Unit 4- Psych emergencies Flashcards
1
Q
Crisis intervention occurs when…
A
When nurses and other healthcare professionals assists to cope and assimilate with broad, creative and flexivle interventions. Typically during this time nurses take a directive role but as the patient begins to calm down the control shifts back to the patient
2
Q
What are some factors that limit a person’s ability to cope or problem solve?
A
- Stressful life events
- Mental illness
- substance abuse
- Hx of poor coping skills
- Diminished cognitive abilities
- Preexisting health problems
- Limited social support
- Developemnetal or physical challenges
3
Q
Erich Lindemann a crisis therorist believed…
A
He believed the same interventions utilized in bereavement would be helpful with other stressful events. He proposed a crisis intervention model as a major element of preventative psychiatry in the community
4
Q
Joint commission on mental illness and health addresses…
A
the need for community mental health centers throughout the country providing crisis services
5
Q
What are the stages of Roberts 7 stage model of crisis intervention?
A
- Plan and conduct crisis assessment (including lethality measures)
- Establish rapport and rapidly establish relationship
- Identify major problems (including the “last straw” or crisis precipitants)
- Deal with feeling and emotions (include active listening and validation)
- Generate and explore alternatives
- Develope and formulate an action plan
- (Crisis resolution)- follow up plan and agreement
6
Q
What is a developmental crisis?
A
Based of off Erik Eriksons stages of growth and development in which specific tasks must be masted to effectively reach maturity. When a person arrives at a new stage, previous coping syles are no longer appropriate and new coping mechanisms have not yet been met. This often leads to increased anxiety …
7
Q
What is a situational crisis?
A
Arises from external sources such as loss of a job, dealth of a loved one, unwanted pregnancy, a move, change of job, change in financial status, divorse and severe physical or mentla illness. Threat ends self- concept and self esteem
8
Q
What is adventitious crisis?
A
Like situational but on a larger scale, a community, natural disasters. national crisis such as terrorists attack, airplane crashes or crimes of violence such as shootings in public places
9
Q
What is an existential crisis?
A
Questioning life’s purpose such as marriage, dealth of a loved one, children becoming adults and leaving the home
10
Q
What is phase 1 of a crisis?
A
A person confronted bya conflict or problem that threatens the self-concept responds with increased feelings of anxiety. THe increase in anxiety stimulates th euse of the problem-solcing techiniques and defense mechanisms in an effort to solve the problem and lower anxiety
11
Q
What is phase 2 of a crisis?
A
If the threat persists and the usual defensive response fails, anxiety and discomfrot continue to rise. Indicidual functioning becomes disorganized. Trial-and-error attempts at solving the problem and restoring a normal balance begins.
12
Q
What is phase 3 of a crisis?
A
If the trial-and-error attempts fail, anxiety can escalate to severe and panic levels, and the person mobilizes automatic relief behaviors such as withdrawl and flight. Some form of compromise, such as redefining the situation or reevaluating needs, may occur in this stage, in order to come to some sort of resolution. An exmaple might be giving in on child visitation in order to end ongoing divorse proceedings
13
Q
What is phase 4 crisis?
A
- If the problem is not solved after considerable time and effors, skills have been ineffective and exhauseted, anxiety can overwhelm the person. In this final phase of crisis, serious personiality disorganization, depression, confusion, violence against others, or suicidal behaviour can devleop
14
Q
Our assessment for a patient in crisis includes. disaster response which includes assessing for
A
- Determine if there is a need for suicidal or homicidal ideation interventions
- Disaster response
- Rescue and evacuation, food and shelter, medical attention (triage) and physical safety
- Assistance with housing, jobs and trauma counseling
- Cognitive impairment
- Behavioral changes
- Emotional issue
- PTSD
15
Q
What does our assessment include of a patient in crisis?
A
- Patients perception (what happened and why they are in distress)
- Assess situational supports (who do you live with who has helped you in the past who do you trust)
- Assess coping skills- how have they coped in the past
- Assessment guidelines
- Warrent psychiatric tx or hospitalization
- What was the precipitating event if you dont already know
- Religious or cultural beliefs
- Does patient need education, new coping skills, enironmental manipulation, crisis intervention or rehabilitation
16
Q
What is our diagnosis/problem for a patient in crisis?
