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?