Ch10 Crises Intervention Flashcards
Phases in Crisis
Phase 1: stressor appears and anxiety increases. Previous problem solving techniques (PPST) are employed!
Phase 2: when PPST d/n relieve stressor anxiety increases further. Previous Coping techniques are attempted! Confused.
Phase 3: all possible resources are called on to resolve the problem. Individual tries to look at problem in different perspective.
Phase 4: with no resolution; tension mounts beyond threshold and may reach panic
Crisis Assumptions
Crisis is ACUTE and personal by nature (what an individual perceives). Crisis is potential for psychological GROWTH want can be precipitated by specific IDENTIFIABLE events. Crisis occurs in ALL individuals at one time in life
Class 1: dispositional crises
And acute response to an external situational stressor. Ex/ husband difficulty @work lets out anger on family- Jen afraid to invite friends over because mom is alcoholic REFER TO AGENCY ASSISTANCE/COUNSELOR
Class 2: crises of anticipated life transitions
Is that expected to happen?!? Normal life-cycle transitions that may be anticipated but the individual feels lack of control of. Ex/ student complaining of numerous VAGUE PHYSICAL COMPLAINTS-has low grades. Works over time. Wife lost job. Cannot study as much. INTERVENTION: PHYSICAL EXAM. FIND PROBLEMS AND VENT. REFER TO SERVICES OF FINANCIAL/OTHER. REASSURE AND GRIEF WORK/ FIND SELFWORTH
Class 3: crises resulting from traumatic stress
Crisis precipitated by unexpected external stresses over which the individual has LITTLE OR NO CONTROL. Ex/ Sally is kidnapped and raped. She is now constantly in fears. or home destroyed by tornado INTERVENTION: EXPLORE FEELINGS AND DISCUSS STAGES OF GRIEF, IDENTIFY SUPPORT SYSTEMS AND NEW METHODS OF COPING
Class 4: maturational/ developmental crises
Crises that occur in response to situations that trigger emotions R/T UNRESOLVED CONFLICTS IN ONE’S LIFE. INTERVENTION: HELP PT IDENTIFY THE UNRESOLVED DEVELOPMENTAL ISSUE
Class 5: crisis reflecting psychopathology
Emotional crises in which PRE-EXISTING PSYCHOPATHOLOGY has been instrumental in precipitating the crisis ex/ therapist tells client she’s moving and client with personality disorder wanders through traffic INTERVENTION: BRING ANXIETY LEVEL DOWN. VERBALIZE FEELINGS AND SOMEONE STAY W/PT TO REASSURE SECURITY AND SAFETY. POSITIVE REINFORCEMENT. POSSIBLY REFER TO LONG TERM CARE. THERAPIST SHOULD PURSUE ISSUE AT LENGTH
Class 6: psychiatric emergencies
No previous history of psychiatric problem. Crisis situations in which general functioning has been severely impaired. Ex/acutely suicidal individuals, drug overdoses INTERVENTION: CHECK VITALS,MAINTENANCE OF ADEQUATE AIRWAY. VENTILATE FEELINGS IN FAMILY THERAPY AND WORK ON COPING METHODS.
Crisis Intervention: Phase 1
Assessment: assess suicidal potential, assess support systems and coping methods:: nursing diagnoses are identified
Crisis Intervention: Phase 2
Planning or therapeutic intervention: appropriate nursing actions are selected for the identified nursing diagnoses. Goals are established for crisis resolution.
Crisis Intervention: Phase 3
Intervention: The actions that were identified in phase 2 are implemented. Use a reality-oriented approach. Identify what precipitated crisis. Show acceptance and set limits. Describe perception of the problem and compare. Explore feelings on things that cannot be changed. Find alternative coping strategies.
Crisis Intervention: Phase 4
Evaluation of crisis resolution and anticipatory planning: reassessment is made to determine if the stated objective was achieved. Can the individual describe a plan of action for dealing with stressors?
Anger Assessment
Frowning, clench fist, low-pitch through clench teeth, yelling, intense eye contact or avoidance of it, easily offended, defensive to criticism, passive-aggression, flushing face, intense discomfort-tension may lead to depression
Aggression Assessment
In contrast to anger: aggression is almost always goal directed. Pacing, restless, verbal physical threats, loud voice, threats of suicide, overreaction to environmental stimuli
Aggression (mild)
Sarcasm
Aggression (moderate)
Slamming doors
Aggression (severe)
Threats of physical violence against others
Aggression (extreme)
Physical acts of violence against others
The difference between anger and aggression
Aggression is almost always goal directed and has the aim of harm to a specific person or object
Intent
It refers to behavior that is INTENDED to harm or destruction (not an accident)
Risk factors
Past history of violence, client diagnosis, and current behaviors
Crises occurs when
An individual experiences a stressor and perceives coping strategies to be ineffective
Traumatic Event: Anxiety (panic) diagnosis OUTCOME:
Client will maintain anxiety at manageable level. ADMINISTER MEDS
Nursing Diagnosis: risk for self-directed or other-directed violence: OUTCOME
The client will not harm self or others. The client will verbalize anger rather than hit others.
Ineffective coping OUTCOME:
Client will be able to recognize anger in self and take responsibility before losing control.
Spiritual Distress OUTCOME:
Client expresses belief and values about spiritual issues. Refer to AA MEETINGS
Risk for post trauma syndrome OUTCOME:
Client demonstrates ability to deal with emotional reactions and individually appropriate manner. (Could have surviver’s guilt) ADMINISTER MEDS
Ineffective community coping OUTCOME:
Client demonstrates increased activities to improve community functioning
Dealing with aggressive pt
- ensure that sufficient staff are available/ call assistance
- Talk down patient
- Punch pillows or “I’ll stay with you” PHYSICAL OUTLETS
- Medicate
- Call code
- Restraint/seclusion
Crisis intervention: problem solving process
Confront the problem, identify realistic changes, explore coping strategies, identify various alternatives, weigh the benefits and consequences, select the most appropriate alternative.
Problem Solving Process
Confront the problem, identify realistic changes, explore coping strategies for what cannot be changed, identify various alternatives for coping w/the situation, weigh the benefits and consequences for each alternative, and select the most appropriate alternative
