Psychosocial Integrity / Topic 7

Make sure to:

  • Identify clients who are experiencing a crisis.
  • Assess the safety of the client and others.
  • Conduct crisis intervention.

Media reports highlight crises leading to workplace violence and suicide across various socioeconomic groups, with healthcare settings being no exception to these incidents. Therefore, it is important for nurses to identify clients in crisis and intervene effectively to prevent loss of lives through violence and suicide.

In this learning experience, learners will develop knowledge and insights into crisis intervention. This includes a focus on recognizing clients in crisis, assessing the safety of both clients and others, and implementing appropriate intervention strategies.

7.1 Identification of Clients in Crisis

A crisis is defined as an emotionally significant event or drastic change in a person's life status. It represents an unstable and/or critical period where there is a potential for an undesirable outcome (Kaplan Nursing, 2023). Instances of psychological crises can include events like homicide, suicide, and suicide-homicide (Burke, 2023). Nurses can employ both subjective and objective data to identify clients who may be at risk of violent towards others or themselves, including suicide (Burke, 2023).

According to Burke (2023), clients who are at risk for suicide or likely to attempt it often exhibit certain signs:

  • Altered sleep patterns.
  • Self-harming behaviors.
  • Feelings of guilt and shame.
  • A lack of interest in the future.
  • Saying goodbye to individuals as if for the last time.  
  • Giving away their possessions.
  • Speaking or writing about committing suicide.
  • Changes in personal appearance and/or personality.
  • Appearing to feel better, which may be due to having formulated a plan for suicide.

Furthermore, Burke (2023) notes that clients who might harm themselves or are at risk of suicide often have certain characteristics. These clients are typically:

  • Lacking resources and support systems.
  • Having a history of traumatic experiences, such as abuse or neglect.
  • Either in the age group of 15-19 years or older than 45 years.

According to Burke (2023), nurses should be aware that clients with a history of certain conditions or experiences are at increased risk for committing acts of violence, including homicide and homicide-suicide. These clients typically have a history of:

  • Unresolved crises.
  • Neurological deficits or head trauma.
  • Psychiatric disorders or substance use disorders.
  • Experiencing neglect or abuse during childhood.
  • Delusions and hallucinations, especially those involving command hallucinations.

Therefore, it is crucial for nurses to vigilantly observe their clients for these behaviors and characteristics. This vigilance is key to identifying clients who may be planning to commit suicide and/or violence, allowing for timely and appropriate intervention to prevent such occurrences.

7.2 Assess Safety of Client and Others

As they assess the safety of their clients and others, nurses should evaluate the potential for violence in their clients and implement appropriate safety precautions (Burke, 2023). According to (Burke, 2023), clients may be categorized into one of four levels of crisis:

  1. Clients experience anxiety and begin to utilize one or more defense mechanisms.
  2. Clients exhibit reduced functional ability and seek alternative coping mechanisms as traditional defense mechanisms prove ineffective.
  3. This level is characterized by reactions of fight, flight, and panic.
  4. Clients in level four crisis display severe signs and symptoms, such as disorientation, feelings of being overwhelmed, detachment, and thoughts of violence towards themselves or others.

It is important for nurses to prevent psychological crises, such as homicide, suicide, and suicide-homicide (Burke, 2023). These types of crises often stem from unresolved issues and depression. A client may harm someone they perceived to be causing their problems, commit homicide with the misguided intention of saving someone from their own pain and suffering, or commit suicide followed by suicide to escape further pain and suffering. To prevent such crises and ensure the safety of their clients and others, nurses need to be proficient in:

  • Understanding their clients.
  • Recognizing warning signs and risk factors associated with crises.
  • Applying their knowledge in caring for and monitoring clients in crisis, such as treating a severely depressed client.

Additionally, nurses must take any threats of violence towards others or suicide seriously and prioritize safety (Burke, 2023). This involves ensuring that:

  • There is a trusting relationship between the nurse and the client.
  • The environment is supportive, caring, nonjudgmental, understanding, trustworthy, open, and honest.
  • Clients are under constant observation through one-to-one supervision.
  • The coping mechanisms of clients are developed and enhanced.
  • To further support clients, nurses should facilitate:
    • Their engagement in both group and individual therapy.
    • Use of stress management and relaxation techniques.
    • Compliance with medication management and adherence to the treatment plan.

7.3 Crisis Intervention

In the event of a crisis, nurses should take the following steps:

  • Gather the history of the current issue directly from the client.
  • Determine the client's current emotional state.
  • Evaluate the client's available support systems.
  • Educate clients about crisis intervention techniques to assist in coping.
  • Assess whether the clients pose a risk of harm to themselves or others.

Additionally, nurses can utilize their understanding of client psychopathology in crisis intervention (Burke, 2023). This involves applying specific knowledge to cater to the unique needs of clients with different backgrounds and conditions, such as:

  • A client with a traumatic head injury.
  • A client who has a history of physical, emotional, or sexual abuse.
  • A client with a history of an underlying substance abuse or psychiatric mental health disorder.

Finally, nurses should align with the goals of crisis intervention as outlined by Kaplan Nursing (2023), which include:

  • Reducing the client's emotional stress and protecting them from additional stress.
  • Assisting clients in accessing appropriate resources and/or support systems.
  • Helping clients to return to their level of functioning prior to the crisis.

At the end of this learning experience, the learner will have acquired knowledge in crisis intervention. The primary objectives are to prepare learners for success in the NCLEX examination and to improve their clinical competencies in managing crisis situations.

After reviewing the provided resources, it is important for learners to identify specific areas requiring further improvement. Focusing on these areas will help in sharpening and advancing the necessary skills for effective crisis intervention and professional practice.

  • Burke, A. (2023, October 6). Crisis Intervention: NCLEX-RN. https://www.registerednursing.org/nclex/crisis-intervention/#identifying-client-crisis
  • Kaplan Nursing. (2023). Next Generation NCLEX-RN Prep 2023-2024: Practice Test + Proven Strategies (9th ed.). Kaplan Test Prep.

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