A
- Depressed mood
- Risk for self-destructive behavior
- Anxiety
- Caregiver stress
- Dysfunctional grief
- Impaired sleep
- Acute confusion
17
Q
What is our some outcome recommendations we can make to a patient in crisis
A
- Take short walks everyday
- Attend counseling sessions every 2 weeks
- Will return to school next semester
- Learn about her disorder
- Will call one person daily for support
- Suggest situational supports such as a teacher, neighbor, friend, hotline
18
Q
What are some interventions we can suggest to a patient in crisis?
A
- Provide a quiet environment
- Identify needed coping skills such as problem solving, relaxation, or job training
- Plan regular follow-up session
- Listen carefully using eye contact and supportive language
- Maintain patient safety
19
Q
What are our primary nursing interventions for a patient in crisis?
A
- Recognize potential problems
- Teach coping skills
20
Q
What are our secondary nursing interventions for a patient in crisis?
A
- Interventions during acute crisis
- Safety of a patient
21
Q
What are tertiary nursing interventions?
A
- REhab
- Community support
- Continued education
22
Q
What is critical incident stress debriefing (CISD)
A
example of a tertiary invervention directed toward a group that has experienced a crisi such as a school shooting or natural disaster. Usually happens in phases
23
Q
What is the inductory phase of CISD?
A
The purpose and overview of the debriefing process is presented. Confidentiatily is assured, team members are identified and questions anwsered
24
Q
What is the fact phase of the CISD?
A
Participants are assisted in discussing the facts of the incident from their perspective
25
What is the thought phase of a CISD?
All participants are asked to discuss their inital thoughts about the incident
26
What is the reaction phase?
Participants engage in freewheeling discussion about the worst, most painful parts of the incident
27
What is the symptom phase of the CISD
Particpants describe cognitive, phsyical, emotional or behavioral experiences at the time of the incident and ongoing
28
What is the teaching phase of CISD?
The feelings of the participants are affirmed. Guidance is provided regarding future symptoms and stress managment techniques
29
What is the reentry phase of CISD?
The debriefing process thus far is reviewd, an any new topics are discussed. Team members provide encouragement and resources for additional help, then summarize the experience
30
What is our evaluation of a patient in crisis?
1. is the patient safe and secure
2. Is the patient able to use healthy coping skills
3. Where is the patients level of functioning/anxiety
4. Is the patient relying on their support system
31
What are different types of domestic violence?
1. Emotional
2. Physical
3. Sexual
4. Neglect
32
What is the social learning theroy?
1. Children who witness abuse or is abused in the family of orgin learns that violecne is acceptable
33
What are some societal and cultural risk factors of domestic violence?
1. Poverty or unemployment r/t stress, not enough money to provide, overcrowding stress
2. Communities with inadequate resources and overcrowding
3. Social isolation of families r/t lack of support
4. Early parenthood r/t lack of patience
5. inadequate coping skills
6. family memebers with chronic health conditions
34
What are the risk factors of domestic violence perpetrators?
1. low self esteem
2. Poor problem-solving skills-- they dont know what to do so they take it out on others
3. History of impulsive behavior
4. Hypersensitivity (sees self as victim)
5. Narcissism (self-centered and lacks compassion)
6. Immaturity
7. Genetics
8. Substance abuse
35
What is IPV?
1. Occurs within the contect of an emotionally intimate relationship
2. Includes lesbian, gay, & transgender relationships
3. Includes physical abuse and or/psychologcal abuse
36
Examples of IPV include?
1. Phsycial injury
2. Psychological abuse
3. Sexual assault
4. Progressive social isolation (abuser will isolate partner because they dont want you to have the help and support needed to leave)
5. Stalking
6. Deprivation "money" "basic needs"
7. Intimidation and threats
8. instilling fear and anger to manipulate
9. Threats to hearm a pet, child or loved one
10. 30-61% of children are abused as well-- even just exposure is considered abuse
37
What is the number one reason of er visits for women
Domestic violence
38
What is the primary cause of homelessness in women?
