Chapter 10 Intervening in Crises
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Chapter 10 Intervening in Crises
overwhelms local resources and threatenthe function and safety of thecommunity.
leaves victims with a damaged sense ofsafety and well-being and varying degreesof emotional trauma
Grieving is a natural response.
Common behavioral responses include anger;disbelief; sadness; anxiety; fear; sleepdisturbances; and increases in alcohol, caffeine,and tobacco use.
Children may experience separation anxiety,nightmares, and problems withconcentrating.
Crisis on the Inpatient Unit
A number of characteristics describe anger, includingfrowning, clenched fists, intense eye contact, yelling andshouting, lowpitched verbalizations forced throughclenched teeth, and emotional overcontrol with flushing offace.
Anger is a stage of thegrieving process.
Anger turned inward results indepression.
Some individuals need assistance torecognize their true feelings asanger.
Aggression can arise from such feelingstates as anger, anxiety, guilt, frustration,or suspiciousness.
Aggressive behaviors may bemild, moderate, severe, orextreme.
Aggression may be characterized by sarcasm, verbal orphysical threats, degrading comments, throwing or strikingobjects or people, suicidal or homicidal ideation, disturbedthought process and perception, and anger disproportionate tothe situation.
Assessing Risk Factors
Prevention is the key issue in themanagement of aggressive or violentbehavior.
The violent individual usuallyfeels underlying helplessness.
The most widely recognized risk factor forviolence in a treatment setting is pasthistory of violence.
Diagnoses that have the highest association with violentbehavior include schizophrenia; organic brain disorders;mood disorders; antisocial, borderline, and intermittentexplosive personality disorders; and substance usedisorders.
The “prodromal syndrome” describes a set of behaviorsthat are predictive of impending violence. They includeanxiety and tension, verbal abuse and profanity, andincreasing hyperactivity.
Dysfunctional grieving may be used whenanger is expressed inappropriately and theetiology is related to a loss.
Risk for self-directed or other-directedviolence
Outcomes evaluate success of theindividual in maintaining anger at amanageable level and the prevention ofharm to self or others.
Phases of CrisisIntervention: The Role ofthe Nurse
Assessment. Information is gathered regardingthe precipitating stressor and the resulting crisisthat prompted the individual to seek professionalhelp.
Planning of Therapeutic Intervention. From the assessment data, thenurse selects appropriate nursing diagnoses that reflect the immediacyof the crisis situation. Desired outcome criteria are established.Appropriate nursing actions are selected taking into consideration thetype of crisis, as well as the individual’s strengths and availableresources for support.
Intervention. The actions identified in the planning phase areimplemented. A reality-oriented approach is used. A rapid workingrelationship is established by showing unconditional acceptance, byactive listening, and by attending to immediate needs. A problemsolvingmodel becomes the basis for change.
Evaluation of Crisis Resolution and Anticipatory Planning. Areassessment is conducted to determine if the statedobjectives were achieved. A plan of action is developedfor the individual to deal with the stressor should it recur.
The minimum therapeutic goal of crisis intervention ispsychological resolution of the individual’s immediate crisisand restoration to at least the level of functioning thatexisted before the crisis period.
A maximum goal is improvement infunctioning above the precrisislevel.
Phase 1: The individual is exposed to a precipitating stressor. Major disorganization of the individual withdrastic results often occurs. Whether or not an individual experiences a crisis in response to a stressfulsituation depends on:
Phase 2: When previous problem-solvingtechniques do not relieve the stressor,anxiety increases further.
Phase 3: All possible resources, bothinternal and external, are called on toresolve the problem and relieve thediscomfort.
Phase 4: If resolution does not occur in previousphases, the tension mounts beyond a furtherthreshold or its burden increases over time to abreaking point.
Major disorganization of the individual with drasticresults often occurs. Whether or not an individualexperiences a crisis in response to a stressful situationdepends on:
The individual’s perception of the event
The availability of situationalsupports
The availability of adequatecoping mechanisms
a sudden event in one’s life that disturbshomeostasis, during which usual copingmechanisms cannot resolve the problem.
Dispositional crises are acuteresponses to external situationalstressors.
Crises of anticipated life transitions occur withnormal life-cycle transitions that may be anticipatedbut over which the individual may feel a lack ofcontrol.
Crises resulting from traumatic stress are those that areprecipitated by an unexpected, external stressor over which theindividual has little or no control and from which he or she feelsemotionally overwhelmed and defeated.
Maturational or developmental crises occur inresponse to situations that trigger emotionsrelated to unresolved conflicts in one’s life.
Crisis reflecting psychopathology is one in which preexistingpsychopathology has been instrumental in precipitating the crisisor in which psychopathology significantly impairs or complicatesadaptive resolution.
Psychiatric emergencies are crisis situations in which generalfunctioning has been severely impaired and the individualrendered incompetent or unable to assume personalresponsibility.
1. Crisis occurs in all individuals at one time or another and is notnecessarily equated with psychopathology.
2. Crises are precipitated byspecific identifiable events.
3. Crises are personal by nature.
4. Crises are acute, not chronic, and will beresolved in one way or another within abrief period.
5. A crisis situation contains thepotential for psychological growth ordeterioration.