Transcript CRISIS INTERVENTION

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Crisis is an inevitable aspects of human existance.stressful events ,or crises, are a
common part of life. They may be Social , Psychological or Biological in nature
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A crisis is a
disturbance
caused by a
stressful event
or a perceived
threat.
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A
crisis is a
disturbance caused
by a stressful event
or a perceived threat
in which a person
usual way of coping
becomes ineffective
in dealing with threat
,causing anxiety.
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 Kaplan
defined crisis as psychological
disequilibrium in a person who confronts a
hazardous circumstance that for him
constitutes an important problem ,which he
can for the time being neither escape nor
solve with his customary problem solving
resources.
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The persons
Usual way of coping becomes
ineffective in dealing with the
threat, causing anxiety.
The threat ,or precipitating event,
usually can be identified
It may have occurred weeks or days
before the crisis
It may or may not be linked in the
individuals mind to the crisis
state he or she is experiencing
Precipitating events can be actual
or perceived losses, threats of
losses, or challenges.( Stuart))
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Crisis occurs in all individuals at one time or
another & is not necessarily equated with
psychopathology
 Crisis are precipitated by specific identifiable
events
 Crisis are personal in nature. what may be
considered a crisis situation by one individual
may not be so for another.
 Crisis are acute, not chronic, will be resolved in
one way or another with in a brief period.
 A crisis situation contains the potential for
growth or deterioration.( Mary Townsend)
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After the precipitating
event ,patients
anxiety begins to rise
Four phases of a crisis
response emerge
a) anxiety activates
the persons usual
methods of coping .
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B. If these do not bring
adequate relief and
support to the person
,progresses to the
second phase,
 C. New coping
mechanisms are tried or
the threat is redefined
so that old ones can
work. Resolution of the
problem can occur in
this phase.

