Chapter 22 Crisis Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Crisis A struggle for emotional balance May lead to personality disorganization An opportunity for emotional growth Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Types of Crisis Situations: Maturational New developmental stage is reached Old coping skills no longer helpful Ineffective defense mechanisms until new coping skills develop Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Types of Crisis Situations: Situational From an external source Loss of a job Severe illness Divorce Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Types of Crisis Situations: Adventitious Unplanned and accidental Natural disaster National disaster Crime of violence Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Caplan’s Four Phases of Crisis: Phase 1 Conflict or problem $ Self-concept threatened $ Increased anxiety $ Use of problem-solving techniques and defense mechanisms $ Resolve conflict or problem $ Reduce anxiety Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Caplan’s Four Phases of Crisis: Phase 2 Problem-solving techniques and defense mechanisms fail $ Threat persists $ Anxiety increases $ Feelings of extreme discomfort produced $ Functioning disorganized $ Trial-and-error attempt to solve problem and restore normal balance Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Caplan’s Four Phases of Crisis: Phase 3 Trial-and-error attempts fail $ Anxiety can escalate to severe and panic levels $ Automatic relief behaviors mobilized (i.e., withdrawal and flight) $ Some form of resolution may be made (compromising needs or redefining situation) Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Caplan’s Four Phases of Crisis: Phase 4 Problem not solved and coping skills ineffective $ Overwhelming anxiety $ Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Crisis: Assessment Suicidal or homicidal ideation or gestures Client's perception of precipitating event Client's situational supports Client's personal coping skills See Assessment Guidelines for a crisis on page 461. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Four Common Problems in the Nurse-Client Relationship Nurse needs to be needed Nurse sets unrealistic goals for client Nurse has difficulty dealing with the issue of suicide Nurse has difficulty terminating the nurse-client relationship Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Potential Nursing Diagnoses for Client in Crisis Ineffective coping Anxiety Compromised family coping Risk for self-directed violence Hopelessness Disturbed thought processes See table 22-2 on page 463. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Outcome Criteria for Client in Crisis Congruence with client's needs, values, and cultural expectations Safety if client is potentially suicidal or homicidal Anxiety reduction so inner resources can be used Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Two Basic Initial Goals of Crisis Intervention Client safety Anxiety reduction Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Crisis Intervention: Three Levels of Nursing Care Primary: Reduce incidence of crises Promote mental health and reduce mental illness Secondary: Ensure client safety Prevent prolonged anxiety from diminishing Personal effectiveness Personality organization Tertiary: Support after crisis Facilitate optimal levels of functioning Prevent further emotional disruptions Review box 22-2 on page 466. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Crisis Resolution Person emerges at: A higher level of functioning The pre-crisis level of functioning A lower level of functioning Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Critical Incident Stress Debriefing (CISD) Seven-phase group meeting Introductory Fact Thought Reaction Symptom Teaching Reentry Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.

Evaluation 4-8 weeks after initial interview If interventions have been successful, the individual’s level of anxiety and ability to function ought to be at pre-crisis levels. Further mental health treatment is often indicated. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved.