1229 Exam 6: Crisis/Disaster Interventions and Suicide Flashcards
An acute disruption of psychological homeostasis in which one’s usual coping mechanism fall and there exist evidence of distress and functional impairment.
Crisis
A crisis for me may not be a crisis for you…
- Individuals perception of the event
- Inability to resolve the event by usual coping mechanisms
- Struggle for equilibrium and adaption
- Threatens personality organization
- Presents opportunity for personal growth
- Acute and time-limited (4-6 weeks)
Types of Crises
Maturational
Situational
Adventitious
As we mature life happens Occurs as we grow Developmental (age) New developmental stage is reached -Graduation -Marriage -Children -Retirement -Death Old coping skills no longer helpful -Hanging with friends -Multiple partners -Self focus -Support systems Ineffective defense mechanisms until new coping skills develop
Maturational Crisis
In some situations life happens Extraordinary External Often unanticipated -Loss/change of job/financial status -Divorce/death of loved one -Severe physical/mental illness
Situational Crisis
Happening according to chance rather than design or inherent nature Coming from outside; not native Unplanned and accidental -Natural disaster -National disaster -Crime of violence -Post traumatic stress disorder
Adventitious Crisis
What does an individual crisis look like?
Anxiety
Overwhelming emotion
Helplessness
Disorganization
Gerald Caplan’s Phase 1 of Crisis
- Conflict or Problem
- Self-concept threatened
- Increased anxiety
- Use of problem-solving and defense mechanisms
- Resolve conflict or problem
- Reduce anxiety
Gerald Caplan’s Phase 2 of Crisis
- Problem-solving techniques and defense mechanisms fail
- Threat persists
- Anxiety increases
- Feelings of extreme discomfort produced
- Functioning disorganized
- Trial-and-error attempt to solve problem and restore normal balance
Gerald Caplan’s Phase 3 of Crisis
- Trial-and-error attempts fail
- Anxiety can escalate to severe and panic levels
- Automatic relief behaviors mobilized (i.e. withdrawal and flight)
- Some form of resolution may be made (i.e. compromising needs or redefining situation)
Gerald Caplan’s Phase 4 of Crisis
- Problem not solved coping skills ineffective
- Overwhelming anxiety
- Possible serious personality disorganization; depression/confusion; violence against others and/or suicidal behavior
How is Crisis Diagnosed?
Assessment
- Safety is first
- -Assess for suicidal/homicidal ideation/gestures
- Then (once patient is safe) assess
- -Perception of precipitating event
- -Situational supports
- -Personal coping skills
- -Self Assessment (of YOUR feelings/coping skills)
General Assessment
Equilibrium may be adversely affected by:
- Unrealistic perception of the precipitating event
- Inadequate situational supports
- Inadequate coping mechanisms
Assessing perception of the precipitating event
Clear definition of the problem is necessary for resolution
Sample question:
-Has anything upsetting happened to you within the past few days or weeks?
-What was happening in your life before you started feeling this way?
-What leads you to seek help now?
-Describe how you are feeling right now.
-How does this problem affect your life? Your future?
-What would need to be done to resolve this situation?
Assessing Situational Supports
It is necessary to determine resources available to the person
The nurse acts as a temporary support system while relationships with individuals or community groups are established
Sample question:
-With whom do you live?
-To whom do you talk when you feel overwhelmed?
-Who is available to help you?
Assessing personal coping skills
It is necessary to determine whether the patient has exhausted all coping resources and whether hospitalization is required
Questions include:
-Have you thought of killing yourself or someone else? If yes, have you thought of how you would do this?
-What things help you feel better?
-What did you try this time? What was different this time?
-What helped you through difficult times in the past?
-What do you think might happen now?
Self Assessment: Common problems in the Nurse-Patient relationship
The Nurse:
- Need to be needed
- Sets unrealistic goals for patient
- Has difficulty dealing with issue of suicide
- Has difficulty terminating nurse-patient relationship
How is it treated?
Crisis Intervention:
-Safety is first
-Support systems
-Teaching
-Follow up
Identify:
-The patient’s response to the crisis warrants psychiatric tx
-Whether the patient was able to identify precipitating factors
-Assessment and identification of situational supports
-Coping styles
-Religious cultural beliefs