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D. If resolution does
not occur ,the person
goes on to the fourth
phase, in which the
continuation of
severe or panic levels
of anxiety which may
lead to psychological
disorganization.
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Perception
Of the
event
Coping
mechanism
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Situational
support
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Human organism
State of
equilibrium
Stressful event
Stressful event
State of
disequilibrium
Need to restore
equilibrium
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A. Balancing factor present
Need to restore
equilibrium
Realistic perception
Distorted perception
Situational support
No-situational support
Coping mechanisms
No coping mechanisms
resolution
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B. One or more balancing
factor absent
unresolved
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Cont……
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Equilibrium
regained
Disequilibrium
continues
No crisis
crisis
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EFFECT OF BALANCING FACTORS
ON A STRESSFUL EVENT
Precipitating event
State of disequilibrium
Perception of event
Realistic
Adequate
effective
support
Coping mechanism
Problem resolved
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Unrealistic
Inadequate
ineffective
Problem unresolved
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According to Baldwin in 1987 .(identified six
classes of emotional crisis)
 Dispositional crisis
 Anticipated life transition
 Traumatic stress\ situational crisis
 Maturational crisis\developmental crisis
 Crisis reflecting psychopathology
 Psychiatric emergencies
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 An
acute response to
an external stressor.
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 Normal
life transition
may be anticipated
but over which an
individual may feel a
lack of control.
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 Precipitated
by
unexpected external
stresses over which
the individual has
little or no control
,from which he or
she feel emotionally
overwhelmed
\defeated.
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 Precipitated
by
events requiring role
changes.
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 Emotional
crisis in which pre-existing
psychopathology has been instrumental in
precipitating in crisis or in which
psychopathology significantly impairs or
complicates adaptive responses.
 Psychopathology include-borderline
personality
 Severe neurosis
 Character disorders
 Schizophrenia
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 Crisis
situation in which general functioning
of the individual is severely impaired ,so that
he cannot assume personal responsibility.
 Suicidal threat
 Drug over dosage
 Alcohol withdrawal
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 Individual
is exposed to a specific and
identifiable precipitating event, he may
experience feelings of
discomort,bewilderment anxiety
increases, previous problem solving
techniques are employed.
 Phase-2.event is perceived as threat and
produce an increase in anxiety when the
persons problem solving skills do not work
,patient may feel very anxious .there may
be feelings of hopelessness,
disorganization ,and confusion.
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 Increased
tension, anxiety disorganization
may
bemanife,sted,physically,cognitively,socia
lly and behaviorally. Common feelings are
desperation and apathy. All possible
resources internal and external are called
to solve the problem and to discomfort.
Individual may try to view the problem
from a different perspective \or overlook
certain aspects of it. new problem solving
technique used if resolution takes place,
the individual returning to a
higher,lower,or previous level of
functioning.
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
Anxiety increased as the internal and external
resources fail to solve the situation and tries out
new problem solving methods and redefines the
threat .so that old methods can work. Kaplan
states ;the tension mounts beyond a further
threshold or its burden increases over time to a
breaking point major disorganization of the
individual with drastic results often occurs.
anxiety may reach panic levels cognitive
functions are disorderd,emtions are liable and
behaviour may reflect the presence of psychotic
thinking. this the prime time for intervention as
feelings of anxiety,helplessness,and
hopelessness.
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 Social
crisis are accidental uncommon and
unanticipated crisis involving multiple loss
.or environmental change .
Social crisis do not occur commonly in every
day of peoples life. when they do occur
,stress level is so high that coping resource
of each person is greatly affected.
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Heroic
Honey moon
Disillusionment
reconstruction
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Heroic-(2 weeks-6months)begins at the time of impact. a
cooperate spirits exists among the,survivers ,as they
perform the act to save lives.
 Honey moon -(2weeks-6months)massive relief effects are
begun, with the help of donated resources ,to begin
community life again. survivors feel a sense of security.
 Disillusionment- (several months-years)
. begins when supportive agencies and services withdraw.
Reconstruction-(several years)
Problem solving improves.survivers begin to rebuild their
community.
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
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Crisis intervention may be
defined a short term,
inexpensive therapy focused
on immediate problem and
usually limited to six
weeks.(stuart-2001).
Is a supportive therapy with
the restoration of the
individual to pre crisis level of
functioning or possible higher
level of functioning.
It can offer immediate help
to a person in crisis needs.
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
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The minimum therapeutic
goal of crisis intervention is
psychological resolution of
immediate crisis and
restoration to at least the
level of functioning that
existed before the crisis
period.
A maximum goal is
improvement in functioning
above the precrisis level.
. Therapist role-supportive
and active support.
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 Assessment
 planning
 Implementation
 evaluation
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Specific cultural factors to be
considered:
Immigration and
citizenship status
 Gender and family roles
 Religious belief system
 Child rearing practice
 Use of family and
extended support
systems
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
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Collect data-aboutThe nature of the crisis
Its effect on the patient-and
an intervention plan will be
developed
Nurse establish a positive
working relationship with the
patient
Balancing factors are
important in the development
and resolution of crisis and
should be assessed;
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 Precipitating
event or stressor
 Patients perception of the event or stressor
 Nature and strength of the patients support
systems and coping resources
 Patients previous strengths and coping
mechanisms
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Nurse should explore the patients needs, the
events that threaten those needs and the time at
which symptoms appear.
 Four kinds of needs
 -self esteem-is achieved when the person attains
successful social role experience.
 -role mastery-is achieved when the person
attains work ,sexual, and family role successes.
 -dependency-is achieved when a satisfying
interdependent relationship with others is
attained.
 -biological function-is achieved when a person is
safe and life is not threatened.

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An over weight
adolescent girl
 A man with two
unsuccessful marriages
 An emotionally isolated,
friendless women
 A chronically ill man
 Themes and surfacing
memories of the patient
give further clues to the
patient.

