
a. The student's description of the precipitating stressor
b. The student's usual ability to cope with stress
c. The student's available support system
d. The student's access to community resources
local resources; function and safety of the community.
A common feature of disasters is that they overwhelm _______ and threaten the?
leave victims with a damaged sense of safety and well-being and varying amounts of emotional trauma.
often happens with disasters as the victim questions "how could this have happened ]" and "what is most important in life?"
a natural response following any loss, including disaster
immediately or may appear weeks or months later
emotional effects of loss and disruption from disaster may show up ?
anger, disbelief, sadness, anxiety, fear, sleep disturbances, and increase in alcohol, caffeine, and tobacco use.
common behavioral responses to disaster
separation anxiety, nightmares, and problems with concentrating.
children may experience these symptoms with disaster
Risk for injury
Risk for infection
Risk for posttrauma syndrome
Ineffective community coping
nursing diagnoses for disaster
1. demonstrates behaviors necessary to protect self from further injury
2. identifies interventions to prevent/reduce risk of infection
3. is free of infection or physical injury
4. maintains anxiety at a manageable level
5. expresses beliefs and attitudes about spiritual issues
6. demonstrates ability to deal with emotional reactions in an individually appropriate manner
7. demonstrates an increase in activities to improve community functioning
outcome behaviors and evaluation of disaster nursing
1. Maintaining anxiety at a manageable level
2. Encouraging free expression of beliefs and values about spiritual issues
3. Assistance to deal with emotional reactions in an individually appropriate manner
4. Promotion of activities to improve community functioning
Interventions with the client who has experienced a traumatic event are aimed at?
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 6 Therapeutic Communication
Chapter 6 Therapeutic Communication P2
Chapter 8 Milieu Therapy—The Therapeutic Community
Chapter 9 Intervention in Groups
OTHER SETS BY THIS CREATOR
Chapter 70 p6
chapter 70 p5
Chapter 70 p4
Chapter 70 p3