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Difficulty: EasyCrisis Intervention

An occupational health nurse is responding to an incident where a factory worker witnessed a severe machinery accident involving a colleague. The witness is trembling, hyperventilating, and repeats, "I should have stopped it. This is entirely my fault. I don't deserve to be here." Which of the following interventions by the nurse are appropriate? Select all that apply.

  1. Direct the conversation to explicitly ask if the worker is experiencing thoughts of self-harmAnswer
  2. Stay physically present with the worker while demonstrating a calm and supportive demeanorAnswer
  3. C
    Assure the worker that the guilt will fade quickly once the investigation is complete
  4. D
    Ask the worker why they feel personally responsible for the equipment failure
  5. E
    Interpret a sudden shift to a peaceful and calm demeanor as a sign of rapid psychological recovery

Answer

The appropriate interventions are to explicitly ask about thoughts of self-harm and to stay physically present with the worker.
The correct interventions prioritize immediate client safety and stabilization. When a client expresses profound guilt and feelings of worthlessness (e.g., 'I don't deserve to be here'), the nurse must directly assess for suicide risk. Additionally, staying physically present with an acutely anxious, trembling, and hyperventilating client provides necessary psychological support, safety, and grounding.

Step-by-Step Solution

1
Analyze the client's current physiological and psychological presentation.
The client is exhibiting severe acute anxiety (trembling, hyperventilating) and expressing extreme survivor's guilt and worthlessness.
Identifying the severity of the crisis and immediate risks is the first step in formulating a plan of care.
2
Determine the highest priority needs based on the assessment.
The highest priorities are physiological/psychological stabilization and ensuring safety, as the client's statements hint at potential self-harm.
In acute crisis intervention, safety and stabilization always take precedence over exploring root causes or offering long-term coping strategies.
3
Select interventions that align with safety priorities and therapeutic communication guidelines.
Asking directly about self-harm addresses safety. Staying present addresses severe anxiety. Options offering false reassurance or asking 'why' are rejected.
Evidence-based practice requires direct assessment of suicide risk and prohibits communication blocks that invalidate the client's experience.

Key Concept

Crisis Intervention: Prioritizing Safety and Therapeutic Communication
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Topics

Crisis Intervention

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