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54 Cards in this Set
- Front
- Back
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A sudden event in one's life, during which usual coping mechanisms cannot resolve the problem; the crisis disturbs homeostasis |
Crisis
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Assumptions on which concept of crisis is based (5)
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* 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 in nature. * Crises are acute, not chronic, and are resolved in one way or another within a brief period. * A crisis situation contain the potential for psychological growth OR deterioration. |
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How long does it take for the typical individual to have a crisis and resolve it?
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1 crisis should take 6 months
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What can cause a crisis?
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Any stressful situation.
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What are the phases in the development of a crisis? (4)
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Phase 1 - The individual is exposed to a precipitating stressor.
Phase 2 - WHen previous problem-solving techniques do not relieve the stressor, anxiety increases further. Phase 3 - All possible resources, both internal & external, are called on to resolve the problem and relieve the discomfort. Phase 4 - If resolution does not occur in previous phases, the tension mounts beyond threshold and over time reaches a breaking point. Major disorganization with drastic results often occurs. |
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What is other terminology that the 4 phases in the development of a crisis get referred to (not in the book)?
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Phase 1 - Trigger
Phase 2 - Escalation Phase 3 - Crisis Phase 4 - Recovery |
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What are the 3 factors that determine whether an individual experiences a crisis in response to a stressful situation?
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1 - The individuals PERCEPTION of the event.
2 - The availability of situational SUPPORT. 3 - The availability of adequate COPING MECHANISMS. |
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An acute response to an external situational stressor
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Dispositional Crisis
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What adaptive things can you teach a woman whose husband beats because of a stressful event at work?
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Provide support and guidance in terms of presenting alternatives to her. Needs & issues are clarified and referrals for agency assistance were made.
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This type of crisis occurs because of a normal life-cycle transition that may be anticipated but over which the individual may feel a lack of control.
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Crisis of anticipated life transitions.
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What would you do (adaptive things) for this patient: College student on probation for low grades who had to increase his hours at work because his wife had a baby and had to quit her job, leading to his inability to study enough.
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Physical exam (physical symptoms could be caused by depression) and ventilation of feelings encouraged. Provide reassurance and support. Refer to services that can provide financial and other types of needed assistance. Problematic areas should be identified and approaches to change discussed.
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This type of crisis is 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.
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Crisis resulting from traumatic stress.
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How could you provide help for this client? A person gets abducted, raped and beaten when leaving work late one evening. Although her physical wounds have healed, she cannot be alone, is fearful, relives the experience in flashbacks and dreams, is unable to eat, sleep or go to work.
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Encourage her to talk about & express her feelings associated w/ the event. Offer reassurance and support. Discuss stages of grief & how rape causes loss of self-worth, triggering the grief response. Identify support systems that can help to resume normal activities. Explore new methods of coping with emotions arising from a situation with which she has had no previous experience.
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This crisis occurs in response to a situation that triggers emotions related to unresolved conflicts in one's life.
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Maturational/Developmental Crisis
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How do you distinguish between Maturational/Developmental Crisis & Crisis of Anticipated Life Transitions?
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Maturational/Developmental Crisis are ones that occur early on in one's life that go unresolved while Crisis of Anticipated Life Transitions are occurring now.
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How do you distinguish between situational and maturational stressors?
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Situational stressors are those that everything else can fall into or Maturational stressors are those of anticipated life events.
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This crisis is an emotional one in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution.
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Crisis reflecting psychopathology.
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What would you do for this client? a man who was raised by a domineering father that became abusive when he does not comply with every command grows up to be a passive-aggressive individual in adulthood.
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Help the individual identify the unresolved developmental issue that is creating the conflict. Offer support & guidance during initial period. The provide assistance to work through the underlying conflict in an effort to change the response pattern.
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What would you do for this client? A woman previously diagnosed with borderline personality disorder who has received therapy for 10 yrs gets notification that her therapist will be moving across the country. She has intense feelings of abandonment & is found wandering in and out of traffic.
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First bring down level of anxiety. Reassure her safety & security. Encourage verbalization of feelings of abandonment. Discourage regressive behaviors. Use positive reinforcement for independent activities and accomplishments. The primary therapist should pursue the feelings of termination at length. Referral to long-term facility may be requried.
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A crisis situation in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility.
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Psychiatric Emergency Crisis
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What type of adaptive things would you do for this client? A young teenage girl gets told by her football quarterback boyfriend that he no longer wants to see her. She is so distraught that she attempts suicide.
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Resolve the physical crisis, then encourage her to vent her feelings of rejection and resulting overdose. Family Therapy & Individual therapy working on adaptive methods of coping with stressful situations.
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Who is the only person that can determine incompetence?
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A judge in the legal system.
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What is the minimum therapeutic goal of crisis intervention?
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A psychological resolution of the individual's immediate crisis and restoration to at least the level of functioning that existed before the crisis period.
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What is the maximum therapeutic goal of crisis intervention?
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Improvement in functioning above the pre-crisis level.
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What is the first thing the nurse has to do when they are called on as crisis helper?
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Assess
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What does the nurse do during the assessment phase with a client?
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Gather information regarding the precipitating stressor and the resulting crisis that prompted the individual to seek help.
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What are the phases of the nurses role in crisis intervention?
