3.3 Crises Intervention and the Role of a Nurse

Question 1

Crises

Answer 1

• Can be precipitated by any stressful situation
• Results in disequilibrium which may require assistance to recover
• Assistance with problem solving during a crises preserves self-esteem and promotes growth with resolution

Question 2

Crises

Answer 2

• Sudden event in one’s life in which usual coping mechanisms cannot resolve a problem.
• Disruption to homeostasis

Question 3

Characteristics of a Crisis

Answer 3

• Occurs in all individuals
• Precipitated by specific identifiable events
• Personal by nature (something may be a crises for one person but not another)
• Acute NOT chronic
• Has the potential for psychological growth or deterioration

Question 4

Phases in Development of Crisis

Answer 4

Phase 1 - Exposed to precipitating factor. Anxiety increases and previous coping methods are used

Phase 2 - Previous coping methods do not relieve the stress, individual becomes more anxious and deals with great discomfort. Helplessness that previous coping methods are not working. Causes confusion and disorganization

Phase 3 - All possible resources are used to help the situation. New problem solving methods are used. If it works than resolution occurs.

Phase 4 - If resolution does not occur tension may reach a breaking point. Anxiety may reach panic levels, cognitive function is disordered, emotions are liable, behavior may reflect psychotic thinking.

Question 5

Factors that Determine Individual Experience to a Crisis

Answer 5

Individual Perception of The Event
- If the event is perceived realistically, equilibrium will more likely be restored. If perception is distorted, attempts at problem solving will likely be ineffective

Availability of Situational Supports
- People available in the environment who can be depended on to solve the problem. Without adequate support, the individual may feel overwhelmed and alone

Availability of Adequate Coping Mechanisms
- When stressful situations occur, individuals rely on previous coping strategies. If these strategies do not work, tension and anxiety increase.

Question 6

TYPES OF CRISES

Question 7

Class 1 - Dispositional Crisis

Answer 7

• Acute response to external situational stressor

Question 8

Class 2 - Crisis of Anticipated Life Transitions

Answer 8

• Normal life cycle transitions that may be anticipated but individual may feel a lack of control

Question 9

Class 3 - Results from Traumatic Stress

Answer 9

• Precipitated by unexpected external stressor where individual has little to no control. They feel emotionally overwhelmed and defeated

Question 10

Class 4 Crisis - Maturational/Developmental Crisis

Answer 10

• Occurs in response to failed attempts to master developmental tasks associated with life cycle transitions

Question 11

Class 5 Crisis - Crisis Reflecting Psychopathology

Answer 11

• Influenced by pre-existing psychopathology
  (personality disorders, anxiety disorders, bipolar disorders, schizophrenia)

Question 12

Class 6 - Psychiatric Emergency

Answer 12

• General functioning is severely impaired and individual is rendered incompetent or unable to assume responsibility for their behavior
  (Acutely suicidal patients, drug overdose, reactions to hallucinogenic drugs, uncontrollable anger, alcohol intoxication)

Question 13

Anger

Answer 13

• Secondary emotion
• Response to underlying issues (grief, depression, anxiety, fear)

MANIFESTATIONS
- Clenched fists
- Intense or avoidance of eye contact
- Passive-aggressive behaviors
- Continuous state of tension
- Low-pitched verbalization through clenched teeth
- Hypersensitivity, easily offended
- Lack of control or overcontrolled emotions
- Flushed face
- Yelling/Shouting
- Defensive response to criticism
- Intense discomfort
- Anxious, tense, angry facial expression

Question 14

Aggression

Answer 14

• Also arises from anxiety, guilt, frustration, suspiciousness

MANIFESTATIONS
- Pacing, restlessness
- Loud voice or shouting
- Increasing agitation with overreaction to environmental stimuli
- Angry mood disproportionate to situation
- Threatening body language
- Use of obscenities
- Panic anxiety leading to misinterpretation of the environment
- Destruction of property
- Verbal/physical threats
- Threats of homicide or suicide
- Suspicious and defensive posturing
- Acts of physical harm towards another person

Question 15

Assessing Anger and Aggressiveness

Answer 15

• PREVENTION IS THE KEY TO MANAGEMENT
• Those who become violent usually feel underlying helplessness

ASSESSMENT
- Past history of violence (Major risk factor)
- Client diagnosis (schizophrenia, major depressive disorders, bipolar, substance abuse)
- Current behavior

Question 16

Crisis Intervention

Answer 16

• Lengthy psychological interpretations are not appropriate
• RESOLVE IMMEDIATE CRISIS ON HAND
• GOAL IS TO RESTORE INDIVIDUAL TO PRE-CRISIS STATE

Question 17

Role of Nurse in Crisis Intervention

Answer 17

1. Assessment
   - Gather information about precipitating stressor. Assess physical/mental status. Determine if client is a threat to himself or others
2. Planning of Therapeutic Intervention
   - Identify nursing diagnosis and plan of action. Include the type of crisis, individual strengths, desired choices, available support.
3. Intervention
   - Remain focused on problem at hand. Discourage lengthy realizations of the client, set firm limits of aggression/destructive behaviors, guide individual through problem solving process. Unconditional acceptance, active listening, attending to immediate needs. (Reality-oriented approach)
4. Evaluation of Crisis Resolution and Anticipatory Planning
   - Evaluates outcomes if objective was achieved. Summarize what occurred and plan response if it happens again.