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Zorluk: Çok zorCrisis Intervention

An occupational health nurse is called to the office of an employee who was just unexpectedly terminated after 20 years with the company. The employee initially threw a chair and screamed at the manager. When the nurse arrives 15 minutes later, the employee is sitting quietly, neatly organizing their desk, and states with a flat, calm affect, "It's fine. I have a very permanent solution to this problem waiting in my car. Tell my manager he won't have to worry about me ever again." Which of the following is the priority nursing intervention?

  1. Maintain a continuous, direct presence with the employee while discreetly directing another staff member to contact facility security or emergency services.Cevap
  2. B
    Document the employee's successful transition to a calmer state and allow them to proceed to their vehicle to safely leave the premises.
  3. C
    Immediately conduct a comprehensive psychosocial assessment to determine the employee's baseline coping strategies and available support systems.
  4. D
    Attempt to de-escalate the situation by telling the employee, "Everything happens for a reason; you will see this as a blessing in disguise later."

Cevap

The most critical intervention is to maintain continuous observation of the employee and immediately activate emergency services or security.
This action correctly identifies the acute lethality of the situation. The employee's sudden shift from violent agitation to calm compliance, paired with statements implying a 'permanent solution' located in their vehicle, are classic red flags for an imminent suicide attempt or act of severe violence. The absolute priority is to ensure the client cannot access their vehicle (the suspected location of the lethal means) by maintaining continuous observation while simultaneously initiating emergency protocols.

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1
Analyze the client's behavioral shift and verbal statements.
The rapid shift from violent agitation to calm organization, combined with the phrase 'permanent solution... in my car' and 'won't have to worry about me ever again', indicates a formulated, imminent plan for suicide or severe violence.
Sudden calmness in a crisis often signifies that the individual has made a decision to end their life, bringing them a false sense of peace.
2
Determine the highest priority based on Maslow's Hierarchy of Needs and acute triage principles.
Immediate physical safety and prevention of access to lethal means (the car) is the absolute highest priority.
Psychological assessments and therapeutic communication are secondary when an active, lethal threat is present.
3
Select the intervention that ensures immediate safety without escalating the situation.
Staying with the client prevents them from leaving to execute their plan, while having someone else call security ensures professional intervention is on the way.
The nurse must secure the environment and obtain emergency assistance without leaving the high-risk individual alone.

Anahtar Kavram

Recognizing sudden mood improvement and covert lethal statements as indicators of imminent suicide risk during a situational crisis.
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Crisis Intervention

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