Actions That Reduce The Risk Of Harm Or Future Violence

Seek an evaluation and advice from a qualified mental health professional or crisis intervention specialist if there are any critical risk factors. Review and familiarize yourself with the material on this web site that pertains to Crisis Intervention. Seek counseling or therapy for any emotional problems or difficulties associated with angry or violent behavior from a qualified mental health professional. Evaluate any alcohol and other drug use and treat as recommended by a qualified professional. Encourage a medical evaluation and treatment for any mental illness or other medical condition requiring medication or medical treatment. If appropriate, consider enrolling and participating in an educational or skills training group that will improve communication and interpersonal skills (e.g. parenting skills, communication, divorce adjustment, assertiveness training, conflict resolution, outdoor and residential program, or strategies to diffuse angry, aggressive and violent behavior). Develop a plan that will minimize and limit all communication that usually leads to conflict, aggression or violence and take steps to resolve problems calmly. Establish a plan that supports communication that does not increase the risk of violence and will support actions that reduce the risk of violence. Insure your own safety and provide for your basic emotional and physical needs while allowing the other person to do the same. If there is physical or sexual abuse, seek advice and further investigation from law enforcement or an attorney who has experience dealing with interpersonal violence especially when violent or homicidal threats have been made. If appropriate, keep records of all contact, conversations and threats made by the person including dates, times and witnesses. If appropriate, enroll in a personal safety and self-defense course. Information regarding these courses can usually be obtained through local telephone crisis services, health care facilities or through the police or sheriff's department.

SUICIDE

DISTURBED THOUGHT PROCESSES Definition: A disruption in cognitive operations and activities. Possible Etiologies ("related to")

[Hereditary factors] [Biochemical alterations] [Unmet dependency needs] [Unresolved grief--denial of depression]
Defining Characteristics ("evidenced by")

Inaccurate interpretation of environment Hypervigilance

[Altered attention span]--distractibility Egocentricity [Decreased ability to grasp ideas [Inability to follow] [Impaired ability to make decisions, problem solve, reason] [Delusions of grandeur] [Delusions of persecution] [Suspiciousness]
Goals/Objectives Short-Term Goal

Within 1 week, client will be able to recognize and verbalize when thinking is non--reality based.
Long-Term Goal

Client will experience no delusional thinking by discharge from treatment.

Interventions with Selected Rationales

1.Convey your acceptance of client's need for the false belief, while letting him or her know that you
do not share the delusion. A positive response would convey to the client that you accept the
delusion as reality.

2.Do not argue or deny the belief. Use reasonable doubt as a therapeutic technique: "I find that hard
to believe."' Arguing with the client or denying the belief serves no useful purpose, because
delusional ideas are not eliminated by this approach, and the development of a trusting relationship may be impeded.

3.Use the techniques of consensual validation and seeking clarification when communication
reflects alteration in thinking. (Examples: "Is it that you mean . . . ?" or "I don't understand what you mean by that. Would you please explain?") These techniques reveal to the client how he or
she is being perceived by others, and the responsibility for not understanding is accepted by the nurse.

4. Reinforce and focus on reality. Talk about real events and real people. Use real situations and events to divert client from long, tedious, repetitive verbalizations of false ideas. 5.Give positive reinforcement when client is able to differentiate between reality-based and non-reality-based thinking. Positive reinforcement enhances self-esteem and encourages repetition
of desirable behaviors.

6.Teach client to intervene, using thought-stopping techniques, when irrational thoughts prevail.
Thought stopping involves using the command "Stop!" or a loud noise (e.g., hand clapping) to interrupt unwanted thoughts. This noise or command distracts the individual from the
undesirable thinking, which often precedes undesirable emotions or behaviors.

7.Use touch cautiously, particularly if thoughts reveal ideas of persecution. Clients who are
suspicious may perceive touch as threatening and may respond with aggression

ADJUSTMENT DISORDER RISK FOR VIOLENCE: SELF-DIRECTED OR OTHER-DIRECTED Definition: Behaviors in which an individual demonstrates that he or she can be physically, emotionally,

and/or sexually harmful to self or to others.

Related/Risk Factors ("related to")

[Fixation in earlier level of development]

[Negative role modeling] [Dysfunctional family system]

[Low self-esteem] [Unresolved grief] [Psychic overload] [Extended exposure to stressful situation] [Lack of support systems] [Biological factors, such as organic changes in the brain] Body language---rigid posture, clenching of fists and jaw, hyperactivity, pacing, breathlessness, and threatening stances History or threats of violence toward self or others or of destruction to property of others Impulsivity Suicidal ideation, plan, available means [Anger; rage] [Increasing anxiety level] [Depressed mood]
Goals/Objectives Short-Term Goals

1. Client will seek out staff member when hostile or suicidal feelings occur. 2. Client will verbalize adaptive coping strategies to use when hostile or suicidal feelings occur.
Long-Term Goals

1. Client will demonstrate adaptive coping strategies to use when hostile or suicidal feelings occur. 2. Client will not harm self or others.
Interventions with Selected Rationales

1.Observe client's behavior frequently. Do this through routine activities and interactions; avoid
appearing watchful and suspicious. Close observation is required so that intervention can occur
if required to ensure client's (and others') safety.

2.Observe for suicidal behaviors: verbal statements, such as "I'm going to kill myself'" and "Very
soon my mother won't have to worry herself about me any longer," and nonverbal behaviors, such as mood swings and giving away cherished items. Clients who are contemplating suicide often
give clues regarding their potential behavior. The clues may be very subtle and require keen assessment skills on the part of the nurse.

3.Determine suicidal intent and available means. Ask direct questions, such as "Do you plan to kill
yourself?" and "How do you plan to do it?" The risk of suicide is greatly increased if the client
has developed a plan and particularly if the client has means to execute the plan.

4.Obtain verbal or written contract from client agreeing not to harm self and to seek out staff if
suicidal ideation occurs. Discussion of suicidal feelings with a trusted individual provides a

degree of relief to the client. A contract gets the subject out in the open and places some of the responsibility for his or her safety with the client. An attitude of acceptance of the client as a worthwhile individual is conveyed.

5. Assist client to recognize when anger occurs and to accept those feelings as his or her own. Have client keep an "anger notebook," in which feelings of anger experienced during a 24-hour period are recorded. Information regarding source of anger, behavioral response, and client's perception of the situation should also be noted. Discuss entries with client and suggest alternative behavioral responses for responses identified as maladaptive.