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Crisis Intervention

by Diana Shenefield, PhD
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    00:01 Welcome! My name is Diana Shenefield and the in class topic we are gonna talk about today is Psychosocial Integrity.

    00:08 As it falls under crisis interventions and you may be saying to yourself crisis interventions is all our patients are under crisis. And that's true.

    00:16 So what can i do as a nurse to identify the patients that are in crisis and what can i do to de-escalate? So we are gonna look at those patients. We are looking at the risk factors for crisis and then again what interventions can the nurse provide to the help the patient through those crisis at the time on their happening, situational crisis or may be that they are coming in under crisis.

    00:41 Our learning outcomes today is we are gonna identify patients in crisis and again it may be every patients in crisis.

    00:49 And it may seem that way depending on what unit you work in.

    00:52 Then again being able to identity those patients at risk and then maintain patient safety. That is our top goal.

    00:59 When patients are in crisis sometimes they are not thinking straight until we wanna make sure they were keeping our patient safe.

    01:05 Are other patient safe as well as keeping ourselves and other healthcare provider safe.

    01:11 So let's start with our typical NCLEX question.

    01:14 When caring for a patient who has been raped which action should a nurse take first? So again we are looking at situational crisis and then you also notice that the question is asking for which would you do first.

    01:27 That kinda gives me an hint that i might do more than one of these things.

    01:31 But i need to find out what i would do first? So i am looking at Maslow. I am looking at physical conditions. I am looking at Psychosocial conditions.

    01:39 So, A. Would i explore legal issues and prosecution? B. Would i acknowledge patient's saftey and fear? C. What i explore patient's feelings about recovery? Or D. What i introduce defensive tactics? So as i am looking through those things and i have this patient in front of me, what i am going to do first? And hopefully you picked B. I am gonna acknowledge a patient's anxiety and fear.

    02:07 One other things you wanna make when you talking about therapeutic communication is you don't want to explore.

    02:13 You don't wanna ask why? You don't wanna make the patient feel guilty.

    02:18 You don't wanna accuse the patient and you don't wanna make the situation about the nurse's feelings.

    02:25 And so as i am looking for the answers here. The first thing i wanted to do is acknowledge what my patient is going through.

    02:32 Acknowledge that they are anxious and that they fear for.

    02:35 So what is a definition of crisis? Its a sudden event in one's life that disturbs homeostasis.

    02:43 So it could be any thing.

    02:45 We just happen to be talking about healthcare.

    02:47 But we also known that people come to us from different areas of life.

    02:51 and things happen outside of healthcare that affect what happens in healthcare.

    02:56 So its going to disturb their homeostasis and during which their usual coping mechanisms cannot resolve the problem.

    03:05 When we look back at the question at the young lady who has been raped.

    03:08 She might have really good coping mechamisms but all of the sudden she's put into situational crisis that she has never faced before.

    03:16 And so she has the inability to resolve the problem using her normal coping mechanism.

    03:22 It is a crucial time with the possibility of an undesirable outcome.

    03:28 When people are in situational crisis they can go either way. They can either deal with it by good coping mechanisms.

    03:37 Or it can turn out in use bad coping mechanisms and have event that we may not participating, want to participating.

    03:47 So what nursing interventions would we look at? We wanna identify patient's stressful precipitating event.

    03:54 Again a lot of times patient will come in and will known what is happened.

    03:58 A lot of time they will be hysterical and we won't know.

    04:01 So we need to identify what has happened.

    04:04 Where are the injuries? Are they psychological injuries? Are they emotional injuries? Are they Physical injuries? What is the participating event? We need to identify the patient's current feelings.

    04:20 Again sometimes people deal with things in different ways and so how is the patient feeling at that time.

    04:26 Are they anxious? Are the fearful? Are they scared? Are they angry? Are they heralded? Again what are they feeling at that time and that would be when i am acknowledging those feelings.

    04:38 And the assess the patient's support system. Again, we are always looking at who does the patient have that can support them.

    04:46 Is it family members? Is it coworkers? It is friends? Is it their church? Who is it that is going to be able to help them through this crisis after they leave our facilities? And then educating the patient on crisis intervention.

    05:01 Giving them the resources and the education that they can use to move themselves through this situation.

    05:08 And assess the patient's potential for self-harm.

    05:12 We always making sure that our patient is safe and their other people are safe as well.

    05:17 So what is their potential? What degree of crisis are they in and or they coping or not coping? And are we looking at self-harm? May be suicide prevention.

    05:28 Are we looking at? Are they going to harm other people? And what we can to de-escalate that? And in setting goals with patient to deal with this crisis.

    05:39 We know as a nursing process we assess.

    05:42 We give our nursing diagnosis and then we set our goals.

    05:46 So what goals can we set with our patient to help move them pass this crisis? to where they can get back to a state of homeostasis.

    05:55 So remember the highest priority for patients is watching for the risk of suicide.

    06:01 A lot of times people that are put into situational crisis can not think straight. They can't, their mind is in different thought processes.

    06:11 so we need to make sure our patient is safe and we are watching for risk of suicide.

    06:16 We also need to make sure we have arrangements to make sure that the patient isn't left alone.

    06:21 Whether be in a hospital, whether be at their home. But to make sure that the somebody who is going to constantly observe them to make sure that the high risk patient doesn't harm themselves.

    06:32 So in closing again depending on where you work you may see patients that are in constant crisis.

    06:38 So being able to de-escalate those crisis, being able to keep your patient safe.

    06:43 To be able to set goals with them, to move them pass that crisis so that they can heal the way that they are supposed to.

    06:52 So that they don't harm themselves or others.

    06:54 Again nursing isn't just about the physical. But you help people to return back to homeostasis. Keep safe.

    07:03 But also watch how they interact with their people around them.

    07:08 What are their social friends? They are the people that are gonna support them.

    07:14 Or as a nurse do i need to make sure that i hooked them up with the right resources.

    07:19 So you are looking at your NCLEX questions again, make sure your patient is safe.

    07:24 And make sure that you are watching them and you are de-escalating when things get out of control. Good look on NCLEX.


    About the Lecture

    The lecture Crisis Intervention by Diana Shenefield, PhD is from the course Psychosocial Integrity. It contains the following chapters:

    • Crisis Interventions
    • Definition of Crisis
    • Nursing Interventions
    • Remember & Closing

    Included Quiz Questions

    1. 4 to 6 weeks
    2. 1 to 2 weeks
    3. 12 to 14 weeks
    4. 24 to 26 weeks
    1. Active, with focus on current situation
    2. Reassuring
    3. Passive listening
    4. Explore early life experiences
    1. One-to-one suicide precautions
    2. Suicide precautions with 30-minute checks
    3. Checking the whereabouts of the patient every 15 minutes
    4. Asking the patient to report suicidal thoughts immediately

    Author of lecture Crisis Intervention

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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