DV
39
DV by women against men is...
under reported
40
Attempting to leave an abuser is the biggest cause of...
## Footnote
1.
female murders by their intimate partner
41
What do we need to know about teen dating violence?
1. 25-33% of adolescents report verbal,physical,emotional or sexual abuse from a dating partner each year
2. Extereme possessivness and jealousy
3. Physical or cyver stalking
4. Manipulation and control
5. Demeaning one's patner in front of others
6. Threatening to commit suicide
7. Forced intimacy or sex
42
What are characteristics of the battered partner?
1. Lives in terror
2. May realiate in self defense
3. Victi or irrational jealousy, isolation, verbal and physical abuse
4. Feelings of low self-esteem and powerlessness are common
5. "brain washing" occurs and self hatered develops
43
What is the denial and blame characteristics of a violent partner?
Denies that abuse occurs, shifts reponsibility of abuse to partner; make statements that victim caused the abuse or caused the abuser to react that way
44
What is emotional abuse characteristic of a violent partner?
Belittles, criticizes, insults, uses name calling, undermines
45
What is control through isolation?
Characteristis of a violent partner limits family or friends, controls activities and social events, tracks time or milage on car and activities, stalk at work, takes to and from work or school, may demand permission to leave the house
45
What is control through intimidation?
Characteristic of a violent partner; uses behaviours to instil fear, such as vile threats, breaking things, destorying property, abusing pets, displaying weapons, threatening children, threatening homicide or suicide and increasing phsyical, sexual or psychological abuse
46
What is control through economic abuse?
Characteristc of violent partner where the abuser controls money, makes partner account for all money spent; if partner works, calls excessively, forces partner to miss work; refuses to share money
47
What is control through power?
Characteristics of violent parner where the abuser makes all descisions, defines roles in relationship, treats spouce like a servant, takes charge of the home and social life
48
What are the characteristics of a battered parnter in IPV?
1. Eventually believes that if she does or says the right thing the abuse will stop. If she does not do anything wrong abuse will not occur. Me be recreating patterns from abuse during childhood that are familiar
2. Becomes psychologically devasted and begins to believe partners words. Lowered self-esteem. Unhealthy bond with the abuser
3. Gradually loses sight of personal boundries for self, children, over time becomes unable to accurately assess the siutation without validation from supportive network
4. Results in constant fear and terror that becomes cumulative and oppressive; contemplates suicide, contemplates homicide, occasionally completes suicide or homicide in self definse. Post traumatic symptoms develop
5. Economic and emotional dependency may result in depression, high risk for secret drug or alchool abuse. If she works, frequently loses job due to her partner stalking and harassing. Is unable to save money to leave.
6. Continues to lose sense of self, continues to lose sense of self, becomes unsure of who she is defines self in terms of partner, children, job others lack personal power
49
The batterer may be....
1. Well adjusted from the outside
2. Possessive and jealous
3. Male supermacy
4. have alcohol problem or drug abuse
5. without tx behaviours esculate
6. abuses someone less powerful or more vulnerable helps the violent partner feel more in control and powerful
50
What are the cycles of violence?
1. Tension-building phase
- Abuser: edgy has minor explosions
- May become verbally abusive; minor hitting, slapping, and other incidents begin
- Victim: feels tense and afriad, like "walking on eggs
- Feels helpless becomes compliant accepts blame
2. Serious battering phase
- The tension becomes unbearable; the victim may provoke an incident to get it over with
- The victim may try to cover up injury or may look for help
3. Honeymoon phase
- Abuser: loving behavior, such as brining gifts and flowers and doing special things for victim. Contrite, sorry, make promises to change
- Victim: trusting, hopeing for change, wants to believe partners promises
51
Why do abused partners stay?
1. Lack of financial support
2. Fear of being murdered
3. Lack of a support system
4. Depression/low self-esteem
5. Religious beliefs against divorse
6. Believe they deserve abuse
7. Stay for the sake of the children
52
What does our assessment for IPV consist of?
