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Chapter 10 Intervening In Crisis
Terms in this set (67)
What does crisis intervention require?
problem-solvig skills that are often diminished by the level or anxiety accompanying disequilibrium
characteristics of crisis are
- Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology
- crisis are precipitated by specific identifiable events
- crisis are personal by nature. what may be considered a crisis situation by one individual may not be so for another
- crises are acute, not chronic, and will be resolved in one way or another within a brief period
- a crisis situation contains the potential for psychological growth or deterioration
what is a crisis?
- A sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem
Individuals who are in crisis feel?
-helpless to change
- do not believe they have the resources to deal with the precipitating stressor
- all behavior is aimed at relief of the anxiety being experienced
- may affect the individual physically as well as psychologically
development of a crisis follows?
a relatively predictable course
Caplan 4 specific phases which individuals progress in response in the state of acute crisis
1) the individual is exposed to a precipitating stressor
2) when previous problem-solving techniques do not relieve the stressor, anxiety increases further.
3) all possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort.
4) If resolution does not occur in previous phases, caplan states that " the tension mounts beyond a further threshold or its burden increases over time to a breaking point. Major disorganization of the individual with drastic results often occurs"
- Anxiety increases
- previous problem-solving techniques are employed
-individual begins to feel a great deal of discomfort at this point.
- coping techniques are attempted, but no longer work (creating helplessness)
- feelings of confusion and disorganization prevail
- individual may try to view the problem from a different perspective, or even to overlook certain aspects of it
- new problem-sovling techniques may be used, and, if effectual, resolution may occur at this phase, with the individual returning to a higher, a lower, or the previous level of per morbid functioning
anxiety may reach panic levels. cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking
Caplan 4 phase are congruent with what concepts?
Balancing factors by Aguilera
the paradigm set forth by Aguilera suggests?
whether or not an individual experiences a crisis in response to a stressful situation depends on the following Three factors.
whether or not an individual experiences a crisis in response to a stressful situation depends on the following Three factors.
1) the individual's perception of the event
2) the availability of situational supports
3) the availability of adequate coping mechanisms
The individual perception of the event
- If the event is perceived realistically, the individual is more likely to draw on adequate resources to restore equilibrium
- if the perception of the event is distorted, attempts at problem-solving are likely to be ineffective and restoration of equilibrium goes unresolved
the availability of situational supports
- "situational supports are those persons who are available in the environment and who can be depended on to help solve the problem"
- without adequate situational supports during a stressful situation, an individual is most likely to feel overwhelmed and alone
the availability of adequate coping mechanisms
-when a stressful situation occurs, individuals draw on behavioral strategies that have been successful for them in the past.
- If these coping strategies work, a crisis may be diverted. If not, disequilibrium may continue and tension and anxiety may increase.
How long should an acute crisis last?
can last from a few horuse to weeks
Acute crisis is characterized by?
an initial phase in which anxiety and tension rise, followed by a phase in which problem-solving mechanisms are set in motion
How can Crises become growth opportunities?
- individuals learn new methods of coping that can be preserved and used when similar stressors recur.
what are the 6 types of crises?
1) Dispositional crises
2) crises of anticipated life transitions
3) Crises resulting from traumatic stress
4) maturational/ developmental crises
5) crises reflecting psychopathology
6) psychiatric emergencies
An acute response to an external situational stressor
Example - domestic abuse
Intervention - intervention: caring for physical wounds
- referred to agency for assistance
Crises of anticipated life transition
Normal life-cycle transitions that may be anticipated but over which the individual may feel a lack of control
Example - on probation from school and has to take on a full time job to pay bills due to wife losing job, leaving little time to study
Intervention - physical examination, refer to services that can provide financial and other types of assistance
Crises resulting from traumatic stress
Crises precipitated by unexpected external stresses over which the individual has little or n control and from which he or she feels emotionally overwhelmed and defeated
Example - abducted by two men with guns, raped and beaten
Intervention - ventilate feelings, stages of grief
maturational/ developmental crises
Crises that occur in response to situations that trigger emotions related to unresolved conflicts in ones's life. these Crises are of internal origin and pendency, value conflicts, sexual identity, control, and capacity for emotional intimacy
Example - getting passed up on postion at work multiple times and getting heckled by father (developmental issues) . becoming passive aggressive and depressed
Intervention - help identify the unresolved developmental issue,
crises reflecting psychopathology
emotional crises in which pre-existing psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution
Example - psychopathology that may precipitate crises include borderline personality, severe neuroses, characterological disorders, or schizophrenia
Intervention - bring down anxiety, have someone stay with client to insure safety, have client verbalize feelings of abandonment, discourage regressive behaviors, referral to long-term care facility amy be required
crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility
Example - include acutely suicidal individuals, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger, and alcohol intoxication
Intervention - Crisis team monitored, psychiatric unit
crisis intervention who becomes part of the clients life?
