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Chapter 13
   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
   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
 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
Goal
Primary goal is resolution of the
immediate crisis

Do not make this a lengthy process


This is not the time for processing
in depth

Actions include support, restore to
pre-existing state or adaptation to
current state
 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
 Nursing Diagnosis – based on assessment
 findings, possible Nursing diagnosis
  Ineffective Coping
  Fear
  Disturbed Thought Processes
  Violence
  PTSD
  Rape Syndrome
 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
 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
 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
 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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Crisis rf order 6

  • 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. 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.  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. Goal Primary goal is resolution of the immediate crisis Do not make this a lengthy process This is not the time for processing in depth Actions include support, restore to pre-existing state or adaptation to current state
  • 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.  Nursing Diagnosis – based on assessment findings, possible Nursing diagnosis  Ineffective Coping  Fear  Disturbed Thought Processes  Violence  PTSD  Rape Syndrome
  • 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.  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.  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.  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?