Chapter 9: Crisis Intervention - Exam 2 Flashcards
what is a crisis?
a sudden event during which usual coping mechanisms cannot resolve the problem, the crisis disturbs homeostasis
what are the phases in crisis development?
- exposed to precipitating stressor
- previous prob-solv tech dont work, anxiety increases
- all possible resources are called on to resolve problem
- if no resolution, tension mounts beyond threshold to a breaking point, leads to drastic results for individual
what do we assess (in patients) during stressful or crisis events
- individual perception of the event
- availability of support
- adequate coping mechanisms
what is a dispositional crisis
acute response to external stressor
eg stressful day at work then yell at family
what is traumatic stress
stress from a traumatic event e.g., sexual assault, house fire, etc
what is crisis reflecting psychopathology?
seen in personality disorders, extreme responses to crisis e.g., patient threatens to kill themselves when they get broken up with.
what is the minimum therapeutic goal of crisis intervention
psychological resolution of the individual’s immediate crisis and restoration to at least the level of functioning that existed before the crisis period
Phases of intervention - how will a nurse approach the crisis
you guessed it…use the nursing process
assesss
plan therapeutic intervention
intervention
evaluate
what is comorbidity?
the simultaneous presence of two or more medical conditions
Individuals with psychiatric disorders are five times more _____ than those without
violent
it is thought that anger is a _______ emotion
secondary; typically masks grief, pain, saddness
a major difference between anger and aggression is ________
intent
anger is an ________ while aggression is an _________
emotion; action
What is the best predictor of a patient being violent
having a history of violence
Robert’s Seven Stage Crisis Intervention Model
(sounds like we need to memorize it)
Page 179 Table 9.2
- psychosocial and lethality assessment
- rapidly establish rapport
- identify the major problem or precipitating factors
- deal with feelings/emotions
- generate and explore alternatives
- implement action plan
- follow up
Important to remember for your own (the nurse’s safety)
don’t ever position yourself in a room you can’t get out of
always trust your instincts - if you don’t feel safe. Get help.
Steps to handle aggressive or escalating behavior
- calmness
- encourage patient to express feelings
- personal space
- avoid accusatory statements
- offer client choices
- reassure their safety
what is a B52
- Pharmacological intervention
- IM or PO
- benadryl, 5mg haladol, 2 mg ativan
- used in acute crisis (not something given around the clock)
This type of therapy is seen to be especially helpful for male psychiatric patients who are experiencing violence/anger
dialectal behavioral therapy
what does dialectal mean?
adjective
1.
relating to the logical discussion of ideas and opinions.
2.concerned with or acting through opposing forces.
‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it’s possible for you to achieve both of these goals together.
what is disaster nursing
disasters such as 9/11, hurricane Katrina, Nashville floods in 2010
disasters leave victims with damaged safety, limited resources, emotional trauma
dispositional crisis
an acute response to an external situational stressor
example - patient is an abusive relationship and flees their abuser
crises to anticipated life transitions
normal life cycle transitions that may be anticipated but over which the individual may feel a lack of control
example - Tommy and Jane have just had a baby, money is tight and tommy has to work extra hours to support his family
Crises resulting from traumatic stress
crisis precipitated by an unexpected external stressor over with the individual has little or no control and as a result of which he or she feels emotionally overwhelmed and defeated
example - ava left work one night and was sexally assaulted by 2 men, her physical wounds have healed but ava in unable to eat, sleep, or funtion.
Crises maturational and developmental crisis
crises that occur in response to failed attempts to master developmental tasks associated with transitions in life
jane is under a lot of stress due to her mothers illness, jane has a young child and is increasingly disorganized and anxious, she believes she is a bad mother and should give up her child for adoption
crises reflecting psychopathology
a crisis that is influenced or triggered by pre-existing psychopathology.
karen was diagnoised with borderline personality disorder and she fears abadonment. her doctor tells her that she will be moving out of state and karen freaks out. karen says everyone leaves her and that she should just disappear
prodromal syndrome
not a diagnosis, a technical term.
indicates escalating behavior characterized by anxiety, tension, verbal abuse, profanity, hyperactivity, clenched fists, arguing, demanding, pacing, agitation
This is the warning stage. The event hasn’t happened yet and you may have not even recognized that it could happen. This is the time to assess the impact an actual crisis could have on your company, employees, customers, suppliers, operations and bottom line
most assaultive behavior is preceded by a period of increasing _________________
hyperactivity
true or false; NANDA does not include a seperate nursing diagnosis for anger because anger is not an unhealthy response
true
anger is one of a broad range of normal emotional responses but becomes unhealthy only when behavior is unsafe
a nursing diagnosis might be:
ineffective coping related to anger and feelings of blah blah blah
rick for self-directed or other-directed violence related to inadequate anger management
the best intervention for a crisis (related to a patient’s anger/aggresion) is ____________
prevention
nurse must assess patient history of violence and violence potential, current behavior
anger is often described as a _________ emotion
secondary
what are some therapeutic nursing interventions when a patient is experiencing a crisis
reality-oriented approach,
remain with individual
show acceptance, active listening
set firm limits on aggresive behavior
acknowledge patient’s feelings
Brittney and Ethan have been married for 3 years and have a 1 year old daughter. Ethan has been having difficulties at work and takes his anger out on Brittney to the point of physical abuse. One day Ethan slaps Britney. When Ethan leaves for work Britney takes the baby to an ER not know what to do.
This is an example of what type of crisis?
Dispositional crisis. An acute response to an external situational stressor.