1. abused partners may be seen in the ED, urgent care clinic, primary care office or outpatient psychiatric practice
2. American academy of family physicians recommends screening for IPV women of reprodective age at each visits
3. Training for law enforcement and health care professionals to help IPV people
4. SIgns
- Discrepancy between injury and explanation
- minimization of injury
- fearfulness
- complete physical assessment
- Psychological signs
5. Assess patient alone
53
What is our nursing diagnosis/problem for IPV
1. Victim of IPV
2. Risk for spiritual distress
3. Post trauma respose
4. Lack of support
54
What is our nursing outcome for IPV
Safe environment
Create safety plan
55
What is our nursing plan and implementation of IPV?
1. Ensure that medical attention is provided to patient. Document injuries using body map. Ask permission to take photos
2. Set up interview in private and ensure confidentilality
3. Assess in nonthreatening manner informtion concerning;
- sexual abuse
- phsyical abuse
- emotional abuse
- abuse of children
- drugs of abuse
- thoughts of suicide or homicide
4. Encourage patient to talk about the battering incident without interruptions, in a kind and gentle manner, without judgmet
5. Ask ho wthe patient is fairing with children in the home
6. Assess if the patient has a safe place to go when the violence is esclating. If she does not, include a list of shelters and safe houses with other written information. sometimes can provide small cards that can fit in a shoe
7. Call law enforcement to make a report and assist the victim
8. Throughout work with battered sopouses, emphasie that the beatings are not their fault
9. encourage patient to reach out to family and friends who they might have been avoidign
10. Know psychotherapists in the community who have experience working with battered spouces or partners
11. If the patient is not ready to act currently, provide a list of community resoruces.
56
What should we know about child abuse in general?
1. A report of child abuse is made every 10 seconds
2. 4-7 children die everyday in the US as a result of child abuse
3. 80% of deaths are under the age of 4
4. Mandatory to report child abuse even if its only a suspicion
5. Overindulgence can be considered a form of chld abuse
57
What might our assessment of a child suspected of being abuse show?
1. Timid or fearful of parent or caregiver
2. Disheveled
3. History of absenteeism
4. After inital intervview of parent, interview child alone
5. Open ended question
6. Reassure child it wasn't their fault
7. proide a complete physical assessment of the child
8. the use o f dolls or drawing might help the child to tell how the injury or accident happen
58
What types of child abuse are there?
1. Physical abuse
2. Neglect
3. Sexual abuse
4. Emotional abuse
59
What is our diagnosis/problem and outcomes for child abuse?
1. Outcome-child safety and well being
2. Diagnosis
- Victim of child abuse
- malnutrition
- risk for impaired child development
- delayed growth and development
3. Planning and implementation
- Understand that the child does not want to betray his or her parents
- notify cps
- collect physical evidence
- document carefully
- treat any injury
60
How do we talk to parents/cargivers of a child suspected of having child abuse?
1. Adot a nonthreatening, nonjudgmental relationship with parents
2. Be direct, uderstanding and professional
3. Be honest about having to report to CPS
4. open ended questions
61
What are some characteristics of an abusive parent?
1. history of violence, neglect, or emotional deprivation as a child
2. Low self-esteem, feelings of worthlessness, depression
3. Poor coping skills
4. Social isolation, may be suspicious of others
5. Few or no friends, little or no involvment in social or community activities
6. Involved in a crisis such as unemployement,divorce, financial difficulties, abusive relationship
7. Rigid, unrealistic expectations of childs behavior
8. frequenlty uses harsh punishment
9. History of severe mental illness, such as schizophrenia
10. Violent temper outbursts
11. Looks to child for satisfaction of needs for love, support, and reassurance
12. Projects blame on the child for his or her problems
13. lack of effective parenting skills
14. Inability to seek help from others
15. Perceives the child as bad or evil
16. History of drug or alcohol abuse
17. Feels little or no control over life
18. Low tolerance for frustration
19. Poor impulse control
62
What should we know about elder abuse?
