CHAPTER 10 - INTERVENING IN CRISES
During the initial interview with a client in crisis, which intervention should the mental health nurse initially implement? 1) Assess the potential for self-harm. 2) Assess the adequacy of the client's support system. 3) Assess the level of pre-crisis functioning. 4) Assess for substance use disorder.
1) Assess the potential for self-harm. Feedback 1: The essential component of the initial interview is to assess how the crisis may affect the client's safety. Assessment of self-harm can give the nurse the information needed to intervene appropriately and keep the client safe. Feedback 2: Determining the adequacy of the client's support system is important. However, the primary concern is provision of client safety by the assessment of self-harm potential. Feedback 3: An important intervention in a crisis situation is to determine the client's pre-crisis level of functioning. Even though this information will assist the nurse to realistically determine client potential, the primary concern must be the provision of client safety. Feedback 4: During the initial interaction, a complete inquiry into the nature of the crisis is essential, including assessment of any substance use disorder. But, this should only be undertaken after assessing the client's potential for self-harm.
Which of the following factors influence the development of a crisis? Select all that apply. 1) The individual's perception of the event 2) The time of year in which the event occurred 3) The individual's age at the time of the event 4) The presence of adequate coping mechanisms 5) The individual's gender
1) The individual's perception of the event 4) The presence of adequate coping mechanisms Feedback 1: If the event is perceived realistically, the individual is more likely to draw on adequate resources to restore equilibrium. If the perception of the event is distorted, attempts at problem solving are likely to be ineffective. Feedback 2: Crisis events can occur at any time of year. The time frame would not specifically influence the development of a crisis. Feedback 3: Crisis events can occur at any age. An individual's age would not specifically influence the development of a crisis. Feedback 4: The presence of adequate coping mechanisms is a factor that influences whether an individual will experience a crisis. Individuals draw on behavioral strategies that have been successful for them in the past. If these coping strategies work, a crisis may be diverted. Feedback 5: The development of a crisis is not influenced by gender. Both males and females experience crisis events.
Which question would be most effective when evaluating the outcome of crisis intervention? 1) "Has education helped you with positive behavioral changes?" 2) "Has crisis therapy precipitated maladaptive coping strategies?" 3) "Have you grown from the experience?" 4) "Why did you use maladaptive coping mechanisms to deal with this crisis?
3) "Have you grown from the experience?" Feedback 1: Client education is not appropriate during crisis intervention. Crisis intervention is focused on intense, goal-directed, short-term therapy to initiate positive behavioral changes. Feedback 2: Crisis therapy helps the client develop adaptive, not maladaptive, coping strategies. Maladaptive coping is a roadblock to resolving crisis. Feedback 3: Through adaptive changes, a crisis is resolved and psychological growth is experienced. If adaptive change is assessed, the outcome of crisis intervention can be evaluated as successful. Feedback 4: When the nurse asks a "why" question, the nurse is demanding an explanation that the client is most likely unable to give. This nontherapeutic technique puts the client on the defensive, blocks the communication process, and does nothing to evaluate crisis intervention.
The nurse determines which is most essential when planning care for a client who is experiencing a crisis? 1) Focusing on emotional deficits 2) Encouraging lengthy explanations of the situation 3) Exploring previous coping strategies 4) Focusing on developmental issues that may have affected the client's ability to cope
3) Exploring previous coping strategies Feedback 1: Focusing on emotional deficits undermines the crisis intervention process. The goal of care delivered during crisis is to assist the client to cope in the immediate present. Feedback 2: Lengthy explanations or rationalizations of the situation should be discouraged, not encouraged. The nurse should promote an atmosphere for verbalizations of true feelings. Feedback 3: Inquiring about previously successful coping strategies will provide insight as to how these strategies can be applied to the current crisis situation. The nurse can then plan care based on the knowledge of the client's past abilities to cope. Feedback 4: The focus should be on the here and now and not on previous developmental issues. The nurse should use a practical, reality-oriented approach to deal with crisis.
