Name : Winda Suryaningtyas

NIM : PO7120123071
Level : 1 B
Supporting Lecturer : Sinta Octaviana, M.Pd

EXPERT LECTURES
DEPARTMENT OF MENTAL CARE
"Managing psychiatric emergencies in hospitals and in the community"
Speaker Lecturer : Ns. Abdul Jalil., M.Kep., SP. Kep.J, Fisqua

1. Healthy Sound?

 Feeling Healthy and Happy

 Able to face the challenges of life

 Accept others as they are

 Be positive to yourself and others

 Productive in daily life

2. Groups prone to mental disorders :

• Mother gave birth
• Elderly living alone
• Schoolboys and
• Teenagers who are often bullied
• After divorcing a partner
• Lose one's job
• Lose a child or a spouse
• Disengagement
• Suffer from a yearning illness
• It hurts all of a sudden
• Accident and loss of limbs
3. Stages of Mental Disorder :
 Prodromal Phase
 Crisis Phase / Acute
 Stable/ Quiet Phase
 Recovery Phase

4. Crisis Type :
 Situational Crisis: Biopsychosocial balance is impaired due to external and
environmental factors. For example: loss, violence, hospitalization.
 Mature national crisis: Cognitive and behavioral changes due to physical changes
during development. For example: Pioneers, acting, being parents, marriage,
teenagers
 Socio-cultural crisis: cultural values and social structures. For example:
discrimination between races, robbery
 a traumatic stress crisis: an unexpected external pressure. For example: robbery,
rape
 Psychopathology crisis: conditions that cause impact and complications. For
example: BPD, Neurosis, Schizophrenia

5. Signs and symptoms of the crisis :

 A heavy burden of anxiety
 Depression or anxiety/agitation
 Anger, guilt, tension, fear
 Irrational and blaming others
 Leadership, despair, futility
 Chaos, overwhelmed
 Panic
 Self-esteem / Low level of confidence
 Crying uncontrollably
 Frustrated, confused, unable to make a decision

6. Goals of Crisis Intervention :

 Psychological resolution of a crisis directly
 Individual recoveries for at least the function level that existed before the crisis
period ended
 Individuals must resolve problems or adapt if there is no solution/solutions
 Less emotional stress
 Protect clients from additional stress
7. Crisis Intervention Strategy :
1. Abreaks: Encourage clients to release emotional feelings that occur over an
incident and become emotional burdensome.
2. Clarification: Encourage a clear expression of the relationship between certain
events in her life, helping to understand her feelings and the pattern of developing
these feelings into a crisis.
3. Manipulation: Influence the client to use the patient's emotions, desires and
values during the therapy process
4. Defense support: Encourage use adaptive healthy behavior to deal with crisis
situations
5. Suggestion: Suggesting the client will influence him to accept the idea and the
client will feel that the nurse can help him feel better and optimistic, and his
anxiety is reduced.
6. Behavior Reinforcement: If the client exhibits adaptive behavior, give a positive
response with appreciation.
7. Solution Exploration: identify alternative ways of solving problems directly in
search of solutions to resolve crises.
8. Improving Self-esteem: Help clients regain feelings of self-esteem, active
participation, communicate effectively, good listening skills, accept their feelings
with respect.

8. Crisis Management in Psychiatric Emergency Situations :

Step 1: Identify the Problem
Step 2: Ensuring patient safety
Step 3: Communicate patient comfort support
Step 4: Checking 3 alternatives that patients can use
Step 5: Helping patients make detailed plans
Step 6: Make a commitment to implement the plan

 Step 1 Identify Problems :

 Determine the problem to understand the problem from the client's point of view.
 This requires the use of active listening skills, empathy, authenticity and
acceptance
 Do Bad News Mitigation
 Perform PANSS-EC assessment, and continue with RUFA assessment
 Set PANSS-EC and RUFA Scores

 Warning signs of irritable behavior and agitated rowdyness :

 Sound intonation rising
 Quiet silence
 A sarcastic comment
  Body language: sharp gaze, sudden forward movement, clenched hands,
protruding chin, bulging chest, menacing movement (pointing fingers, foot-
setting), pacing and turning.
 Aggressive behavior: kicking, hitting, clawing, hitting, hitting, hitting.spit,
snatch, ruin, hit yourself, etc

 RUFA (Adaptive Functional General Response) :

 Individual responses to events and problems
 Responses include thoughts, feelings, and behaviors
 Responses can be adaptive and maladaptive
 The response may change according to the stimulus
 environment (social, social and psychological)
 Response should be rated every 24 hours
 24 hour RUFAI (0-10), 48 Hour RUFA II (1:00 PM).1-20), RUFA III 72
hours (21-30)

 Strategies to reduce escalation/quickness :

 Recognize if patients seem hostile, it may not be us who are being bullied,
don't be afraid.
 Hostility occurs due to the stress and pressure of the problem faced. Help
identify the underlying situation.
 stress/stress.
 Put yourself in their position, show concern, affection, and empathy, and
you may be able to win others' hearts or gain their cooperation.
 Control your own emotions - and body language - is essential.

 Step 2. Ensuring Client Security :

 It is important to maintain continuous client security at the forefront of all
interventions.
 This means constantly evaluating possible physical and psychological hazards for
clients as well as others.
 Evaluating and ensuring safety is a continuous part of the crisis intervention
process

 Step 3. Communicate support for comfort :

 Provide support by communicating care to clients and providing emotional and
instrumental support and information
 If the patient is able to participate/ show a good response, the patient can be
helped using his coping skills
 If the patient is unable to participatecollaboration is an action to be taken
 Injections of 10 mg of diazepam and 5 mg of Lodomer become indispensable
when patients are in an agitative condition even become aggressive
  Step 4. Check out three alternatives that might be usable :
 Supporting clients to assess their situational resources or people they have known
in the past or in the past who may care about what happened to them → family
support
 Helps clients to identify coping mechanisms or actions, behavior or cross-
resources.the environment he might use to help him get through the current crisis
→ Calm Down Method
 Helps clients to check their thinking patterns and if possible, find ways to redraw
the situation to change their views on problems that can lower the level of the
problem.
 Her anxiety. Talk Down through verbal de-escalation

 Step 5. Help clients make detailed plans :

 Teach/provide coping mechanisms and concrete and positive action steps for the
client to address the problem.
 Make the patient not feel deprived of his freedom, independence or respect.
 Provide a sense of control and autonomy for the client.
 Planning to achieve a sense of balance and stability in the short term

 Step 6. Make a commitment to the implementation of the plan :

 Control and autonomy are important for the final step of the process of asking
clients to summarize plans verbally.
 Commitments can be written and signed by both individuals.
 Committed to the plan and to take definite positive steps towards the re-
establishment of the pre-crisis state of function.
 Commitments made by clients must be voluntary and realistic.
 A plan that has been developed only by the staff will not be effectiv

9. RESPONSE TIME :
1. Behavioral emergencies, also called behavioral crises or psychiatric emergencies,
occur when a person's behavior is so out of control that the person becomes a
danger to everyone.
2. The situation is so extreme that the person must be treated immediately to avoid
injury to themselves or others
3. Emergency response time is the time it takes to start a patient Triage in the ER
until they receive doctor's service, which is approximately 5 (five) minutes