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Patients living situation
and support in the
environment .does the
patient live alone or
with family or with
family or friends
 Who offers
understanding and
strength
 Supportive clergyman or
friend
 Assess coping resources
 Suicidal or homicidal risk

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 Assess
patients strengths and previous coping
mechanisms
 How the patient handled other crises
 How were anxiety relieved
 Was physical activity relieve tension
 Did the patient find relief in crying
 Exploring previous coping mechanisms
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 Previously
collected data are analyzed
and specific interventions are proposed
 Dynamics underlying the present crisis are
formulated
 Alternative solutions to the problem are
explored and steps for achieving the
solutions are identified
 Nurse decides which environmental
supports to engage or strengthen and how
best to do this-
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 The
expected outcome of patient care is –
the patient will recover from the pre crisis
level of functioning .. A more ambitious
expected outcome would be for the patient
to recover from the crisis event and attain a
higher than pre crisis level of functioning and
improved quality of life.
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It includes interventions
that directly change the
patients physical or
interpersonal situation.
 It provide situational
support or remove
stress.
 Mobilizes the patients
supporting social systems
and serving a liaison
between the patient and
social support agencies.

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Interventions that
convey the feeling that
the nurse is on the
patients side and will be
a helping person .
 The nurse uses
warmth,acceptance,emp
athy,caring,and
reassurance to provide
this type of support.

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 It
is designed to reach high risk
individuals and large groups as quickly as
possible.
 Applies a specific method to all people
faced with similar type of crisis.
 Expected course of he particular type of
crisis studied and mapped out.
 The intervention is then set up to ensure
that the course of the crisis results in an
adaptive response.
 Interventions following an acute stress
are referred to as debriefing.
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
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


It is type of crisis intervention
Understand the specific
patient characteristics that
led to the present crisis and
use intervention according to
that. Uses It is more useful in situational
and maturational crisis.
Homicidal and suicidal risk
Course of the patients crisis
cannot be determined and
resolution has not been
achieved using the generic
approach.
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1.
2.
3.
4.
5.
Restore psychological
safety
Provide information
Correct misattributions
Restore and support
effective coping
Ensure social support
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2
!
4
5
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 Catharsis
 Clarification
 Suggestion
reinforcement of
behaviour
 Support of defenses
 Raising self esteem
 Exploration of
solutions

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
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
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The release of feelings that take place as the patient talks about emotionally charged areas
As feelings about the events are realized ,tension is reduced.
Nurse solicits the patients feelings about the specific situation ,recent events, and significant
people in the particular crisis.
Ask open ended questions and repeat the patients words.
Dose not discourage crying or angry outbursts but rather sees them as a positive release of
feelings.
Feelings seem out of control ,in case of rage ,or despondency nurse should discourage
catharsis and help the patient concentrate on thinking rather than feeling
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When the nurse helps
the patients identify
the relationship
between events
behaviors ,and
feelings.
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Influencing a person to
accept an idea or belief
that the nurse can help
and that the person will
in time feel better.
It is a technique in which
the nurse engages
patients emotions,
wishes, or values to their
benefit in the
therapeutic process.
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Giving the patient
positive responses to
adaptive behaviour.
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Encouraging the use of
healthy ,adaptive
defenses and discard
those that are
unhealthy or
maladaptive .
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Helping the patient regain
feelings of self-worth by
communicating
confidence that the
patient can find
solutions to the
problems. the nurse also
should convey that the
patient is a worthwhile
person by listening to
and accepting the
patients feelings ,being
respectful ,and praising
help-seeking efforts.
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Examining alternative
ways of solving the
immediate problem .
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The nurse and the patient
evaluate whether the
intervention resulted in a
positive resolution of the crisis.
specific questions ..
The expected outcome been
achieved?
Have the patient symptoms
relieved?
Does the patient have adequate
support systems and coping
resources ?
Is the patient demonstrating
adaptive crisis responses?
Dos the patient need to be
referred for additional
treatment?
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
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
General hospitals
Emergency room
Schools
Occupational health centers
Industrial area
Crisis intervention centers
Community mental health
centers
Department of psychiatry
Managed care clinics
Long term care facilities
Home health agencies
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 Nurses
come across
clients, react to an
impending surgery
with crisis reaction,
when it is
,amputation,mastect
omy,hystrectomy
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 The
nurse may come
across victims of
crisis in rape
,accident, I, natural
calamities. The nurse
then implement brief
intervention measure
such as reduce
anxiety. If needed
referral may be
done.
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 They
have
ambulatory clients
who make –
 suicidal threat,
 Unwanted pregnancy
 Loss
 Reduction of illness
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1.
2.
3.
4.
5.
6.
7.
8.
9.
Mobile crisis programs
Family work
group work
Telephone contacts
Disaster response
Prevention work
Home visit
Victim outreach
programs
Health education
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5
3
6
2
modalities
1
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9
8
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
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Utilizes temporary ,brief
therapy model that is
problem focused .it does not
alive into general family
issues &problems, but it
focuses on a specific problem.
It involves the whole family.
The family is viewed as
system with family members
interactive process. a crisis
affecting any family member
affects all members ,causing
shifts in family relationships
,and in this crisis is defined as
a family problem.
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
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Mobile crisis teams provide frontline interdisciplinary crisis
intervention to individuals
,families ,and communities.
They are providing on-site
assessment ,crisis management
,treatment, referral, and
educational services to patients
,families ,law enforcement
offices, and the community at
large.
Studies of mobile crisis services
show favorable outcomes for
patients and families and lower
hospitalization rates.
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The nurse and group help the
patient solve the problem and
reinforce the patients new
problem solving behavior.
Nurses role in the group is
active ,focal ,and present
oriented.
Group acts as a support
system for the patient and is
their fore of particular
benefit to socially isolated
people.
The nurse can comment on
the faulty coping behavior
seen in the group and
Encourage group discussion
about it.
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 Crisis
intervention is
practicing telephone
or internet
communication
,rather than through
face to face
contracts.
 It is using when they
are at the peak of
their distress
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