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1 - Assessment
2 - Planning of Therapeutic Intervention 3 - Intervention 4 - Evaluating of Crisis Resolution and Anticipatory Planning |
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What does the nurse do during the Planning of Therapeutic Intervention phase with a client?
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From the assessment data, the nurse identifies nursing diagnoses.
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Is suicidal ideation a nursing diagnoses or a clinical manifestation?
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Clinical Manifestation
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Is Loss of Support a nursing diagnoses or a clinical manifestation?
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Clinical Manifestation
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Give examples of nursing diagnoses for Loss of Support.
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Disruptive Family Processes
Ineffective Coping |
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What is another term used for Clinical Manifestations?
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Assessment Data
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What does the nurse do when implementing the Intervention Phase?
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Implements the steps identified in the 2nd phase.
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What guidelines should you following during the intervention phase?
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* Use a reality-oriented approach.
* Establish a rapid working relationship by showing unconditional acceptance and by attending to immediate needs. Simply - make sure you are using the problem-solving model as the basis for change. |
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What is the nurses role during Phase 4 of Crisis Intervention?
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Reassess to determine whether the stated objectives were achieved. A plan of action is developed for the individual in the event the stressor reoccurs.
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How do you identify anger?
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By a cluster of characteristics that incude intense distress, frowning, pacing, eyebrown displacement, clenched fists, raised voices, increased energy, fatigue, gritting teeth, flushed face, emotional over-control. In kids you might see withdrawn behavior, isolation (the exact opposite you would expect to see).
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How do you differentiate anger from aggression?
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Anger is not usually carried out in a physical way towards an individual while aggression usually is.
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What characteristics might you see in aggression?
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Sarcasm
Verbal/Physical Threats Change in Voice Tone Degrading Comments Pacing Striking Objects/People Suspiciousness Suicidal or Homocidal Ideation Self-Mutilation Invasion of Personal Space Increased agitation or irritability Misinterpretation of stimuli Exaggerated anger Disturbed thought process/perception |
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Anger is...
Aggression is... |
an emotion
an act |
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What are the 3 factors that have been identified as important considerations in assessing for potential violence?
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1 - Past history of violence
2 - Client diagnosis 3 - Current behavior |
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Name some of the most common diagnosis associated with violence.
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Substance abuse/intoxication
Schizophrenia Post-traumatic stress disorder Organic brain disorders Personality disorders Bipolar mania |
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What is the most likely harming behaviors that a schizophrenic likely to carry out & why?
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Self-Harming
One of the primary symptoms w/ Schizophrenia is hallucinations, these people hear voices in their head 24 h a day. The only way they can get rid of those voices is to kill themselves. Many times the voices tell them to do things to themselves because they perceive themselves as lousy, worthless, etc. |
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Which client would you be the most concerned about them harming another individual? Schizophrenic, Bipolar, Substance Abuse/Intoxication, or Post-Traumatic Stress Disorder
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Substance Abuse/Intoxication. Because of the chemicals in their body.
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Define prodromal syndrome. What are the characteristics?
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Certain current behaviors that are predictive of impending violence including Anxiety & Tension, Verbal Abuse & Profanity, Increasing Hyperactivity
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What are some specific behaviors associated with prodromal syndrome.
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Rigid Posture
Clenched Fists & Jaws Grim, Defiant Affect Talking in a Rapid, Raised Voice Arguing or Demanding Using Profanity & Threatening Verbalizations Agitation & Pacing Pounding & Slamming |
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What distance should you keep from an individual who is angry or agitated?
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Arms Length
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What nursing diagnoses might be used for clients who are exhibiting inappropriate expression of anger or aggressive behavior?
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Ineffective coping
Risk for self-directed violence Risk for other-directed violence Dysfunctional Grieving Denial |
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Lets say we have a client who is has a nursing diagnosis of Dysfunctional Grieving because they are very angry that someone left them, what would be an expected outcome goal that would be appropriate & measurable.
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The client will be able to verbalize one stage of the grieving process on 9/12 by 1400.
Education is always a good overall outcome goal. |
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What are some other interventions used with anger/aggression management?
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Remain calm
Set verbal limits on behavior Keep diary of anger Avoid touching the client Help determine source of anger Role Model Ignore derogatory marks When behaviors are observed, address them early. Find alternative ways of releasing tension. Observe for escalation of anger. Mirroring (mirror what you want them to do) Teaching to control internally Physical outlets Medications Call for assistance Restraints Observation & documentation Ongoing assessment Staff debriefing |
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What is the purpose of staff debriefing?
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It allows you to de-stress. Once it is written out helps you to be able to turn it over to some place else.
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What is a common issue that people who go through a disaster experience?
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A damaged sense of safety and varying degrees of emotional trauma.
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What would you do during the assessment phase in a disaster nursing scenario?
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Grieving is a natural response.
Common behavioral responses include anger, disbelief, sadness, anxiety, fear, sleep disturbances, and increase in alcohol, caffein, and tobacco use. |
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What might you see with a child who is experiencing a disaster scenario?
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Separation anxiety
Nightmares Problems with concentrating |
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What are some appropriate nursing diagnosis in a Disaster Scenario?
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Risk for Injury
Risk for Infection Anxiety (Panic) Fear Spiritual Distress Risk for PTSD Ineffective Community Coping |
