Always screen for and report suicidal or homicidal ideation as the first priority.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A survivor of a recent assault is brought to the emergency department in acute crisis, appearing numb and unable to make decisions. Which crisis intervention principle guides the nurse's care?
Answer: B. Crisis intervention is present-focused, directive, and aimed at restoring the person to their pre-crisis level of functioning. The nurse provides support, ensures safety, helps mobilize coping resources, and assists with immediate problem-solving.
Question 2 of 5
In crisis intervention, the nurse's immediate priority is to:
Answer: B. First ensure safety and assess for danger to self/others, then help the client regain a sense of control and use coping resources. Crisis work is short-term and focused on the present problem.
Question 3 of 5
A community mental health nurse is following a client with depression who lives at home. Which statement requires IMMEDIATE intervention?
Answer: B. A statement that the client has given away prized possessions and feels everyone would be better off without them suggests active suicidal ideation with possible planning and requires immediate safety intervention. Fatigue, decreased appetite, and social withdrawal are concerning but the suicide risk takes priority.
Question 4 of 5
A client with depression has not slept well for days. Which is an appropriate nursing intervention?
Answer: B. Promote sleep hygiene: consistent routine, reduce daytime napping, limit caffeine, encourage daytime activity, and create a restful environment. Allowing all-day sleep and heavy caffeine worsens insomnia.
Question 5 of 5
A client in acute mania is too active to sit and eat. The best nursing intervention is to:
Answer: B. Provide high-calorie finger foods and fluids the client can eat 'on the go,' since they cannot sit still; nutrition and hydration are priorities in mania.
Keep the streak going with more questions like these, each with a full rationale.
What is crisis intervention?
Crisis intervention is short-term, present-focused, and directive, aimed at restoring the person to at least their pre-crisis level of functioning. The first priority is always ensuring safety.
Key points to remember
- A crisis is time-limited (usually resolves in 4-6 weeks) because the high anxiety state cannot be sustained.
- Types include maturational (developmental, like a new baby), situational (job loss, illness), and adventitious (disaster, violence).
- Crisis intervention is short-term, reality-oriented, directive, and focused on the immediate problem, not deep personality change.
- The goal is to return the person to their pre-crisis level of functioning or higher.
- Assessment first targets safety and risk of harm to self or others, then the precipitating event, coping, and support systems.
- The nurse takes a more active, directive role than in ongoing therapy because the client's problem-solving is impaired.
Nursing priorities
- Assess immediately for safety and suicidal or homicidal risk.
- Help the client identify the precipitating event and express feelings.
- Focus on the here-and-now problem and set realistic short-term goals.
- Mobilize support systems and connect the client to community resources.
- Reinforce existing strengths and teach adaptive coping strategies.
Patient teaching
- A crisis is temporary and you can return to your normal functioning with support.
- Lean on your support people and the resources we connect you with.
- Keep crisis and hotline numbers accessible and use them if distress escalates.
Red flags: report now
- Always screen for and report suicidal or homicidal ideation as the first priority.
- Do not attempt long-term, insight-oriented therapy during an acute crisis.
- Never leave a client at risk of self-harm alone or without a safety plan.
References
Clinical references for this topic