Floods earthquakes ,airplane
crashes ,fires,nulear accidents
,and other natural and
unnatural disasters precipitate
large numbers of crises.
It is important that nurses in
the immediate post disaster
period go to places where
victims are likely to gather
,such as morgues ,hospitals
,shelters ,and areas
surroundings the disaster site.
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 Many
out rich programmes uses crisis
intervention techniques to identify the
needs of the victims and connect with
appropriate referrals and other resources.
 A victim advocate can contact employers
regarding the need for food and shelter if
necessary.
 Crisis intervention may be done in acute
phase of rape ,through victim outreach
programme .
 In abusive relationships and domestic
violence also victim outreach programmes
are useful.
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Crisis intervention and disaster response es now
concentrate more on prevention.
 A) Primary prevention
 Disaster notification network control
 Follow a protocol –so that all the available
personal are altered or called for duty when
need arise
 The personal should be familiar with the
equipment and supplies
 Disaster drill performed periodically and a
periodic check of response should be the part of
response plan.

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B)planning
 A hospital disaster committee provides the focus
for institutional disaster planning.
 A department planning may be done in which
specific responsibilities are given to each unit.
 C)priority list
 Each unit should make a priority list with most
important to least important.
 D)drills
 Take top exercise functional exercise may
carried out.

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
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Home visits are usually made
by the community health
nurse.
She have to observe and
assess the clients in their own
environment.
Potential high risk families
can be identified, and
referred.
Families with new babies ,sick
members,death,divorce are
potential clients.
The nurse have an ongoing
relationship and can
intervene effectively.
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

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Health education can take place
during the entire crisis intervention
process ,it is emphasized during the
evaluation phase.
At this time the anxiety of the
patient might have reduced and he
can use better cognitive skills. The
nurse then teaches the patient to use
newly learned coping mechanisms in
future situations.
Nurses should identify people who
are at increased risk for developing
crisis and in teaching coping
strategies to avoid the development
of crisis
The public also need education to
identify the people who may need
crisis intervention and the modalities
and services of crisis intervention .
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To qualify academically to
perform therapy in crisis
,nurses need to have
Two years experience in
psychiatric hospital
Masters degree in
psychiatric nursing
One year intensive training
in crisis intervention at
community health
center.
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She should be warm and
understanding
She should be able to use
herself as a therapeutic tool
She should be able to control
intense emotions
She should have willingness to
assume responsibility, and she
needs to be flexible and ready
to respond to any time to the
crisis.
She should be sensitive to the
client needs and relate to
him positively.
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 Fight
against bioterrorism:
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