Cues Objectives Interventions

GUADI Z, Ye s s ami n T.
MODULE 4A QUI Z: CRI SI S I NTERVENTI ON
Nsg. Dx. Phases Outcome
BSN 3 f 1

Cues:
- Receives a phone call from her father telling her that she will no longer get
Ensuring Client Safety Making Plans
financial support
- She tells the nurse that she is seriously considering taking an overdose of
non-aspirin pain capsules to make her father guilty

Interventions:
Risk for self-directed violence related to sudden
1. Identify the level of self-harm precautions needed. Identify whether the patient
overwhelming event
needs hospitalization or not.
2. Assess the environment of the patient at home
3. Assess the patient?s ability to contract for safety within 24-48 hours
4. Offer self and stay close by the patient throughout the interventions
Interventions:
1. Come up with a schedule of activities with the patient that she has to follow for
next 1-2 days
2. Provide a 24-hour emergency hotline phone number that the patient may call
when she feels the need to self-harm
3. Educate the patient on relaxation techniques she can perform when she is
uneasy such as breathing techniques, meditation, journaling, walking, etc.

Objectives:
- Within 2 hours of nursing intervention, the patient will be able to verbalize
thoughts, feelings, and behavior that leads up to her wanting to commit
self-harm
- After 8 hours of nursing intervention, the patient will be able to identify at least 2
people whom she can seek support from and emotional guidance when she
feels the need to continue her plans of self-harm
- Within 24-48 hours, the patient will contract to safety and will be free from
self-harm
- After 48 hours, the patient will return for a follow-up with verbalization of
decreased/ no tendencies of self-harm
6 phases of Crisis Intervention
Defining the problem
Interventions:
1. Establish rapport with the patient by finding a common ground and being
non-judgmental, empathetic, and genuine towards the patient
2. Encourage patient to verbalize feelings, thoughts, and emotions surrounding the
recent event that occured with her father
3. Incorporate therapeutic communication techniques such as listening, offering
general leads, reflecting, etc.
Providing Support
Interventions:
1. Assist the patient in performing activities
2. Encourage the patient to verbalize feelings, thoughts, and emotions that might
have lead to her wanting to commit self- harm
3. Offer self by being available to patient's physical and emotional needs
Examining Alternatives
Interventions:
1. Assist the patient identify important persons in her life that she can seek support
and emotional guidance from
2. Assess for existing coping mechanisms practiced by the patient during stressful
events.
3. Explore alternative ways on how the patient handles anger and frustration
Obtaining Commitment
Interventions:
1. Implement a no-self-harm contract with the patient
2. Explain to the patient the meaning of that contract
3. Schedule a follow-up check up with the patient
Evaluation:
- Th e goal is f u lly m et if t h e pat ien t is able t o:
1. Verbalize relevant thoughts, feelings, and behavior that leads up to her
wanting to commit self-harm.
2. Identify at least 2 people whom she can seek support from and emotional
guidance when she feels the need to continue her plans of self-harm
3. Contract to safety and will be free from self-harm until the next follow-up
check-up
4. Verbalize decreased/ no tendencies of self-harm during the follow-up
check-up
- Th e goal is par t ially m et if t h e pat ien t is able t o:
1. Verbalize some thoughts, feelings, and behavior that leads up to her wanting
to commit self-harm.
2. Identify only 1 person whom she can seek support from and emotional
guidance when she feels the need to continue her plans of self-harm
3. Contract to safety and will be free from self-harm until the next follow-up
check-up
4. Verbalize that she still wants to perform self-harm during the follow up
- Th e goal is n ot m et if t h e pat ien t is non-cooperative in the interventions, still
pursues to commit self-harm, or has already done self-harm.