Therapist or intervener
Therapist is needed for?
individual emotional state is unable to problem solve
- not lengthy, set to resole crisis then have client go back to pre-crisis functioning
psychosocial and lethality assessment
- Gather information regarding the precipitating stressor and the resulting crisis
that prompted the individual to seek professional help
Phases of crisis intervention: The role of the nurse ( 7 stages)
1) psychosocial and lethality assessment
2) rapidly extablish rapport
3) identify the major problems or crisis precipitants
4) deal with feelings and emotions
5) generate and explore alternatives
6) implement an action plan
7) follow up
psychosocial and lethality assessment interventions
conduct a rapid but thorough biopsychosocial assessment
rapidly establish repport
- counselor uses genuineness, respect, and unconditional acceptance to establish rapport with the client
- skills such as good eye contact, a nonjudgemental attitude, flexibility, and maintaing a positive mental attitude are important
identify the majo problems or crisis precipitants
- identify the precipitating event that has led the client to seek help at the present time
- identify other situations that led up to the precipitating event
- prioritize major problems with which the client needs help
- discuss the client's current style of coping, and offer assistance in areas where modification would be helpful in resolving the present crisis and preventing future crises
deal with feelings and emotions
- encourage the client to vent feelings. provide validation
-use therapeutic communication techniques to ehlpl the client explain his or her story about the current crisis situation
- eventually and cautiously, begin to challenge maladptive beliefs and behaviors, and help client adopt more rational and adaptive options
generate and explore alternatives
-collaboratively explore options with the client
- identify coping strategies that have been successful for the client in the past
- help the client problem some strategies for confronting the current crisis adaptively
implement an action plan
- there is a shift at this stage from crisis to resolution
- develop a concrete plan of action to deal directly with the current crisis
- having a concrete plan restores the client's equilibrium and psychological balance
- work through the meaning of the event that precipitated the crisis. how could it have been prevented? what reps ones may have aggravated the situation?
-plan a follow- up visit with the client to evaluate the post-crisis status of the client
- beneficial scheduling of follow-up visits include 1 month and 1 year anniversaries of the crisis event
during psychosocial and lethality assessment Nurse performs
- ask individual to describe the event
- determine when it occurred
- assess the individual's physical and mental status
- determine if the individual has experienced this stressor before
- what were previous coping methods (did they work?)
- what were new coping methods (did they work)
-assess for suicide
- assess use of substances
Diagnoses reflecting the immediacy of the crisis situation may be?
- ineffective coping
- anxiety (severe panic)
- disturbed thought processes
- risk for self or other directed violence
- rape - trauma syndrome
- post - trauma response
planning of therapeutic intervention
Anger can be associated with a number of typical behaviors, including?
- frowning facial expression
- clenched fists
- low-pitched verbalizations forced through clenched teeth
- yelling and shouting
- intense eye contact or abidance of eye contact
- easily offended
- defensive response to criticism
- passive - aggressive behaviors
- emotional over control with flushing of the face
- intense discomfort; continuous state of tension
individuals who become fixed in the "anger" stage may become?
why is would anger be turned inward?