1. Incidence of elder abuse will also increase proportionally
2. 10% of older adults are mistreated annually. 70-80% not reported
- individuals
- institutions
- self neglect
3. People older than 80 years of age are 2-3 times more likely to suffer abuse and neglect
4. Mandatory reporting in all states but 6
5. For adult protective service to intervene, elder has to be deemed to unale to care for self
63
What are give types of elder abuse?
1. Phsycial abuse: The infliction of physical pain or injury through slapping, hitting, kicking, pushing, restraining, overmedicating or sexually abrusing
2. Pschological abuse: The infliction of mental anguish through yelling, name calling, humilating, or threatening
3. Financial abuse or exploitation: The misuse of someone's property and resources by another person or refusal by a caregiver to provide needed resources
4. Neglect: failure to fulfill a caretaking obligation to provide nutrition, hydration, shelter, clothing, utilities, medical services, or other basic needs. This category may also include self-neglect
5. Sexual abuse: Nonconsensual sexually molesting, touching, inappropriate comments or exposure to videos or acts, or actual rape
64
What are the characteristics of the abuser of an elder?
1. caretaker stress and burden
2. middle-aged adult child or family member
3. Caregiver dependnet on the elder
4. May be using substances
5. may have been abused as children
6. In instituations, abuse may be from other residents
65
What might our assessment of elder abuse show?
1. Fear of being alone with caregiver
2. Malnutrition or dehydration
3. Bedsores, skin tears, bruises, swelling or fractures
4. Passive, withdrawn or emotionless behavior
5. Appears overmedicated
6. Vaginal or rectal pain, tears, bleeding or STI
7. Concern oer finances
8. Transfer of property who lacks mental capacity to do so
9. valubles missing
66
What are our diagnosis for elder abuse?
1. Victim of elder abuse
2. Victum of elder neglect
3. Impaired nutrition status
4. Physical injury from abuse
67
What are our nursing outcomes for elder abuse?
1. Abuse has ceased
2. plans in place to maintain safety
3. Less anxiety and tension between patient and caregiver
4. respite, sharing for responsibilities for caregiver
68
What is our planning and implementation for elder abuse?
1. Medical services
2. Contact adult protective services
3. Family or caregiver support
4. ALternate housing
5. notify community agencies
69
What do we need to know about anger?
1. Varies according to cultural perceptions and social background
2. Is a normal human emotion, is unplanned and is a reaction to a stressors
3.Varies in intensity from mild irritation to intense fury and rage
4.Is a response to feelings of hurt, fear or vulnerability threat to one's physical or emotional needs or a challenage
5.Can be constructive if assertive communication and critical reasoning is applied
6.Unhealty if it alters a person's functioning or relationships, or if it escalates to agression and violence
70
What is agression and violence
1. Can be defined as hurting others physically or psychologically
2. Can be approrpiate and self protective
3. Can be overt or covert
71
What do we need to know about violence?
1. Anger is not always its orgin
2. Intion of doing harm
3. Expression of hostility and rage with the intent to injure or damage
4. Leads to significantly phsyical and psychological harm to others
5. Bullying is a common form of violence
72
What do we need to know about bullying?
1. Intended display and use of violence
2. Defined as offensive, intimidating, malicious, condescending behavior designed to humiliate and terrorize
3. Peristent systemic violence toward and individual or group
4. Bullying in general is between persons with diffrent levels of authority
5. Lateral bullying is bullying among equals
73
What are some examples of bullying behaviors?
1. Unwanted and invalid critism with excessive monitoring of other's work
2. Gossiping,spreading lies or false rumors, derogatory nicknames
3. Taking credit for anothers work and blocking career pathway and other oppurtunities
4. Publicly making derogatory comments about staff memebers, their work including eye rolling, dismissive behavior in front of others
5. Using sarcasm or ridicule
6. Blaming someone without factual justification
7. being condesending or patronizing
8. breaking confidences
9. usuing phsyical or verbal inneudo or abuse, usuing foul language, raising one's voice, humuiliating in front of colleages
74
what is the prevalence and comorbitity of anger, agression and violence?
