Welcome! My name is Diana Shenefield
and the in class topic we are gonna talk
about today is Psychosocial Integrity.
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.
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.
Our learning outcomes today is we
are gonna identify patients in crisis
and again it may be every patients in crisis.
And it may seem that way depending
on what unit you work in.
Then again being able to identity
those patients at risk
and then maintain patient safety.
That is our top goal.
When patients are in crisis sometimes they
are not thinking straight until we wanna make
sure they were keeping our patient safe.
Are other patient safe as well as keeping
ourselves and other healthcare provider safe.
So let's start with our
typical NCLEX question.
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.
That kinda gives me an hint that i
might do more than one of these things.
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.
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.
One other things you wanna make when you
talking about therapeutic communication
is you don't want to explore.
You don't wanna ask why?
You don't wanna make
the patient feel guilty.
You don't wanna accuse the patient
and you don't wanna make the
situation about the nurse's feelings.
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.
Acknowledge that they are
anxious and that they fear for.
So what is a definition of crisis?
Its a sudden event in one's
life that disturbs homeostasis.
So it could be any thing.
We just happen to be
talking about healthcare.
But we also known that people come
to us from different areas of life.
and things happen outside of healthcare
that affect what happens in healthcare.
So its going to disturb their homeostasis
and during which
their usual coping mechanisms
cannot resolve the problem.
When we look back at the question at
the young lady who has been raped.
She might have really good coping mechamisms but
all of the sudden she's put into situational crisis
that she has never faced before.
And so she has the inability
to resolve the problem using
her normal coping mechanism.
It is a crucial time
with the possibility of
an undesirable outcome.
When people are in situational crisis
they can go either way. They can either
deal with it by good coping mechanisms.
Or it can turn out in use bad
coping mechanisms and have
event that we may not participating,
want to participating.
So what nursing interventions
would we look at?
We wanna identify patient's
stressful precipitating event.
Again a lot of times patient will
come in and will known what is happened.
A lot of time they will be
hysterical and we won't know.
So we need to identify
what has happened.
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.
Again sometimes people deal
with things in different ways
and so how is the patient
feeling at that time.
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.
And the assess the patient's support system.
Again, we are always looking at
who does the patient have
that can support them.
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.
Giving them the resources and
the education that they can use
to move themselves through this situation.
And assess the patient's
potential for self-harm.
We always making sure
that our patient is safe
and their other people
are safe as well.
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.
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.
We know as a nursing process we assess.
We give our nursing diagnosis
and then we set our goals.
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.
So remember the highest
priority for patients
is watching for the risk of suicide.
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.
so we need to make sure our patient is safe
and we are watching for risk of suicide.
We also need to make sure we have arrangements
to make sure that the patient isn't left alone.
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.
So in closing again depending on where you work
you may see patients that
are in constant crisis.
So being able to de-escalate those crisis,
being able to keep your patient safe.
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.
So that they don't harm
themselves or others.
Again nursing isn't just about the
physical. But you help people
to return back to homeostasis. Keep safe.
But also watch how they interact
with their people around them.
What are their social friends?
They are the people that
are gonna support them.
Or as a nurse do i need to make sure that
i hooked them up with the right resources.
So you are looking at your NCLEX questions
again, make sure your patient is safe.
And make sure that you are watching them
and you are de-escalating when things get
out of control. Good look on NCLEX.