Week 5 Flashcards
crisis causes..
- disequilibrium
a crisis is… (5)
- a state of psychological disequilibrium in response to an obstacle or problem
- usual resources (coping, supports) are ineffective
- acute emotional turmoil, disrupted sense of self
- functional impairment, difficulty problem solving
- anxiety, tension rises, disorientated
what are 2 types of crisis
- situational
- developmental
what are examples of a situational crisis
- MVA
- fire
- fail an exam
- breakup
what are examples of developmental crisis
- birth of a new baby
- young adult moving away from family
- retirement
what is developmental crisis
- natural things which occur over the course of human development
how many phases of crisis are there
4
what is phase 1 of crisis
- anxiety is increased to stimulate problem solving skills & defense mechanisms in response to a problem or conflict
what is phase 2 of a crisis
- threat persists
- increased anxiety produced feelings of extreme discomfort and disorganization
describe phase 3 of crisis
- anxiety escalates to severe/r panic lvls and automatic relief behaviors may be mobilized such as withdrawal and flight
describe phase 4 of crisis
- problem remains unresolved/coping skills are ineffective
- the individual may tranition to a mental health emergency
what is a mental health emergency
- state of overwhelming anxiety where the individual experiences disorganization, depression, confusion, behavioral disturbances
what are the foundations of crisis intervention (4)
- time limited (4-6 weeks)
- a threat/opportunity (open to new learning)
- a turning point in life
- addresses the immediate crisis
describe the nurses role in crisis intervention
- active & inactive
what are the goals of crisis intervention (3)
- resolving immediate problem
- regaining emotional equilibrium
- return to previous/higher lvl of functioning
what is a risk alert r/t crisis
- suicides can happen impulsively in moments of crisis w breakdown in the ability to deal w daily stressors
what is included in the seven-stage crisis intervention?
- assessment (including suicide and safety risk)
- establish rapport/relationship
- identify dimensions of presenting problem (assessment)
- explore feelings & emotions
- generate & explore alternatives
- develop & formulate a plan
- develop a follow-up plan
what dimensions of the presenting problem should be assessed? (3)
- perception of problem (what does it mean? what is happening in individual’s life?)
- coping abilities (how are they coping? previous coping?)
- supportive resources (what resources do they have? are they accessible?
what is included in the process of crisis intervention
- assessment
- planning (encourage problem solving)
- intervention
- evaluation (are goals met? is follow up needed?
- crisis plan (anticipate further problems?)
what is included in the intervention aspect of crisis intervention (5)
- early intervention
- facilitate understanding
- identify & teach new coping skills
- focus on problem solving
- encourage self reliance thru reinforcing the person’s strengths
what are some examples of typical crisis situations (5)
- thoughts of suicide
- S&S of mental illness that is out of the ordinary for the person
- psychosocial crisis or traumatic event
- supporting families (family support program)
- substance use
what should nurses know about suicide & suicide prevention (3)
- early identification
- risk factors
- protective factors
what are potential obstacles in nurses engaging pts in conversations about suicide (3)
- time restraints
- values & beliefs of the nurse
- personal history w suicide
suicide may become an option in someone’s mind as an answer when: (5)
- there is a need to escape
- there is a struggle to cope in general
- there seems to be no other option
- suicide fits in some other plan
- there is an overhwleming sense of hopelessness, helplessness, and powerlessness
what is involved in asking about suicide (3)
- express concern as a lead in to asking about suicide
- gather info
- explore protective factors/future orientation
what is an example of how to express concern as a lead-in to asking about suicide
“many people feel hopeless at times and may consider suicide - have you had any thoughts about suicide?”
–> helps to reduce stigma and shame associated w suicide
describe info should gather when asking about suicide (4)
- ru currently having any thoughts of killing yourself?
- do you currently have any desire to kill yourself?
- do you have a specific plan to kill yourself?
- do you intend to carry out this plan?
describe how to explore protective factors/future orientation when asking about suicide
- what kept you going in the past when you had suicidal thoughts?
- what things would lead you to feel more hopeful about the future?
what is included in suicide risk assessment (6)
- reason for assessment/re-assessment
- risk factors
- protective factors
- suicide inquiry
- risk lvl/interventions
- next re-assessment
completed for each pt on admission and should be done for all mental health pts
describe what some risk factors for suicide that should be assessed in SRA (7)
- suicidal behavior
- current/past psychiatric disorders
- key symptoms
- family hisotry of suicide
- precipitants, stressors, interpersonal
- change in treatment
- access to firearms
IS PATH WARM can be used to assess risk
what are protective factors
- those things whic hold meaning for an individual and might make them less liely to commit suicide
what are 2 categories of protective factors
- internal
- external
what are examples of internal protective factors
- ability to cope w stres
- religious beliefs
- frustration tolerance
what are example of external protective factors
- responsibility to children or pets
- positive therapeutic relationships
- social supports
what are the 6 aspects of suicide inquiry
- ideation
- plan
- behaviors
- intent
- explore ambivalence
- homicide inquiry
describe ideation r/t suicide
- freq
- intensity
- duration
in the last 48 hrs, month, and worst ever
describe plan r/t suicide (5)
- timing
- location
- lethality
- availability
- prepartory acts
describe behaviors related to suicide inquiry (4)
- past attempts
- aborted attempts
- rehearsals vs nonsuicidal
- self-injurious actions
describe intent r/t suicide inquiry (2)
extent to which the individual:
- expects to carry out the plan
- believes the plan/act to be lethal vs self-injurious
describe explore ambivalence r/t suicide inquiry
- reasons to die vs reasons to live
describe homicide inquiry
- when indicated, especially in character disordered or paranoid males dealing w loss or humilitation
determination of risk lvl in SRA is based on?
- clinical judgement after completing steps 1-3
why is risk lvl imp in SRA
- to formulate interventions which are written in the progress notes
in step 5, risk lvl/intervention, of SRA what must be considered (2)
- changeability of suicide risk status (ex. if the individual is highly reactive or impulsive)
- assessment confidence (ex. if the clinician felt the individual was untruthful or was not forthcoming)
describe interventions during SRA (2)
- should be pt centered and reduce the risk of suicide for that particular individual at that particular time
- follows site policies
what is the focus of intervention in SRA (3)
- immediate safety needs
- mitigating risk factors
- strengthening protective factors
when do reassessments typically occur in SRA
- typically at transition points of care and as indicated
what are some sample in-pt interventions r/t suicide risk
- more frequent 1-on-1
- shower only, no tub baths
- encourage use of coping skills
- safety check of belongings
etc.
see more in slides
what is a safety plan
- a document created w the pt which provides the pt w coping strategies and individualized options and resources they can use to respond safely, should they have a recurrence of suicidal ideation in the future
what are components of a safety plan (4)
- potential triggers
- coping strategies
- community resources to sue or be aware of such as a support group, crisis hotline
- personal protective factors such as family, friends, supports
what are various interventions towards recovery (8)
- ongoing assessment
- establishment of therapeutic relationships - collab approach
- interventiosn needs to help suicidal persons transform hopelessness into hopefulness –> work w strengths (protective factors), identify precipitating factors
- collaboratively develop a safety plan
- explore treatment to address mental health problems
- treatment needs to help suicidal individuals develop
- build social supports, resources, reasons for living
- discharge from hospital is another risk time, have open & transparent discussion to proactively manage increased risk
the phrase that survivors of suicide (those who have lost a loved one to suicide) and practitioners in the field prefer..
“died by suicide”
