week 4 Flashcards
what is crisis?
an acute state of psychological imbalance resulting in poor coping w/ evidence of distress & functional impairment; main cause of crises are intensely felt threat/stressful event
*TLDR: struggle for equilibrium/balance r/t an obstacle/problem; causes functional impairment (ex: unable to eat or think well)
who is Erich Lindemann (40s)?
- studied the grief reactions of relatives of victims who died in the 1942 fire (made the foundation of the crisis theory & intervention)
- concluded that while acute grief is a normal reaction to a distressing situation, preventive interventions CAN eliminate/reduce the serious psych consequences of anxiety r/t crisis; he believed that the same interventions helpful in bereavement would be helpful in crises
who is Gerald Caplan (60s)?
- advanced the crisis theory & intervention strategies POSED BY E. LINDEMANN
- first identified 4 phases of crisis
- recognized that crisis can be viewed in many diff points
what are the 3 types of crises?
Situational: in response to external & unanticipated events
- ex: fam member died, sudden medical diagnosis, lost a job
Developmental: occurs during a developmental stage in life (midlife crisis)
- ex: leaving home for the first time
Adventitious/disaster: not part of everyday life
- ex: tornado, earthquakes, mass shootings
what are the 4 phases of crisis (CAPLAN)?
Phase 1
- initial encounter w/ situation
- anxiety is increased to stimulate problem solving skills & defense mechanisms in response to a problem/conflict
- use of healthy/unhealthy coping mechanisms
Phase 2
- threat persists, increased anxiety produces feelings of extreme discomfort & disorganization
- things haven’t changed [anxiety is increasing]
Phase 3
- anxiety escalates to severe panic levels & automatic relief behaviors may be mobilized such as withdrawal & flight
- issue is building more; self is still trying to find an acceptable solution & compromise to feel better
Phase 4
- problem stays unresolved; coping skills are ineffective
- individual may transition to a mental health emergency – state of overwhelming anxiety where the pt. experiences disorganization, depression, confusion, behavioral disturbances (triggers a mental health illness & might need to go to ED & seek help)
- potential safety risks – to self or others *have they had thoughts of suicide?
how long do crisis interventions take?
4-6 weeks only (only addresses immediate crisis); not a long-term therapy
- goal: to return pt. to at least pre-crisis level of functioning
what are the 2 conditions for crisis?
- The pts. view of the event as the cause of considerable distress, disruption, or both
- The pts. inability to resolve disruption by previously used coping mechanisms
what are the 3 precipitating/balancing factors & how do they inform a crisis?
IF 1 OR MORE FACTORS AREN’T PRESENT = DISEQUILIBRIUM
- Realistic perception of the event
- The way info is absorbed, processed, & used from the environment depends on each person
- If one has a realistic perception of an event & has access to adequate resources, restoration of homeostasis will occur & there will be NO crisis - Supportive resources
- Includes nurses, other HCPs, & community members who use crisis intervention (process focused on resolution of immediate issue through personal, social, & environmental resources) to assist those in crisis - Adequate coping mechanisms
- Coping skills are acquired from many sources (ex: cultural responses, modelling behaviours of others, & life opportunities that broaden experience & promote new adaptive coping responses)
what are the goals of early intervention?
- Stabilization of the situation
- Rapid resolution of the crisis experience
- Prevention of further deterioration/trauma
- Achievement of (at least) pre-crisis level of functioning
- Promotion of effective problem solving & realistic understanding of the experience
- Facilitation of a sense of self-reliance & belief in one’s ability to return to independence & apply new coping skills to future challenges
what are some factors that may compromise one’s ability to cope w/ a crisis event?
- Number of other stressful life events the person is currently coping with
- Presence of other unresolved losses
- Presence of coexisting psychiatric or medical problem
- Presence of excessive fatigue/pain
- Quality & quantity of one’s usual coping skills
what are the goals of crisis intervention?
RESOLVE, REGAIN, RETURN
- Resolve immediate (ROOT) problem *what’s brought pt. in today? (anxiety usually)
- Regain emotional equilibrium
- Return to previous/higher level of functioning
***RISK ALERT:
Suicides can happen impulsively in moments of crisis w/ a breakdown d/t inability to deal w/ daily stress
MAIN goal of care: return pt. back to usual homeostasis & re-establish equilibrium
what is Robert’s 7-stage model of crisis intervention?
assessment ->
establish rapport ->
identify problems/cause ->
explore feelings/emotions ->
explore alternatives ->
develop plan (individualized) *collaborative plan w/ pt. ->
follow up w/ plan
what are some examples of typical crisis situations?
- thoughts of suicide
- S/S of mental illness that’s out of the ordinary for the person
- psychosocial crisis or traumatic event (ex: divorce, loss of job)
- substance use/abuse
true or false: suicide is more prevalent with women
false; men have higher suicide rates
*lethality increases w/ age too; the elderly (esp. men) are at a higher risk
acute suicide risk: what s/s to watch for?
IS PATH WARM
- ideation
- substance abuse
- purposelessness
- anxiety/agitated
- trapped
- hope/helplessness
- withdrawal
- anger/agitation
- recklessness
- mood changes
what should the suicide risk assessment (SRA) consist of?
DONE IF SEE SIGNS OF SUICIDAL IDEATION/RED FLAGS *standardized in mental health settings (written in IPN)
- Reason for assessment/re-assessment
- Risk Factors
- Protective Factors
- Suicide Inquiry
- Interventions
- Next Reassessment
what are the immediate interventions for someone at risk for suicide?
- maintain patient’s safety
- implement hospital observation * as per protocol
- reduce the level of suicidal ideation
- development of Safety Plans
- initiate treatment for underlying disorder
- evaluate for all risk factors**
reduce level of social isolation - ensure thorough documentation in patient’s chart
what’s a safety plan?
document made w/ pt, which provides pt. w/ coping strategies & individualized options & resources they can use to respond safely, should they have a recurrence of suicidal ideation in the future.
Components of a Safety Plan
- Potential triggers
- Coping strategies
- Community resources to use or be aware of (ex: support group, Klinic, Crisis hotline)
- Personal protective factors (ex: family, friends, supports)
true or false: the phrase, “died by suicide” is suggested
true; this is preferred.
do NOT use:
- Completed suicide
- Committed suicide
- Successful suicide
- Attention-seeking behaviour
why do we do suicide risk assessments?
- new admission (required for every pt.)
- reassessment for all pts. w/ a hx of suicidal ideation
- changed psychiatrist & anxious about new person to work with
SRA: what are protective factors?
protects pt. from acting on suicidal thoughts
SRA: what are some internal/external factors that protects pt. from acting on suicidal thoughts?
Internal: ability to cope w/ stress, religious beliefs, frustration tolerance
External: responsibility to children or beloved pets, positive therapeutic relationships, social supports
what are the risk factors for suicide?
- Suicidal behaviour
- Current/past psychiatric disorders
- Key symptoms
- Family hx of suicide
- Precipitants/stressors/Interpersonal
- Change in treatment
- Access to firearms
&&& IS PATH WARM
