Robert's 7 Stages

Stage 1 - Psychosocial and Lethality Assessment

Conduct a rapid but thorough biopsychosocial assessment.

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.

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.

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.

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.

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?

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.

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.

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.

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

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.

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.

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?