Ch. 10 Intervening in crises part 2 (Test 2) Flashcards
What is Phase 2 of crisis intervention?
Planning of therapeutic intervention. From the assessment data, the nurse selects appropriate nursing diagnoses that reflect the immediacy of the crisis situation.
In what stage are desired outcome criteria established?
Phase 2
When appropriate nursing actions are selected, what is taken into consideration?
The type of crisis as well as the individual’s strength and available resources for support
What is phase 3 of crisis intervention?
Intervention. The actions identified in the planning phase are implemented.
What approach is used in phase 3?
Reality oriented
How is a rapid working relationship established? In what phase does this occur?
By showing unconditional acceptance, by active listening, and by attending to immediate needs. Phase 3.
What is the basis for change in phase 3?
A problem solving model becomes the basis for change
What is phase 4 of crisis intervention?
Evaluation of crisis resolution and anticipatory planning. A reassessment is conducted to determine whether the stated objectives were achieved.
What is developed in phase 4?
A plan of action is developed for the individual to deal with the stressor should it recur
Anger can be identified by a cluster of characteristics that include:
Frowning, clenched fists, low pitched voice, yelling and shouting, intense (or no) eye contact, easily offended, defensive response to criticism, passive aggressive behavior, flushed face, emotional over control, intense discomfort
Aggression can be identified by a cluster of characteristics that include:
Pacing, restlessness, verbal or physical threats, threats of homicide or suicide, loud voice, argumentative, tense facial expression and body language, increased 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
A major difference between anger and aggression is what?
Intent. Aggression refers to behavior that is intended to inflict harm or destruction.
What is the key issue in management of aggressive or violent behaviors?
Prevention
What three factors are important considerations in identifying extent of risks?
Past history of violence, client diagnosis, current behaviors
What is the most widely recognized risk factor for violence in a treatment setting?
Past history of violence
The most common client diagnosis associated with violence are?
Substance abuse/intoxication, schizophrenia, mood disorders, dementia, antisocial/borderline/and intermittent explosive personality disorders
Certain (what?) are predictive of impending violence and have been called a (what?); they include…?
Current behaviors. Prodromal syndrome. They include anxiety and tension, verbal abuse and profanity, and increasing hyperactivity
Specific behaviors associated with the prodromal syndrome include:
Rigid posture, clenched fists and jaws, grim and defiant affect, talking in a rapid raised voice, arguing and demanding, using profanity and threatening verbalizations, agitation and pacing, and pounding and slamming
Nursing diagnoses for inappropriate expression of anger or for aggressive behavior include:
Ineffective coping, risk for self directed or other directed violence
What are identified as criteria for evaluation regarding anger and aggression management?
Outcome behaviors
Anger and aggression management interventions:
Remain calm, set verbal limits on behavior, keep diary of anger, avoid touching the client, help determine source of anger, ignore derogatory remarks, help find alternative ways of releasing tension, role-model, observe for escalation of anger, when behaviors are observed first ensure that sufficient staff are available
Techniques for dealing with aggression include:
Talking down, physical outlets, medications, call for assistance, restraints, observation and documentation, ongoing assessment, staff debriefing
Evaluation of anger and aggression management
Evaluation consists of reassessment to determine if the nursing interventions have been successful in achieving the objectives of care
What is a common feature of disasters?
They overwhelm local resources and threaten the function and safety of the community
Disasters leave victims with…?
A damaged sense of safety and well being and varying amounts of emotional trauma
Disaster nursing assessment- grieving is a (what?) response:
Natural response
Common behavioral responses to disaster include:
Anger, disbelief, sadness, anxiety, fear, sleep disturbances, and increase in alcohol, caffeine, and tobacco use
Children after disaster may experience:
Separation anxiety, nightmares, and problems with concentrating
Disaster nursing diagnoses
Risk for injury, risk for infection, anxiety (panic), fear, spiritual distress, risk for Post-Trauma Syndrome, ineffective community coping.
Disaster nursing outcome identification
Outcome behaviors are identified as criteria for evaluation
Disaster nursing interventions are aimed at?
- 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 appropriately manner. 4. Promotion of activities to improve community functioning.
Evaluation of disaster nursing
Evaluation consists of reassessment to determine if the nursing interventions have been successful in achieving the objectives of care