1. Workplace violence in healthcare is higher than that found in private secor industrace
2. Workplace violence against nurses is a major occupational health problem
3. Most prequently in psychiatric units, eds, waiting room and geriatric units. Nurses in eds experience the highest rate of on the job violence
4. Nurocognitive disorders can result in agited agressive or violent behavior
5. Psychiatric patients are 10 times more likely to be victims of violence and only 3-5% of violent acts can be attributed to the mentally ill
6. those with antisocial personalility disorder and those with substance use disorders are more prone to violent behavior
7. A perivious history of violence is a stronger predictor of future incidents of violence not mental health status
75
Violent adult behavior is linked to...
childhood agression such as setting fires, being cruel to animals or agressive to peers or adults
76
Many violent agressive adults were the...
target of violence in childhoon
77
What is the strongest contributing factor to violent behaviors?
Substance/alcohol abuse
78
True or false: Those of lower social economic are more likely to be victims and perpetrators of violence
true
79
Where are socially angry reactions learned are reinforced?
Family and societal norms
80
What are some neurobiolgoical factors of agression
| review
1. limbic system is responsible for our emotions Regulates the behavior of agression in humans and animals, and it judges events as either aversive or rewarding
2. amygdala supports agression and violence and responds to perceived threats
3. hypothalamus is stimulated by anger and causes the body to respond anticipated harm
4. Prefrontal cortex receives messages from the limbic system and modulates the aggressive impulses in a social context, making judgments of these impulses
5. MRIs and PET scans of the prefrontal cortex show changes in violent indiiduals. A reduction in the gray matter and decreased blood flow and metabolism are seen
81
What are some neurotransmitter factors with agression?
1. Low serotonin funciton = increased impulsie agression
2. Increased norepinephrine = enhances vigilance, and umpulsivity and violence
3. Higher degrees of dopamine storage correlates with higher degrees of agressive responses
82
What are genetic and cultural considerations of agression and violence?
1. genetic factor alone doesnt contribute to violence although there is a genetic component to violence
2. Cultural considerations
3. Males are far more viiolent than females
4. Highest prevenalnce of violence is lower economic status males, have substance abuse disorders and or have psychotic or organic medical disorder
5. Subcultures were healthy, appropriate and effective ways of dealing with frustration, anger and agression are not modled and uses intimidation and agression as acceptable reinforce the use violence
83
What might our assessment of agression,violence show?
1. Ask the patient of previous violence, substance abuse or psychotic behavior
- have u ever thought of harming someone
- Have you ever seriously injured another person?
- WHat is the most violent thing you have done
- Do you have a plan to harm someone
- Does the patient have the means to carry out this plan
- Is the patient male ages 15-24 years of age with low socioeconomic status and weak support system
84
What are predictive factors for violence
signs and symptoms that usually (but not always) precede violence
1. Angry,irritable affect
2. hyperactivity; most important predictor of imminent violence (pacing, restlessness, slamming doors)
3. Increasing anxiety and tension; clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have SOB, sweating, and rapid pulse rate)
4. verbal abuse; profanity, agrumentativeness
5. loud voice, change of pitch or very soft voice forcing others to strain to hear
6. intense eye contact or avoidance of eye contract
7. Recent acts of violence, including property violence
8. Stone silence
9. suspiciousness or paranoid thinking
10. alohol or drug intoxivcation (withdrawal)
11. Possession of a weopon or object that may be used as a weapon
12. Milieu of characteristics conductive to violence
13. loud
14. overcrowding
15. staff inexperience
16. provocative or controlling staff
17. poor limit setting
18. staff inconsistency
85
What might our assessment on violence show
1. A history of violecne is the best predictor of future violence
2. Paranoid ideation and frank psychosis (command hullucinations)
3. Patients who are hyperactive, impulsive predisoposed to irritability are at higher risk
4. Recongize cues
5. Know triggers
6. assess place in agression cycles
86
What are the stages of violence?
1. Preassaultive stage
2. Assaultive stage
3. Post assultive stage
87
What do we need to know about the preassultive stage of violence?