In order to return a client to a pre-crisis level of functioning, which client information should the nurse initially assess? 1) Incompetency 2) Psychotic episodes 3) Personal strengths 4) Family support
3) Personal strengths Feedback 1: A mentally ill client may be incompetent to care for self. However, incompetency is not the primary consideration by the nurse. Focus should be placed on initially assessing personal strengths in order to plan effective care and help the client return to a pre-crisis level of functioning. Feedback 2: There is a possibility that a mentally ill client may experience psychosis. However, in order to assist the client to return to a pre-crisis level of functioning, the nurse must initially assess the client's strengths and help the client use these strengths effectively. Feedback 3: Every person, even those diagnosed with mental illness, has strengths as well as weaknesses. Assessing strengths and helping the client use these strengths effectively will facilitate a return to a level of pre-crisis functioning. Feedback 4: An external support system, including a supportive family, can help facilitate a client's return to a pre-crisis level of functioning. However, it is the client who must be able to cope with crisis situations. Assessing strengths and helping the client use these strengths effectively will facilitate a return to a level of pre-crisis functioning.
A crisis is an internal disturbance. Which is characteristic of a crisis? 1) Crises are chronic in nature. 2) Crises are universal in nature. 3) Precipitating events are specific and identifiable. 4) A crisis will eventually lead to psychological growth.
3) Precipitating events are specific and identifiable. Feedback 1: Crises are acute, not chronic, and will be resolved in one way or another within a brief period. Feedback 2: Crises are personal, not universal, by nature. What may be considered a crisis situation by one individual may not be so for another. Feedback 3: Crises are precipitated by specific, identifiable events. Feedback 4: A crisis situation contains the potential for either psychological growth or deterioration.
A woman who has been recently widowed is unable to cope with the tasks of daily living because a recent hurricane completely destroyed her home. She is unable to identify any available family support. The nurse identifies that the client is experiencing which type of crisis? 1) Dispositional crisis 2) Life transitions crisis 3) Traumatic stress crisis 4) Maturational/developmental crisis
3) Traumatic stress crisis Feedback 1: Dispositional crisis is an acute response to an external situational stressor. This client has both internal (loss of husband) and external (destruction of home) stressors. Feedback 2: Life transitions crises are normal life cycle transitions that may be anticipated but over which the individual may feel a lack of control. The situations that this client is experiencing could not have been anticipated. Feedback 3: Crises resulting from traumatic stress are precipitated by unexpected external stresses over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated. The natural disaster described in the question has precipitated a traumatic stress crisis. Feedback 4: Maturational/developmental crisis occurs in response to situations that trigger emotions related to unresolved conflicts in one's life. These crises are of internal origin and reflect underlying developmental issues that involve dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy. The natural disaster described in the question is of external, not internal, origin and does not revolve around unresolved conflicts.
An adolescent recently lost his father in a plane crash. He has begun to question his belief in God. He cries out, "No God would have let my father die like that! I'm so angry I could scream!" Which is the nurse's best response? 1) "You shouldn't say things like that." 2) "Are you having any thoughts of wanting to harm yourself in any way?" 3) "I believe that God has your father in a safe place right now." 4) "You're feeling so angry. I'm here for you. I'm listening."
4) "You're feeling so angry. I'm here for you. I'm listening." Feedback 1: This response uses the nontherapeutic communication technique of rejecting. It communicates to the client that expressed feelings are not acceptable. Feedback 2: Although, if indicated, it may be appropriate to assess for thoughts of suicide, the question does not describe any suicidal ideations. The client is expressing anger, which is the primary emotion that should be addressed. Feedback 3: This response uses the nontherapeutic communication technique of making stereotyped comments. This statement does not address the client's anger and may block further expression of feelings. Feedback 4: The nurse is using the therapeutic techniques of restatement and offering self. Restatement communicates that the nurse is hearing what the client is saying. Offering self will help build trust by the nurse being there for the client and recognizing and accepting the client's anger in a nonjudgmental capacity.
An athlete has been recently diagnosed with diabetes mellitus but denies the diagnosis. The athlete's speech is monotone when stating, "I'm ready to end my life." Which would be the priority outcome of crisis intervention for this client? 1) The client will participate in unit activities. 2) The client will express the desire for continued therapy by day 3. 3) The client will list five personal strengths by day 2. 4) The client will remain safe during hospitalization.
4) The client will remain safe during hospitalization. Feedback 1: Participation in unit activities is an indication of an improvement in mood; however, because of this client's potential for self-harm, this would not be the priority outcome. Also, this outcome does not contain a time frame and therefore cannot be measured. Feedback 2: A desire for continued therapy indicates that the client is seeking solutions to current problems; however, because of this client's potential for self-harm, this would not be the priority outcome. Feedback 3: Recognition of personal strengths is important for planning effective interventions; however, because of this client's potential for self-harm, this would not be the priority outcome. Feedback 4: The priority outcome for a suicidal client is that the client remains safe. All other outcomes are inconsequential if the client commits suicide.