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NURS 3514 - Mental Health > Week 5 > Flashcards

Week 5 Flashcards

1
Q

crisis causes..

A
  • disequilibrium
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2
Q

a crisis is… (5)

A
  • 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
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3
Q

what are 2 types of crisis

A
  • situational

- developmental

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4
Q

what are examples of a situational crisis

A
  • MVA
  • fire
  • fail an exam
  • breakup
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5
Q

what are examples of developmental crisis

A
  • birth of a new baby
  • young adult moving away from family
  • retirement
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6
Q

what is developmental crisis

A
  • natural things which occur over the course of human development
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7
Q

how many phases of crisis are there

A

4

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8
Q

what is phase 1 of crisis

A
  • anxiety is increased to stimulate problem solving skills & defense mechanisms in response to a problem or conflict
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9
Q

what is phase 2 of a crisis

A
  • threat persists

- increased anxiety produced feelings of extreme discomfort and disorganization

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10
Q

describe phase 3 of crisis

A
  • anxiety escalates to severe/r panic lvls and automatic relief behaviors may be mobilized such as withdrawal and flight
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11
Q

describe phase 4 of crisis

A
  • problem remains unresolved/coping skills are ineffective

- the individual may tranition to a mental health emergency

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12
Q

what is a mental health emergency

A
  • state of overwhelming anxiety where the individual experiences disorganization, depression, confusion, behavioral disturbances
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13
Q

what are the foundations of crisis intervention (4)

A
  • time limited (4-6 weeks)
  • a threat/opportunity (open to new learning)
  • a turning point in life
  • addresses the immediate crisis
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14
Q

describe the nurses role in crisis intervention

A
  • active & inactive
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15
Q

what are the goals of crisis intervention (3)

A
  • resolving immediate problem
  • regaining emotional equilibrium
  • return to previous/higher lvl of functioning
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16
Q

what is a risk alert r/t crisis

A
  • suicides can happen impulsively in moments of crisis w breakdown in the ability to deal w daily stressors
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17
Q

what is included in the seven-stage crisis intervention?

A
  • 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
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18
Q

what dimensions of the presenting problem should be assessed? (3)

A
  • 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?
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19
Q

what is included in the process of crisis intervention

A
  • assessment
  • planning (encourage problem solving)
  • intervention
  • evaluation (are goals met? is follow up needed?
  • crisis plan (anticipate further problems?)
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20
Q

what is included in the intervention aspect of crisis intervention (5)

A
  • early intervention
  • facilitate understanding
  • identify & teach new coping skills
  • focus on problem solving
  • encourage self reliance thru reinforcing the person’s strengths
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21
Q

what are some examples of typical crisis situations (5)

A
  • 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
22
Q

what should nurses know about suicide & suicide prevention (3)

A
  • early identification
  • risk factors
  • protective factors
23
Q

what are potential obstacles in nurses engaging pts in conversations about suicide (3)

A
  • time restraints
  • values & beliefs of the nurse
  • personal history w suicide
24
Q

suicide may become an option in someone’s mind as an answer when: (5)

A
  • 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
25
Q

what is involved in asking about suicide (3)

A
  • express concern as a lead in to asking about suicide
  • gather info
  • explore protective factors/future orientation
26
Q

what is an example of how to express concern as a lead-in to asking about suicide

A

“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

27
Q

describe info should gather when asking about suicide (4)

A
  • 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?
28
Q

describe how to explore protective factors/future orientation when asking about suicide

A
  • what kept you going in the past when you had suicidal thoughts?
  • what things would lead you to feel more hopeful about the future?
29
Q

what is included in suicide risk assessment (6)

A
  • 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

30
Q

describe what some risk factors for suicide that should be assessed in SRA (7)

A
  • 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

31
Q

what are protective factors

A
  • those things whic hold meaning for an individual and might make them less liely to commit suicide
32
Q

what are 2 categories of protective factors

A
  • internal

- external

33
Q

what are examples of internal protective factors

A
  • ability to cope w stres
  • religious beliefs
  • frustration tolerance
34
Q

what are example of external protective factors

A
  • responsibility to children or pets
  • positive therapeutic relationships
  • social supports
35
Q

what are the 6 aspects of suicide inquiry

A
  • ideation
  • plan
  • behaviors
  • intent
  • explore ambivalence
  • homicide inquiry
36
Q

describe ideation r/t suicide

A
  • freq
  • intensity
  • duration

in the last 48 hrs, month, and worst ever

37
Q

describe plan r/t suicide (5)

A
  • timing
  • location
  • lethality
  • availability
  • prepartory acts
38
Q

describe behaviors related to suicide inquiry (4)

A
  • past attempts
  • aborted attempts
  • rehearsals vs nonsuicidal
  • self-injurious actions
39
Q

describe intent r/t suicide inquiry (2)

A

extent to which the individual:

  • expects to carry out the plan
  • believes the plan/act to be lethal vs self-injurious
40
Q

describe explore ambivalence r/t suicide inquiry

A
  • reasons to die vs reasons to live
41
Q

describe homicide inquiry

A
  • when indicated, especially in character disordered or paranoid males dealing w loss or humilitation
42
Q

determination of risk lvl in SRA is based on?

A
  • clinical judgement after completing steps 1-3
43
Q

why is risk lvl imp in SRA

A
  • to formulate interventions which are written in the progress notes
44
Q

in step 5, risk lvl/intervention, of SRA what must be considered (2)

A
  • 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)
45
Q

describe interventions during SRA (2)

A
  • should be pt centered and reduce the risk of suicide for that particular individual at that particular time
  • follows site policies
46
Q

what is the focus of intervention in SRA (3)

A
  • immediate safety needs
  • mitigating risk factors
  • strengthening protective factors
47
Q

when do reassessments typically occur in SRA

A
  • typically at transition points of care and as indicated
48
Q

what are some sample in-pt interventions r/t suicide risk

A
  • more frequent 1-on-1
  • shower only, no tub baths
  • encourage use of coping skills
  • safety check of belongings
    etc.

see more in slides

49
Q

what is a safety plan

A
  • 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
50
Q

what are components of a safety plan (4)

A
  • 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
51
Q

what are various interventions towards recovery (8)

A
  • 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
52
Q

the phrase that survivors of suicide (those who have lost a loved one to suicide) and practitioners in the field prefer..

A

“died by suicide”

NURS 3514 - Mental Health (11 decks)

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