Psychiatric Nursing Crisis Case Study – Vignette

Psychiatric Nursing Crisis Case Study – Vignette 

Case Study

Elle, 39, has come in for treatment for severe panic attacks. Her daughter, Savannah, is leaving for college for the first time and is planning on driving up with a friend who will attend the same college. Savannah does not want her mother to go along. Elle says, “I have nightmares about them crashing somewhere and nobody knowing where they are.” She says she and Savannah have had arguments about this. Elle reports that the panic attacks began “about two weeks ago when Savannah and her dad both agreed that it was okay for her to drive up to the college with Jason.” Elle says that her worries are “not about sex. Jason is her best friend, but they’ve never dated, and in fact, Jason has a girlfriend. I admit the college is not far away, so it won’t be an overnight trip, but I don’t want Savannah to drive up with Jason. A three-hour drive. I want to do it.”
During assessment, you learn that 2 years ago, Savannah and her twin, Sophia, were in an after-prom car accident, in which teens in a car were driving to the next town over to go to the beach. Savannah’s twin was killed. Savannah was in the hospital for months and needed physical therapy for 18 months. As she describes the accident, Elle points out that the driver, Sophia’s date, escaped serious injury. “Funny, isn’t it?” she says. “The drunk driver always escapes injury while he hurts everyone around him.”
Savannah has pointed out that “Jason doesn’t drink. You know this. You’ve known him all his life. You’ve always liked him, even when I get annoyed with him.” Elle admits this, but still says, “I don’t want that boy driving her up there. It’s a long way.” Savannah complains that every time the subject comes up, Elle has a panic attack. Elle tells you privately, and sincerely, “I don’t mean to have these panic attacks. And I don’t want them. This just isn’t me.”

1. Elle admits Jason doesn’t drink; he isn’t sexually involved with Savannah, and she has known him all his life, and that she’s always liked him. Yet she refers to him now as “that boy.” (1) Her fears aside, what emotional response to this new crisis for Elle is she displaying, particularly toward Jason? Do you think this emotion is directed just at Jason or at someone else as well? (2) What does this tell you about her current perception of this crisis?
2. Now that you have a clearer vision of Elle’s perception of the crisis, what further aspects of Elle’s current status should you assess?
3. While finishing your assessment, you learn that Elle has two very close friends, and a pretty solid marriage. Her husband has avoided the arguments between Savannah and Elle, declaring that “Savannah is a grown-up now, and capable of making such a small choice as who will drive her to school, on her own.” He refuses to get involved, and while he is sympathetic and affectionate during and after Elle’s panic attacks, he says they scare him a little. He wonders if there isn’t medication to control these.
   You also learn that her best friend is her sister, who lives in town. This sister moved in with Elle right after Sophia’s death and was a “great comfort” during the early stages of grief and also came to the hospital almost every day to sit with Elle and Savannah during those first rough months. Elle’s sister has proposed that they have a “girl time” with Savannah the night before she leaves for college, but Elle has said, “I can’t think about that right now.”
   You have not quite decided which level of crisis intervention to use just yet, but how could you apply strategies from the first three levels of crisis intervention—environmental manipulation, general support, and generic approach—in tackling Elle’s current situation?

How could you apply strategies from the fourth level of crisis intervention—i.e., the individual approach—in tackling Elle’s current situation?