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Robert's 7 Stages
Stage 1 - Psychosocial and Lethality Assessment
Conduct a rapid but thorough biopsychosocial assessment.
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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.
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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.
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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.
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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.
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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?
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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.
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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.
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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.
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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
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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.
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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.
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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?