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Chapter 13
   Definition     A sudden event in one’s life that disturbs homeostasis,      during which usual coping mechanisms can ...
   Phase 1     Exposure to the precipitating stressor /mount usual coping      mechanisms. Perception of the event is pi...
 Dispositional – Stressor with an acute response by the experiencing  person Anticipated – An event that you can anticip...
GoalPrimary goal is resolution of theimmediate crisisDo not make this a lengthy processThis is not the time for process...
 Assessment        - Gather Information  Perception of the Crisis Event  Precipitating Events to the Crisis  Usual Cop...
 Nursing Diagnosis – based on assessment findings, possible Nursing diagnosis  Ineffective Coping  Fear  Disturbed Tho...
 Plan  Unless the client is a threat to self or others,   negotiate a plan with client – preserve autonomy  Ask the cli...
 Intervention  Pre-Introductory – Consider own, attitudes, values     beliefs – nonjudgemental    Physical Safety First...
 Intervention  Guided Problem Solving   ▪ Help client to identify the source of the crisis   ▪ Help client to identify r...
 Evaluation  Was the identified goal met, partially met, not     met?    Was there a positive behavior change?    Are ...
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Crisis rf order 6

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Mental Health Fall '12

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Crisis rf order 6

  1. 1. Chapter 13
  2. 2.  Definition  A sudden event in one’s life that disturbs homeostasis, during which usual coping mechanisms can not resolve the problem. Characteristics  Universal  Precipitated by identifiable event  They are personal in nature – what is crisis for you may not be for me  They are acute and will be resolved in one way or another within a brief period of time
  3. 3.  Phase 1  Exposure to the precipitating stressor /mount usual coping mechanisms. Perception of the event is pivotal Phase 2  Usual problem solving mechanisms fail Phase 3  Mobilize new resources ▪ Internal – try new personal coping mechanisms ▪ External – family, friends, and professional Phase 4  If crisis not resolved, results is panic, disorganized thought, psychosis. Some use the term “Nervous Breakdown”. Professional help essential – hospitalization indicated
  4. 4.  Dispositional – Stressor with an acute response by the experiencing person Anticipated – An event that you can anticipate is going to cause you stress (ie nursing school – you know you will face time demands) Traumatic – Serious, unexpected event (ie, rape). Causes significant mental impact and requires heightened support/tx Developmental – Unresolved developmental issue earlier in life serves as the source of crisis (ie, Erikson/failure to achieve trust in infancy). Key is to address unresolved issue, not he behavior in front of you* Psychopathology – Underlying D/O (ie Depression) is the etiology of the crisis. Key is to address D/O, not the behavior in front of you* Emergency – Function severely impaired (ie Suicide, Violence, Psychosis, Substance Abuse). Key is ABC’s (physiologic and safety) , then psychosocial*unless the behavior in front of you is a threat to safety, then prioritize
  5. 5. GoalPrimary goal is resolution of theimmediate crisisDo not make this a lengthy processThis is not the time for processingin depthActions include support, restore topre-existing state or adaptation tocurrent state
  6. 6.  Assessment - Gather Information  Perception of the Crisis Event  Precipitating Events to the Crisis  Usual Coping Mechanisms Employed? How Effective?  New Coping Mechanisms Tried? How Effective?  Bio-Psych-Social State (Review pg 142-147 Townsend) ▪ Safety First – Assess Harm to self or others? Psychotic – loss of touch with reality, hallucinations? ▪ Bio - General Survey, VS, PA (Stimulation of sympathetic system?) ▪ Psych – (Relationship with self )– self esteem, self concept, perceptions, coping strategies, use of substances ▪ Social – (Relationship with others) - Social Support Systems
  7. 7.  Nursing Diagnosis – based on assessment findings, possible Nursing diagnosis  Ineffective Coping  Fear  Disturbed Thought Processes  Violence  PTSD  Rape Syndrome
  8. 8.  Plan  Unless the client is a threat to self or others, negotiate a plan with client – preserve autonomy  Ask the client, “who, what, when, how, where”  Consider carefully the clients pre-existing state – Clients may have a compromised pre-existing state.  Focusing on restoration of pre-existing state, or maximum level of functioning
  9. 9.  Intervention  Pre-Introductory – Consider own, attitudes, values beliefs – nonjudgemental  Physical Safety First- Always ABCs, then psych- soc  Reality Orientation - With altered cognition  Focus Conversation – limit ramblings  Impose Professional Boundaries
  10. 10.  Intervention  Guided Problem Solving ▪ Help client to identify the source of the crisis ▪ Help client to identify realistic changes to make ▪ Help client to see what they can not change ▪ Help client to identify alternatives to what they are currently doing ▪ Help client to identify, or nurse to suggest alternate resources and support systems
  11. 11.  Evaluation  Was the identified goal met, partially met, not met?  Was there a positive behavior change?  Are there adaptive coping mechanisms?  Evidence of growth?  Are there elements the client can use in the future?

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