Crisis Management (ATI Ch. 27)

Crisis
an acute, time-limited (lasting 4-6 weeks) event that a client experiences an emotional response that can’t be managed with normal coping mechanisms.
Crisis (personal)
is a personal struggle for equilibrium and adaptation. What might be considered a crisis for one person may not be so for another.
Crisis (characteristics)
sudden event with little or no time to prepare, perception of the event as overwhelming or life-threatening, loss or decrease in communication with significant other, sense of displacement from the familiar, an actual or perceived loss.
3 types of Crisis
Situational/external, maturational/internal and adventitious
situation/external
often unanticipated loss or change experienced in every day, often unanticipated, LIFE events.
maturational/internal
achieving new developmental STAGES, which requires learning additional coping mechanisms.
adventitious
the occurrence of NATURAL disasters, crimes, or national disasters. Large scale psychological trauma caused by natural disaster. CISD tool is used in the community when this happens
crisis (risk factors)
accumulation of unresolved losses, life stressors, mental and physical health issues, excessive fatigue or pain, age and developmental stage, support system and prior experience with stress/crises.
crisis (data)
suicidal or homicidal ideation requiring hospitalization, client’s perception of the precipitating event, cultural or religious needs, support system and present coping skills.
4 phases of a crisis
phase 1-4
crisis phase 1
escalating anxiety from a threat activates increased defense responses.
crisis phase 2
anxiety continues escalating as defense response fail, functioning becomes disorganized, and the client resorts to trial and error attempts to resolve anxiety.
crisis phase 3
trial-and-error methods of resolution fail, and the clients anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors.
crisis phase 4
client experiences overwhelming anxiety that can lead to anguish and apprehension, feeling of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self.
Crisis intervention
provides rapid assistance for individuals or groups. the initial task for the nurse it to provide a sense of safety by assessing clients potential suicide or homicide.
Crisis intervention (procedure)
ID current problem and direct interventions for resolution, take an active, directive role with the client, help client set realistic and attainable goals.
CISD
Critical Incident Stress Debriefing
CISD definition
is a group approach that can be used with a group of people who have been exposed to a crisis situation.
Crisis Client Safety
initiate hospitalization to protect clients who have suicidal or homicidal thoughts. Prioritize interventions to address the client’s physical needs first.
* Decrease Anxiety
Develop a therapeutic nurse-client relationship, remain with the client, listen and observe, eye contact, ask questions related to the client’s feelings, ask questions related to the event, demonstrate genuineness and caring, clear communication if needed with clear directives, avoid false reassurance and non therapeutic response, relaxation techniques, ID and teach coping skills
Crisis plan of action
short-term, no longer than 24-72 hr, focused on the crisis and realistic and manageable.
Crisis medications
administer anti-anxiety and/or antidepressants (paxil) medication as prescribed. benzodiazepine is used to minimize anxiety.
Crisis client education
Identify and coordinate with support agencies and other resources. Plan and provide follow up care.