Mental Health Chapter 9 Crisis Intervention PDF

Chapter 9 Crisis Intervention Copyright ©2019 F.A. Davis Company Introduction § Any stressful situation can precipitate a crisis. § Assistance with problem solving during the crisis period preserves self-esteem and promotes growth with resolution. Copyright ©2019 F.A. Davis Company Crisis, Defined §...

Chapter 9 Crisis Intervention Copyright ©2019 F.A. Davis Company Introduction § Any stressful situation can precipitate a crisis. § Assistance with problem solving during the crisis period preserves self-esteem and promotes growth with resolution. Copyright ©2019 F.A. Davis Company Crisis, Defined § Crisis is defined as a sudden event in one’s life, during which usual coping mechanisms cannot resolve the problem; the crisis disturbs homeostasis. Copyright ©2019 F.A. Davis Company Characteristics of a Crisis § Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology. § Crises are precipitated by specific identifiable events. § Crises are personal by nature. § Crises are acute, not chronic, and are resolved in one way or another within a brief period. § A crisis situation contains the potential for psychological growth or deterioration. Copyright ©2019 F.A. Davis Company Phases in the Development of a Crisis 1. The individual is exposed to a precipitating stressor. 2. When previous problem-solving techniques do not relieve the stressor, anxiety increases further. 3. All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. Copyright ©2019 F.A. Davis Company Phases in the Development of a Crisis (continued_1) 4. If resolution does not occur in previous phases, tension mounts beyond a further threshold, or its burden increases to a breaking point. Major disorganization of the individual occurs. Copyright ©2019 F.A. Davis Company Phases in the Development of a Crisis (continued_2) § Whether individuals experience a crisis in response to a stressful situation depends on three factors: § The individual’s perception of the event. If the event is perceived realistically, the individual is more likely to draw upon adequate resources to restore equilibrium. If the perception of the event is distorted, attempts at problem-solving are likely to be ineffective, and equilibrium is not restored. § The availability of situational supports. Aguilera stated, “Situational supports are those persons who are available in the environment and who can be depended on to help solve the problem.” Without adequate situational supports during a stressful situation, an individual is most likely to feel overwhelmed and alone. § The availability of adequate coping mechanisms. When a stressful situation occurs, individuals draw upon behavioral strategies that have been successful for them in the past. If these coping strategies work, a crisis may be diverted. If not, disequilibrium may continue and tension and anxiety increase. Copyright ©2019 F.A. Davis Company Types of Crises § Dispositional crisis: An acute response to an external situational stressor § Crisis of anticipated life transitions: Normal life-cycle transition that may be anticipated but over which the individual may feel a lack of control Copyright ©2019 F.A. Davis Company Types of Crises (continued_1) § Crisis resulting from traumatic stress: Precipitated by an unexpected, external stressor over which the individual has little or no control, and from which he or she feels emotionally overwhelmed and defeated Copyright ©2019 F.A. Davis Company Types of Crises (continued_2) § Maturational/developmental crisis: Occurs in response to a situation that triggers emotions related to unresolved conflicts in one’s life Copyright ©2019 F.A. Davis Company Types of Crises (continued_3) § Crisis reflecting psychopathology: An emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crisis, or in which psychopathology significantly impairs or complicates adaptive resolution Copyright ©2019 F.A. Davis Company Types of Crises (continued_4) § Psychiatric emergency: A crisis situation in which general functioning has been severely impaired and the individual is rendered incompetent or unable to assume personal responsibility Copyright ©2019 F.A. Davis Company Crisis in the Inpatient Unit: Anger/Aggression Management § Assessment § Anger can be identified by a cluster of characteristics that include: Frowning Clenched fists Low-pitched voice Yelling and shouting Copyright ©2019 F.A. Davis Company Crisis in the Inpatient Unit: Anger/ Aggression Management (continued_1) § Aggression can be identified by a cluster of characteristics that include: Pacing; restlessness Verbal/physical threats Threats of homicide or suicide Loud voice; argumentative Tense facial expression and body language Copyright ©2019 F.A. Davis Company Crisis in the Inpatient Unit: Anger/ Aggression Management (continued_2) § Assessing risk factors § Prevention is the key issue in management of aggressive or violent behavior. § Three factors are important considerations in identifying the extent of risks. Past history of violence Client diagnosis Current behaviors Copyright ©2019 F.A. Davis Company Crisis in the Inpatient Unit: Anger/ Aggression Management (continued_3) § Diagnosis/outcome identification § Planning/implementation § Evaluation Copyright ©2019 F.A. Davis Company Clicker Question 1 1. Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student’s crisis? A. The time of year in which the event occurred B. The presence of support systems C. A lack of adequate coping mechanisms D. The individual’s family birth order Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: C Adequate coping mechanisms can influence the development of a crisis. If a person can draw on past successful coping strategies, a crisis may be diverted. The second student had a lack of adequate coping mechanisms. Copyright ©2019 F.A. Davis Company Crisis Intervention § The minimum therapeutic goal of crisis intervention is psychological resolution of the individual’s immediate crisis and restoration to at least the level of functioning that existed before the crisis period. Copyright ©2019 F.A. Davis Company The Role of the Nurse in Crisis Intervention § Nurses may be called on to function as crisis helpers in virtually any setting committed to the practice of nursing. § Phase 1. Assessment Information is gathered regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help. Copyright ©2019 F.A. Davis Company The Role of the Nurse in Crisis Intervention (continued_1) § Phase 2. Planning of therapeutic intervention From the assessment data, the nurse selects appropriate nursing diagnoses that reflect the immediacy of the crisis situation. Desired outcome criteria are established. Appropriate nursing actions are selected, taking into consideration the type of crisis, as well as the individual’s strengths and available resources for support. Copyright ©2019 F.A. Davis Company The Role of the Nurse in Crisis Intervention (continued_2) § Phase 3. Intervention The actions identified in the planning phase are implemented. A reality-oriented approach is used. A rapid working relationship is established by showing unconditional acceptance, active listening, and attending to immediate needs. A problem-solving model becomes the basis for change. Copyright ©2019 F.A. Davis Company The Role of the Nurse in Crisis Intervention (continued_3) § Phase 4. Evaluation of crisis resolution and anticipatory planning A reassessment is conducted to determine whether the stated objectives were achieved. A plan of action is developed for the individual to deal with the stressor should it recur. Copyright ©2019 F.A. Davis Company Clicker Question 2 2. For the past 3 days, a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions? A. The student’s description of the precipitating stressor B. The student’s usual ability to cope with stress C. The student’s available support system D. The student’s access to community resources Copyright ©2019 F.A. Davis Company Clicker Question Answer 2 Correct Answer: A It is important to assess the precipitating stressor that led to the student’s behavioral symptoms. This data will be crucial when planning client care. Copyright ©2019 F.A. Davis Company Disaster Nursing § A common feature of disasters is that they overwhelm local resources and threaten the function and safety of the community. § Disasters leave victims with a damaged sense of safety and well-being and varying amounts of emotional trauma. Copyright ©2019 F.A. Davis Company Disaster Nursing: Background Assessment Data § Grieving is a natural response. § Common behavioral responses include anger, disbelief, sadness, anxiety, fear, sleep disturbances, and increases in alcohol, caffeine, and tobacco use. § Children may experience separation anxiety, nightmares, and problems with concentrating. Copyright ©2019 F.A. Davis Company Disaster Nursing: Nursing Diagnosis / Outcome Identification § Risk for injury § Risk for infection § Anxiety (panic) § Fear § Spiritual distress § Risk for post-trauma syndrome § Ineffective community coping Copyright ©2019 F.A. Davis Company Disaster Nursing: Evaluation § Evaluation consists of reassessment to determine if the nursing interventions have been successful in achieving the objectives of care. Copyright ©2019 F.A. Davis Company