1. patient becomes increasingly agitated
2. Verbal intervention
3. Maintain patients self esteem and dignity
- Patients are doing the best they can
- Patients want to improve
- Patients bevior makes sense to them
4. Things to say:
- It sounds like you are in pain and confused
- Youre here to get help and we are going to figure out whats going on
- Let us help you do not be afraid
88
What should we know about the assalutive stage?
1. Medication, seclusion and restraints
2. 10 foot role is important
89
Restraint and seclusion can be used under these circumstances (requires and order)
1. Patient presents a clear and present danger to self and others
2. Patient requests to be in seclusion or restrained
3. Patient has been legally detained for involuntary treatment and is an escape risk
4. alternative interventions has been attempted prior to seclusion or restriant
- trauma informed care
- verbal intervention
- decrease in stimulation
- presense of significant other
- sitter with 24 hours observation
- seclusion and restraints require training and proof of competency
- use least restrictive restrain
- know unit and hospital policy
90
What are medications used for acute agressive episodes?
1. Benzodiazepines
2. Antispchotics
- Ziprasidone IM
- Olanzapine IM or orally disintergrating
- Haloperidol
91
What is post assaultive stage?
When the patient no longer requires seclusion and or restraints
1. Review the incident with the patient
2. Discuss precipitating factors
3. Plan alternative ways of responding
92
What is discussed in critical incident debriefing?
1. Was quiality care provided
2. Could we have done anything to prevent the violence
3. If yes, what could we have done instead
4. Did the team respond as a team
5. Is there a need for more education?
6. Fear and anger must be discussed to prevent long term psychological effects
93
What does our documentation of a violent episode include?
1. Reason for seclusion and restraints
2. Assessment of behaviors occured during the preasaultive and assultive stage
3. All nursing interventions for each stage and patients response
4. Evaluation of interventions
5. Detailed description of behavior of patient for each stage
6. Name of provider who came and assessed patient
7. Interventions performed while patient was in restraints or seclution
8. Any injuries to patient or staff
9. how was patient was reintergrated into the unit
94
What should we know about anticipating anxiety and anger
1. Hosptials can be intimidating to some people. They feel not heard, out of control of the sition and tired. SOme resort to violence because of poor coping skills
2. Patients with chemical or alcohol dependency may be anxious because they do not have access to their substance
3. Provision of comfort items (certain foods, decaf drink) before requested may decrease anxiety. providing clear communication which decreases abiguity may also decrease anxiety
4. Other interventions may be use of distractions such as magazines video games. Keeping a routine helps anxiety. no surprises
5. For patients who become angry, the nurse should leave the room and inform the patient that they will return when the sitution is clamer. No chastising, threatening or being punitive
6. Withddraw attention from abuse and replace with compassion and emtoinal support
95
What should we know about patients with neurocognitive deficits?
1. Patients with cognitive deficits are at risk for acting aggressively. This can result from delirum, dementia or brain injury
- Reality orientation and medication
2. Catastrophic reaction- scream, strike out, or cry
- Remain clam, smile, use gentle touch, keep your voice soft
- Say the patients name. Ask the patient what they need. Bathroom?
- Use short simple sentences
- Decrease stimulus
96
what is grief?
It is the response to the loss
97
What is uncomplicated grief
normal progression through grief
98
What is anticipatory grief?
Grief that starts in advance for both patient and family
99
What is disenfranchised grief?
1. Not socially sanctioned, openly acknowledged or publicly mourned.
100
What is complicated grief
grief work is unresolved and occurs when individuals have difficulty coming to terms with their loss and experience phenomna outside the normal grief reaction. which impaires the individuals ability to function in social or occupational situations or resume previous roles
101
what is ambigous loss?
No resolution and no predictable ending or closure. Phsyical body is absent but person is still psychologically present (plane crashes, MIA)
second kind- body is present, but person is physicologcally changes dusch as dementia
102
What are the four tasks of mourning
1. accept the reality of the loss
2. Process the pain of grief while caring for the self
3. Adjust to a world without the deceased
4. Find a meaniful connection with deceased while starting a new life
103
