NCLEX Review Guide: Mental Health - Crisis Theory and Intervention, Family Violence

Crisis Definition and Characteristics

• A crisis is a temporary state of disequilibrium when usual coping mechanisms fail to resolve a stressful situation. Crises are self-limiting, typically lasting 4-6 weeks, and can result in either growth or deterioration.
• Balancing factors include realistic perception of the event, adequate situational support, and adequate coping mechanisms. When these are absent, crisis development is more likely.

Assessment and Initial Response

1. Ensure safety first - assess for suicidal/homicidal ideation immediately
2. Assess precipitating event and client's perception of the crisis
3. Evaluate available support systems and coping resources
4. Determine level of functioning before the crisis occurred

Types and Characteristics

• Domestic violence includes physical, emotional, sexual, and economic abuse occurring in intimate relationships. The cycle of violence consists of tension-building, acute battering, and honeymoon phases.
• Child abuse encompasses physical, sexual, emotional abuse, and neglect. Mandatory reporting is required for all healthcare providers when abuse is suspected.
• Elder abuse includes physical, psychological, sexual, financial abuse, and neglect of adults 60+ years old. Often perpetrated by family members or caregivers.

Assessment Techniques

• Conduct interviews privately and confidentially, away from potential perpetrators. Use direct, non-judgmental questions about safety and relationships.
• Document injuries objectively using body maps and photographs when possible, noting size, color, location, and pattern of injuries.
• Screen routinely during healthcare visits, especially during pregnancy, emergency visits, or when injuries don't match the reported cause.