Crisis Intervention - Nurse Role Phases/7-Stage Crisis Model

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Phases of Nursing Roles; Roberts Seven Stage Crisis Intervention Model
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1

Robert's 7 Stages

Stage 1 - Psychosocial and Lethality Assessment

Conduct a rapid but thorough biopsychosocial assessment.

2

Robert's 7 Stages

Stage 2 - Rapidly Establish Rapport

  • The counselor uses genuineness, respect and unconditional acceptance to establish rapport w/client
  • Skills such as good eye contact, a nonjudgmental attitude, flexibility, and maintaining a positive mental attitude are important.
3

Robert's 7 Stages

Stage 3 - Identity the Major Problems or Crisis Precipitants

  • Identify the precipitating event that has led the client to seek help at the present time.
  • Identify other situations that led up to the precipitating event.
  • Prioritize major problems w/ which the client needs help.
  • Discuss client's current style of coping, and offer assistance in areas where modification would be helpful in resolving the present crisis and preventing future crises.
4

Robert's 7 Stages

Stage 4 - Deal W/Feelings & Emotions

  • Encourage the client to vent feelings, provide validation.
  • Use therapeutic communication techniques to help the client explain his or her story about the current crisis situation.
  • Eventually, and cautiously, begin to challenge maladaptive beliefs and behaviors, and help the clients adopt more national and adaptive options.
5

Robert's 7 Stages

Stage 5 - Generate and Explore Alternatives

  • Collaboratively explore options with the client
  • Identify coping strategies that have been successful for the client in the past.
  • Help the client problem-solve strategies for confronting current crisis adaptively.
6

Robert's 7 Stages

Stage 6 - Implement an Action Plan

  • There is a shift at this stage from crisis to resolutions
  • Develop a concrete plan of action to deal directly w/ the current crisis
  • Having a concrete plan restores the client's equilibrium and psychological balance.
  • Work through the meaning of the event that precipitated the crisis. How could it have been prevented? What responses may have aggravated the situation?
7

Robert's 7 Stages

Stage 7 - Follow-Up

  • Plan a follow up visit with the client to evaluate the post crisis status of the client.
  • Beneficial scheduling of the follow-up visits include 1 month and 1 year anniversaries of the crisis event.
8

Nurses Role Phases

Phase 1 - Assessment

  • Crisis helper gathers information regarding precipitating stressor and resulting crisis that promoted individual to seek professional help.
  • Ask individual to describe event that precipitated crisis
  • Determine when it occurred
  • Assess individual's physical & mental status
  • Determine if methods of coping were used and if so, what was the result.
  • Assess suicide or homicide potential, plan, and means
  • Assess adequacy of support system.
9

Nurses Role Phases

Phase 2 - Planning of Therapeutic Intervention

  • Select appropriate nursing actions
  • Consider the type of crisis, individual's strengths and available support resources.
10

Nurses Role Phases

Phase 3 - Intervention

  • Use a reality-oriented approach - the focus of the problem is on here and now.
  • Remain w/individual experiencing panic anxiety
  • Establishing a rapid working relationship by showing unconditional acceptance - active listening and attending immediate needs
  • Discourage lengthy explanations or rationalizations
11

Nurses Role Phases

Phase 3 - Intervention - pt 2

  • Set firm limits on aggresive, destructive behaviors - as these tend to occur at high levels of anxiety - establish what is acceptable and MAINTAIN consistency.
  • Clarify the problem that individual is facing - describe your perception of the problem back to the client.
  • Help individual determine what he or she believes brought on the crisis.
  • Acknowledge feelings of anger, guilt, helplessness and powerlessness - avoid giving such feelings positive feedback.
12

Nurses Role Phases

Phase 3 - Intervention - pt 3

  • Guide individual through problem solving process - confront source of problem, encourage discussion of changes to make - make sure they are realistic
  • Encourage exploration of feelings about aspects that can't be changed - assess coping.
  • Discuss alternative strategies for creating changes
  • Assist individual in choosing alternative coping strategies.
13

Nurses Role Phases

Phase 4 - Evaluation

  • Have positive behavioral changes occured?
  • Has the indivudal developed more adaptivie coping strategies ? Are they effective?
  • Has the individual grown from the experience by gaining insight into his/her responses to the crisis situations?
  • Does individual believe he/she should respond w/ healthy adaptation in future stressful situations.
  • Can the individual describe a plan of action for dealing w/similar stressors?

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