# A nurse is providing crisis intervention for a client experiencing an acute psychiatric crisis. Which nursing action should be the nurse's first priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543431 > language: ko > subject: Mental Health ## 문제 A nurse is providing crisis intervention for a client experiencing an acute psychiatric crisis. Which nursing action should be the nurse's first priority? ## 보기 1. Establish a therapeutic relationship and ensure the client's immediate safety **✔ 정답** 2. Explore the client's past coping mechanisms and support systems 3. Encourage the client to express feelings about the traumatic event 4. Develop a comprehensive discharge plan with follow-up resources **정답: 1** ## 해설 In crisis intervention, the first priority is to ensure immediate safety and establish a therapeutic relationship, as this provides the foundation for all other interventions. Exploring past coping, encouraging expression, or planning discharge are premature without this foundation. ## 심화 해설 Understanding Crisis Intervention Priorities In any acute psychiatric crisis, the foundational principle guiding nursing actions is the hierarchy of needs. Before any therapeutic work can begin, the individual's physiological and psychological safety must be secured. This is not merely a step in a process but the bedrock upon which all subsequent interventions are built. The nurse's immediate focus is on assessing for imminent risks, such as suicidal ideation, self-harm, or aggression, and creating an environment that is physically and emotionally safe. The research underscores this priority. A phenomenological study on crisis encounters reveals a "Reciprocal Insecurity Paradox," where both the nurse and the service user can experience heightened anxiety and uncertainty in the initial moments of a crisis [1]. This dynamic means that a nurse's first, deliberate action to ensure safety is crucial for de-escalating this mutual insecurity. By calmly and clearly establishing safety, the nurse begins to build the initial trust needed to move forward. Similarly, a case report on managing a suicidal crisis in an adolescent with a complex medical condition highlights that the very first diagnostic and therapeutic consideration is navigating the immediate risk, especially when standard interventions are complicated by the patient's physical vulnerability [2]. This reinforces that safety assessment is the non-negotiable starting point, adaptable to each unique clinical situation. Why Other Actions Are Secondary Exploring past coping mechanisms and support systems, while a vital component of a full psychosocial assessment, is a secondary step. This exploration requires a degree of cognitive engagement and emotional stability that a person in an acute crisis typically does not possess. The initial phase of crisis intervention is about stabilization, not detailed history-taking. The qualitative study on operating room crises provides a parallel: nurses identified feeling unprepared for the immediate, chaotic demands of a crisis, emphasizing that the priority is managing the acute event, not analyzing its origins . This principle applies directly to psychiatric crises, where the "event" is the patient's overwhelming emotional and psychological state. Encouraging the expression of feelings is a core therapeutic communication technique, but its timing is critical. Prematurely asking a client to delve into the traumatic event without first ensuring they feel safe and grounded can lead to re-traumatization and an escalation of the crisis. The therapeutic relationship must be established, and safety confirmed, before such vulnerable exploration is possible. A study on interprofessional collaboration for suicide prevention identifies structural gaps and the need for coordinated approaches, but these are system-level considerations for ongoing care, not the nurse's first action at the bedside during an acute crisis . The immediate priority is always the individual's safety within the current encounter. Developing a comprehensive discharge plan is an essential part of the care continuum but is entirely inappropriate as a first action. Discharge planning is a forward-looking task that occurs once the patient is stabilized and has moved past the acute phase of the crisis. It is a critical component of relapse prevention and continuity of care, as suggested by the need for coordinated approaches across care sectors , but it is not an immediate crisis intervention. The initial encounter must focus on the present moment: ensuring the client survives the crisis and begins to regain a sense of control.References (research sources) - [1]The Reciprocal Insecurity Paradox: A Phenomenological Analysis of the Crisis Encounter Between the Mental Health Nurse and Service User With Complex Emotional Needs.Research articleHaslam M, McKeown M, Jones E, Lamph G, Wright K. (2026) · DOI: 10.1111/nin.70125 - [2]Management of suicidal crisis in an adolescent with Becker muscular dystrophy: a case report.Case reportWan H, Zheng L, Wu X, Xiong J, Zhou C. (2026) · DOI: 10.1186/s12888-026-08139-1 ## 임상 시나리오 Crisis Intervention: First PrioritySafety Before Therapeutic Engagement In any acute psychiatric crisis, the nurse's first action is to ensure immediate safety. This involves assessing for suicidal ideation, self-harm, or aggression and creating a physically and emotionally secure environment. The Reciprocal Insecurity Paradox describes how both nurse and client experience heightened anxiety initially. A calm, deliberate focus on safety de-escalates this mutual insecurity and begins building trust. CautionDo not delay safety assessment to explore feelings or coping mechanisms. For patients with complex medical conditions, adapt the safety evaluation to account for physical vulnerabilities that may complicate standard interventions. ## 핵심 개념 - **Crisis Intervention** — A short-term, focused therapeutic approach designed to stabilize an individual in acute psychological distress and restore pre-crisis functioning. - **Hierarchy of Needs** — A psychological framework, often associated with Maslow, prioritizing physiological and safety needs as the foundation that must be met before higher-level needs can be addressed. - **Reciprocal Insecurity Paradox** — A phenomenon in crisis encounters where both the nurse and the client experience heightened anxiety, requiring deliberate safety actions to de-escalate mutual insecurity. ## 같은 주제 문제 - [A nurse is conducting an initial assessment of a 28-year-old client who presents to the em…](https://mymerci.kr/pages/nclex_q.php?qn_id=543430) - [A nurse is working with a client experiencing an acute crisis following a recent job loss …](https://mymerci.kr/pages/nclex_q.php?qn_id=543432) - [A nurse is working with a client experiencing an acute psychological crisis after a trauma…](https://mymerci.kr/pages/nclex_q.php?qn_id=543433) - [A nurse is working with an adolescent client experiencing an acute psychological crisis af…](https://mymerci.kr/pages/nclex_q.php?qn_id=543434) - [A nurse is providing crisis intervention for a 35-year-old client experiencing an acute ps…](https://mymerci.kr/pages/nclex_q.php?qn_id=543435) - [A nurse is working with a 22-year-old college student experiencing an acute panic attack w…](https://mymerci.kr/pages/nclex_q.php?qn_id=543436) - [A nurse is caring for a 60-year-old client with dementia who is experiencing an acute beha…](https://mymerci.kr/pages/nclex_q.php?qn_id=543437) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._