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Mental Health Fall '12
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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
GoalPrimary 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?