- for the individual to maintain control over the pent-up anger
clients who will not acknowledge anger as there feeling should be?
- assisted to recognize their true feelings and to understand that anger is perfectly acceptable emotion when it is expressed appropriately
Aggression can arise from?
Aggressive behaviors can be classified as?
- mild (sarcasm)
- moderate ( slamming doors)
- severe (threats of physical violence against others)
- extreme ( physical acts of violence against others
Aggression may be associated with?
- pacing, restlessness
- tense facial expression and body language
- verbal or physical threats
- loud voice, shouting, sue of obscenities, argumentative
- threats of homicide or suicide
- increase in agitation, with overreaction to environmental stimuli
- panic anxiety, leading to misinterpretation of the environment
- disturbed thought processes; suspiciousness
- angry mood, often disproportionate to the situation
Anger vs Agression
- aggression is almost always goal directed and has the aim to harm to a specific person or object.
- aggression is on ethe negative outcomes that may emerge from gneral arousal and anger
a requisite in the definition of aggression
- refers to behavior that is intended to inflict harm
- unintentional harm is not considered aggression
the key issue in the management of aggressive or violent behavior is?
3 factors that are important to considering assessing for potential violence include?
1) past history of violence
2) client diagnosis
3) current behavior
past history or violence
- major risk factor for violence in treatment setting
- correlated with assaultive behavior
- major depression
- bipolar disorder
- substance abuse
substance abuse in addition to mental illness compounds?
- risk of violence
what is prodromal syndrome?
- anxiety and tension, verbal abuse and profanity, and increasing hyperactivity
- usually do not occur in stages, but overlap and occur simultaneously
behaviors associated with prodromal stage are?
- rigid posture
- clenched fists and jaws
- grim affect
- talking in rapid, rainsed voice
- arguing and demanding
- using profanity and threatening verbalizations
- agitation and pacing
- pounding and slamming
assaultive behaviors are preceded by a period of?
- increasing hyperactivity
- should be considered emergent and demand immediate attention
when anger is expressed inappropriately and the etiology is related to a loss what nursing diagnosis should be used?
- dysfunctional grieving
Nursing diagnoses that may be considered for clients demonstrating inappropriate expression of anger or aggression
- Ineffective coping r/t negative role modeling and dysfunctional family system evidenced by yelling, name calling, hitting other, and temper tantrums as expressions of anger
- risk for self-directed or other- directed violence related to having been nurtured in an atmosphere of violence; history of violence
criteria for the measurement of outcomes in the care of the client needing assistance with management of anger and aggression
- able to recognize when he or she is angry and seeks out staff to talk about his or her feelings
- able to take responsibility for own feelings of anger
- demonstrates the ability to exert internal control over feelings of anger
- able to diffuse anger before losing control
- uses the tension generated by the anger in a constructive manner
- does not cause harm to self or others
- is able to use steps of the problem - solving process rather than becoming violent as a means of seeking solutions
evaluation consists of?
- reassessment to determine if the nursing interventions have been successful in achieving the objectives of care
Questions that may provide information to determine the success of working with a client exhibiting inappropriate expression of anger
- is the client able to recognize when he or she is angry now?
- can the client take responsibility for these feelings and keep them in check without losing control?
- does the client seek out staff to talk about feelings when they occur?
- is the client able to transfer tension generated by the anger into constructive activities?
- has harm to client and others been avoided?
- is the client able to solve problems adaptively without undue frustration and without becoming violent?
A Disaster is?
the event overwhelms local resources and threatens the function and safety of the community
who is more effected by a violent disaster that is natural or man- made
- lack life experiences and coping skills
emotional effects of loss and disruption may show up when?
immediately or may appear weeks or months later
psychological responses following trauma (adults) (adolescents)
- sleep disturbance
- increases in alcohol, caffeine, and tobacco
psychological responses following trauma ( preschool children)
- separation anxiety
- regressive behaviors
- hyperactive or withdrawn behaviors
psychological responses following trauma ( older children)
- difficulty concentrating
- somatic complaints
- sleep disturbances
- concerns about safety
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