388: Week 5 - Suicide Assessment/Therapeutic Relationships/Crisis Intervention Flashcards
What are the 8 steps of a “Suicide Risk Assessment”?
- Direct questioning
- Assess suicidal thoughts on a scale of (1-10)
- Ask if they have ever attempted to harm/kill them self before
- Do they have a plan? What is their plan (Method, time place)?
- Are they able to access/carry out that plan (i.e. do they have immediate access to a gun, drugs, etc.)
- What up to this point has allowed them to choose life over death?
- Who would they call if they decided to act on their suicidal thoughts?
- Give suggestions for resources (24 hr crisis center, ER, psychiatrist/psychologist)
What are the risk factors for suicide?
- Prior suicidal thoughts, behaviors, attempts
- Suicide plan -> this is the most significant risk factor!!
- Lack of resources (social supports) -> Formal = no access to formalized health care such as nurse, physician, social workers; Informal = family & community support systems
- Anniversary date of death of a loved one
Describe some of the “Do’s” when completing a Suicide Risk Assessment
- understand yourself physically and mentally (recognize when you are stressed or burned out)
- take care of yourself (physically, psychologically and spiritually)
- Understand the boundaries of intervening with suicidal ind
- Debrief w/ colleagues (ensure safety, etc.)
- Know what resources are available to you and for the client
Describe some of the “Dont’s” when completing a Suicide Risk Assessment
- make promises that you cannot keep (i.e. confidentiality)
- allow your work to consume you
- jeopardize your own safety
- fall prey to myths regarding suicide (talking about suicide may cause the person to attempt suicide, children are too young to kill themselves)
What are the different types of relationships that may exists?
- Social
- Intimate
- Therapeutic
What are the characteristics of a “Social” relationship?
- primary function is for friendship or task accomplishment
- needs are mutually met
- communication is often superficial or is based around providing advice or simply for conversation that is focused on shared interests
What are the characteristics of an “Intimate” relationship?
- b/t 2 ind w/ an emotional commitment to one another
- mutual needs are met (there is an interdependence on one another)
- Communication is based on the sharing of: personal information, intimate desires, life-long goals/desires
What are the characteristics of a “Therapeutic” relationship?
- established b/t a nurse and a patient
- goal is to enhance growth of the patient
- attention is focused on issues and concerns regarding the patient
- Communication: therapeutic techniques are used to help client identify and explore their own needs, set goals, assist in development of new coping skills and to encourage behavioral change
What are the differences b/t social and therapeutic conversations?
- focus and purpose is different
- conversation is one-sided
- specific boundaries exist re: personal info (RN’s self-disclosure), dress, setting and use of touch
- TR convos use open-ended questions freq
- open body language is maintained by RN
- RN focuses more on posing questions as opposed to giving advice
- avoid asking “Why?” as it may be perceived as judgmental
What are key elements in establishing and carrying out therapeutic conversations?
- Est trust and resp the client
- Engage w/ the pts
- Set focus and boundaries of the interaction
- Explore client’s understanding of what is going on… why the interview is taking place (setting the stage)
- allow and encourage client to express their thoughts and feelings
- refrain from asking numerous questions and not allowing adequate time for client to reflect and respond
- Attend to the pace of the interaction
What boundaries should be established during a therapeutic relationship?
- clothing
- use of touch
- male/female boundaries (especially with histories of sexual abuse)
- contact outside of the health care setting
- choose appropriate interview location (provides privacy, but is also safe for you)
- avoid charting judgments but record all content of conversations
What are the characteristics of “Stress”?
- It is positive in normal amounts
- Should be tolerable/tolerated by the body’s response system and ind should have effective strategies to cope
- Can become Toxic when it is recurrent and ind lacks resources/methods to mitigate/reduce it
What defines/characterizes a “Crisis”?
-psychological disequilibrium in which one cannot escape or solve with customary solving resources
-increased chance when we are vulnerable to stress, reached when emotional resources and problem solving abilities are taxed, and when we are unable to perceive solutions to manage or reduce stressors
CHARACTERISTICS:
-a turning point
-problem or conflict
-situation perceived as a threat
-state of psychological disequilibrium (as stated above)
-self-limiting (acute stage ends around 4-6 weeks)
What are the 3 types of Crises?
- Maturational
- Situational
- Adventitious
What is a “Maturational Crisis”?
- one related to growth and/or developmental theories
- ex. loss of identity as we age, mid-life crisis, loss of structure with retirement
