crisis intervention

characteristics of a crisis?

sudden, acute event disturbing life balance → coping mechanisms are diminished (problem-solving is difficult and causes significant anxiety), personal and subjective, can lead to growth or deterioration, not selective (anyone can experience)

what are the 4 phases of a crisis?

trigger exposure, problem solving fails, resource mobilization, breaking point

what happens during phase 1 of a crisis?

exposure to a stressor; initial coping skills are used, anxiety increases

what happens during phase 2 of a crisis?

if coping fails; feelings of discomfort, helplessness and confusion, anxiety increases more

what happens during phase 3 of a crisis?

person mobilizes all possible resources (internal and external) to resolve crisis → may resolve here or escalate

what happens during phase 4 of a crisis?

if unresolved, anxiety becomes unbearable, possibly leading to panic or psychosis

what is a dispositional crisis?

acute response to external stressor → domestic violence, family conflict

what is an anticipated life transition?

normal transitions with loss of control → job loss, scholarship loss

what is traumatic stress?

unexpected, uncontrollable event → assault, trauma

what is a maturational/developmental crisis?

failed attempts to master developmental tasks → new parents, illness in family

what is a crisis reflecting psychopathology?

triggered by pre-existing psychiatric conditions → borderline personality disorder

what is a psychiatric emergency?

severe impairment → acute suicidality, overdose, psychosis

what are some signs of anger?

tense/frowning face, clenched fists/teeth, shouting, avoidant eye contact, hypersensitivity, passive-aggressive, flushed face → often secondary to other emotions (grief, fear, anxiety, frustration)

what does aggression look like?

pacing, threats, shouting, destruction of property → can be reactive (impulsive, fear-based) or proactive (calculated, predatory with intent to harm)

how to assess for risk factors for violence?

know if there is a hx of violence/aggression, specific dx (psych, substance abuse), current behavior, broset violence checklist

what are some nursing actions to take when dealing with a patient w anger/aggression?

stay calm, set verbal limits, encourage journaling, avoid touching, identify source of anger, observe for prodromal syndrome (early psychosis symptoms), ensure staff presence, de-escalate

what are the main goals of crisis intervention?

ensure safety (physical and emotional), provide support and stabilize the situation, help the person regain control and return to pre-crisis functioning

how do anger and aggression differ?

anger: often a secondary emotion, not always negative; aggression: behavior intended to harm, can be reactive/impulsive or proactive/planned

what are some de-escalation techniques?

stay calm and use a non-threatening voice, maintain open hands and supportive body language, avoid touching, validate emotions but not harmful behavior, remove other patients

when is seclusion used?

when patient is a danger to others; last resort

when are restraints used?

when patient is a danger to self → assessed q 15 min, remove slowly

what is the nursing process for crisis intervention?

assessment, planning, intervention, evaluation

what “is” disaster nursing?

responding to events that overwhelm community resources and threaten safety → help patients cope with acute and long-term effects

how do adults typically respond to disasters?

anger, sadness, fear, irritability, sleep disturbance, incr substance use

how do children typically respond to disasters?

separation anxiety, regression, withdrawal, somatic complaints

what nursing interventions to use for patients with anxiety or ineffective coping?

create a calm environment, speak in short sentences, build trust, assess for physical harm, teach new coping strategies, give positive feedback for improved coping