NURS-342: Mental Health Nursing Care (Module 3)

What can precipitate a crisis?

Any stressful situation

How does problem-solving assistance help during a crisis?

It preserves self-esteem and promotes growth with resolution

How is a crisis defined?

A sudden event in which usual coping mechanisms fail to resolve the problem, disturbing homeostasis

True or False: Experiencing a crisis automatically indicates psychopathology.

False

True or False: Crises are personal events.

True

True or False: Crises are chronic events.

False

What two outcomes can result from a crisis?

Psychological growth or deterioration

What occurs in Phase 1 of crisis development?

The individual is exposed to a precipitating stressor

What happens in Phase 2 of crisis development?

Anxiety increases when previous problem-solving techniques fail

What occurs in Phase 3 of crisis development?

Internal and external resources are mobilized to resolve the problem

What happens in Phase 4 of crisis development?

Tension reaches a breaking point, causing major disorganization

What three factors determine whether a person experiences a crisis?

Perception of the event, availability of situational supports, and availability of coping mechanisms

Why is perception important in crisis development?

The individual’s interpretation of the event influences the crisis response

What is a dispositional crisis?

An acute response to an external situational stressor

What is a crisis of anticipated life transitions?

A normal life-cycle transition where the individual feels a lack of control

What is an example of a dispositional crisis?

Hitting a spouse after being fired or disciplined at work

What is the nursing intervention for a dispositional crisis?

Support the victim of the reaction

What communication skill is necessary for every type of crisis?

Therapeutic communication

What is an example of a crisis of anticipated life transitions?

Stress related to moving accompanied by fatigue

What interventions are appropriate for a crisis of anticipated life transitions?

Assess physical/emotional complaints and offer support

What is a crisis resulting from traumatic stress?

A crisis caused by an unexpected external stressor over which the individual has little control

What are examples of traumatic stress crises?

Violence or fire

What interventions are used for traumatic stress crises?

Encourage expression of feelings, offer support, explain grief/loss, and help resume normal activities

What is a maturational/developmental crisis?

A crisis triggered by unresolved developmental conflicts or life challenges

What interventions are used for developmental crises?

Anxiety reduction, safety assessment, and referral to resources/counseling

What is a crisis reflecting psychopathology?

A crisis complicated by pre-existing psychopathology

What is an example of a psychopathology-related crisis?

A long-term therapist leaving

What interventions are appropriate for a psychopathology-related crisis?

Reduce anxiety, ensure safety, encourage verbalization of feelings, transfer care if needed, and hospitalization if necessary

What is a psychiatric emergency?

A crisis in which functioning is severely impaired and the individual cannot assume personal responsibility

What is an example of a psychiatric emergency?

Suicide attempt

What interventions are required in a psychiatric emergency?

Emergency stabilization and hospitalization for safety

What are signs of anger in an inpatient crisis?

Frowning, clenched fists, low-pitched voice, yelling, and shouting

What are signs of aggression?

Pacing, restlessness, threats, loud argumentative voice, tense body language, homicidal/suicidal threats

What is the key issue in managing aggressive or violent behavior

Prevention

What three factors help identify risk for violence?

Past history of violence, diagnosis, and current behaviors

How should the nurse communicate with an aggressive client?

Use a calm voice, simple communication, and avoid sudden movements

How can nurses reduce escalation?

Reduce stimulation, use verbal redirection, set limits, administer medications if needed, and use time-out

Why should nurses enlist cooperation from aggressive clients?

To work together toward resolving the issue

What nursing diagnoses are common during crisis situations?

Ineffective coping and risk for violence

What are evaluation goals in crisis management?

Recognizing feelings, using control, and avoiding violence

What is the minimum goal of crisis intervention?

Restore the individual to at least the precrisis level of functioning

What is the maximum goal of crisis intervention?

Improve functioning above the pre-crisis level

What occurs during Phase 1 of crisis intervention?

Assessment of the precipitating stressor and resulting crisis

In what settings may nurses function as crisis helpers?

Virtually any nursing practice setting

What occurs during the planning phase of crisis intervention?

Nursing diagnoses, outcomes, and interventions are selected

What factors are considered when selecting interventions?

Type of crisis, client strengths, and support resources

What type of approach is used during crisis intervention?

A reality-oriented approach

How is a rapid therapeutic relationship established?

Through unconditional acceptance, active listening, and attending to immediate needs

What model becomes the basis for change during intervention?

A problem-solving model

What occurs during the evaluation phase of crisis intervention?

Reassessment to determine whether goals were achieved

Why is anticipatory planning important?

To prepare the individual to manage future stressors

What is a common feature of disasters?

They overwhelm local resources and threaten community safety

How do disasters affect victims psychologically?

They damage the sense of safety and well-being and can cause emotional trauma

What behavioral responses are common after disasters?

Anger, disbelief, sadness, anxiety, fear, sleep disturbances, and increased substance use

How may children respond to disasters?

Separation anxiety, nightmares, and difficulty concentrating

What nursing problems may occur after disasters?

Risk for injury, infection, anxiety, fear, spiritual distress, post-trauma syndrome, and ineffective community coping

What are outcome behaviors used for?

Criteria for evaluation

What are the goals of interventions after traumatic events?

Maintain manageable anxiety, support spiritual expression, assist emotional coping, and improve community functioning

What is the purpose of evaluation in disaster nursing?

To reassess whether nursing interventions achieved care objectives

Why is substance use disorder among nurses considered an “invisible” problem?

Many nurses with SUD go unidentified and untreated, potentially endangering patients.

What is a nurse’s legal and ethical responsibility regarding impaired coworkers?

Report suspected impairment to a supervisor to protect patient safety.

What are three major red flags of nurse impairment?

Behavioral changes, physical indicators, and drug diversion.

What behavioral changes may indicate impairment?

Frequent absences, excessive bathroom trips, and medication errors.

What physical indicators may suggest SUD in nurses?

Changes in appearance or alertness.

What is drug diversion?

Redirecting medication for personal use or sale.

What are common diversion tactics used by impaired healthcare workers?

Opioid count discrepancies, excessive wastage, record corrections, and medicating coworkers’ patients.

What patient complaint may indicate drug diversion?

Reporting ineffective pain relief despite medication being documented as given.

What behavioral signs may suggest diversion or impairment?

Isolation, inappropriate emotional responses, and memory lapses.

What are the legal consequences of drug diversion?

Criminal charges, felony convictions, and loss of licensure.

What is the primary role of State Boards of Nursing?

To regulate nursing practice and protect the public.

How many states have a Board of Nursing?

All 50 states.

What authority do BONs have over impaired nurses?

They can discipline nurses practicing while impaired.

What is the goal of BON disciplinary action?

To reduce patient safety risks and maintain professional integrity.

What resource helps nurses locate state-specific assistance programs?

The NCSBN “Find a Program” tool.

What are NCSBN Alternative-to-Discipline programs?

Programs designed to help nurses recover while protecting public safety.

What is the philosophy behind Alternative-to-Discipline (ATD) programs?

Focus on treatment and recovery instead of immediate license revocation.

How does early intervention improve client safety?

It removes impaired nurses from practice quickly.

How does early intervention affect long-term recovery?

It increases the likelihood of successful recovery and return to practice.

 What happens when a nurse enters an ATD program?

They participate in a structured recovery program with monitoring.

What monitoring methods are commonly used in ATD programs?

Contracts, toxicology testing, and required therapies.

What funds Texas Peer Assistance Program for Nurses (TPAPN)?

Nurse licensure fees

Under what law does TPAPN operate?

The Texas Nurse Practice Act.

What does the Texas Nurse Practice Act require employers to do?

Report suspected nurse impairment.

What support is included in TPAPN recovery plans?

Customized recovery plans and peer mentors.

What is the goal of TPAPN?

Reintegration into nursing practice after stable recovery.

What determines the intensity of recovery support?

Severity of the nurse’s impairment.

What restriction commonly applies to recovering nurses regarding narcotics?

Temporary prohibition from handling or administering controlled substances.

Why are recovering nurses often prohibited from floating?

They must remain on a predetermined monitored unit.

What scheduling restrictions are often placed on recovering nurses?

No more than 12-hour shifts and no on-call assignments.