CRISIS INTERVENTION INTRODUCTION Stressful situations are the part of everyday life. Any stressful situation can precipitate a crisis. Crisis result in a disequilibrium from which many individuals require assistance to recover. A crisis crisis is a severe severely ly stress stressful ful experie experience nce for which which coping coping mechani mechanisms sms fail fail to provid providee any adaptation, whether the experience is positive or negative. Usually, a crisis occurs when the precipitating event is unusual or rare. E.g. one woman coped with chronic physical abuse by her husband, who abused by her husband, who abuse both drugs and alcohol. Crisis intervention requires problem- solving skills that are often diminished by the level of anxiety anxiety accompanying accompanying disequilibri disequilibrium. um. Assistanc Assistancee with problem solving during during the crisis crisis The prio priori rity ty of cris crisis is perio period d preser preserves ves selfself- esteem esteem and promot promotes es growth growth with with resolu resolutio tion n. The intervention/counseling is to increase stabilization. Crisis interventions occur at the spur of the moment and in a variety of settings, as trauma can arise instantaneously. Crisis counselors must keep in mind that crises are temporary, no longer than a month, although the effects may become long-lasting
DEFINITION Crisis is defined by Lagerquist, “A sudden event in one’s life that disturbs homoeostasis, during which usual coping mechanisms cannot resolve the problem.” Kaplan and Sadock (1998) state’ “A crisis is self limited and can last from a few hours to weeks. It is characterized characterized by an initial phase in which anxiety and tension rise, followed by a phase in which problem solving mechanisms are set in motion.” “A crisis is a turning point, resulting from a stressful or threat to one’s well being. It occurs where a conflict, problem or situation is perceived as threatening and not readily solvable by past methods.” Anxiety increases, effective cognitive functioning decreases and behavior becomes becomes disorganiz disorganized. ed. Te person person urgently urgently seeks help because old problem problem solving solving methods do notwork. Crisis Intervention can be defined as emergency psychological care aimed to assist individuals in returning to normal levels of functioning and to prevent or alleviate potential negative psychological trauma
There are some ASSUMPTIONS on which the concept of crisis is based (Caplan1964, Kaplan & Sadock 1998) 1. Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology.
2. Crisis Crisis is precipitat precipitated ed by specif specific ic identifi identifiable able events. events. 3. Crisis Crisis is personal personal by nature. nature. What What may be considere considered d a crisis situati situation on by one individual individual may not be so for other.
4. Crisis Crisis is acute acute,, not chronic chronic and will will be resolved resolved in one way or another another within within a brief brief period. 5. A crisis crisis situation situation contains contains the potential potential for psychol psychological ogical growth growth or deterior deterioration. ation.
PHASES IN THE DEVELOPMENT OF CRISIS The development of a crisis situation follows a relatively predictable course. Caplan (1964) outlined 4 specific phases through which individuals’ progress in response to a precipitating stressor and which culminate in the state of acute crisis. Phase 1: The individual is exposed to a precipitator stressor. Anxiety Anxiety increases; increases; previous previous problem-solving techniques are used previous us proble problem m solvin solving g techni techniques ques do not reliev relievee the stresso stressor, r, anxiety anxiety Phase 2: When previo increase further. The individual begins to feel a great deal of discomfort at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not stressful. Feelings of confusion and disorganization prevail.
Phase 3: All possible recourses, both internal and external are called on to resolve the problem and relieve the discomfort . The individual may try to view the problem from a different perspective or even to overlook certain aspects of it. New problem solving techniques may be used and if effectual, resolution may occur at this phase, with the individual returning to a higher, a lower or the previous level of premorbid functioning. Phase 4: If resolution does not occur in previous phases, Caplan states that “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 disordered, emotions are labile and behavior may reflect the presence of psychotic thinking.
Universal Principles of Crisis Intervention While dealing with crisis, both personal and societal, there are five basic principles outlined for interv interventi ention. on. Victim Victimss are initia initially lly at high high risk risk for maladap maladaptiv tivee coping coping or immobi immobiliz lizati ation. on. Intervening Intervening as quickly quickly as possible possible is imperative. imperative. Resource mobilization mobilization should should be immediatel immediately y enacted in order to provide victims with the tools they need to return to some sort of order and normalcy, in addition to enable eventual independent functioning. The next step is to facilitate understanding of the event by processing the situation or trauma or trauma.. This is done in order to help the victim gain a better understanding of what has occurred and allowing him or her to express feeling about the experience. Additionally, the counselor shoule assist the victim(s) in problem solving within the context of their situation and feelings. This is necessary for developing selfefficacy and self-reliance self-reliance.. Helping the victim get back to being able to function independently by actively facilitating problem solving, assisting in developing appropriate strategies for addressing those concerns, and in helping putting those strategies into action. This is done in hopes of assisting the victim to become self-reliant
General Approach to Crisis Intervention ACT Model of Crisis Intervention developed by Roberts as a response to the September 11, 2001 tragedy outlines a three stage framework:Assessment Crisis Intervention Trauma Treatment (ACT) (ACT) This This theory theory of crisis crisis interv intervent ention ion integr integrate atess numero numerous us assessment tools tools and triage triage procedures; Roberts’ seven stage crisis intervention model and the ten step acute traumatic stress management protocol creates one comprehensive model for responding to crisis that can be utilized in most all crisis situations. It is important to note that this should be followed as a guide not to be followed rigidly. The first step is the assessment stage; this is done by determining the needs of victims, other involved persons, survivors, their families, and grieving family members of possible victim(s) and making appropriate referrals when needed. Three types of assessments need to be conducted. The first is triage assessment, which is an immediate assessment to determine lethality and determine determine appropriate appropriate referral to one of the following: following: emergency inpatient hospitalization hospitalization,, outpatient treatment facility or private therapist, or if no referral is needed. A crisis assessment also needs to be completed which consists of gathering information regarding the individual’s crisis state, environment, and interpersonal relationships in order to work towards resolving the current crisis. This step helps facilitate development of an effective and appropriate treatment plan. The last area of assessment includes a biosocial and cultural assessment. This would be completed completed by using systemati systematicc assessment assessment tools to ascertain ascertain the client’s client’s current level of stress, stress, . situation, present problem, and severe crisis episode The goal of the crisis intervention stage of Robert’s ACT model is to resolve the client’s presenting problems, stress stress,, psychological trauma, trauma, and emotional conflicts. This is to be done with a minimum number of contacts, as crisis intervention is intended to be time limited and goal directed.S directed.Stage tage one of the seven step approach focuses on assessing assessing lethality. lethality. The clinician clinician is to plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment; this should be done promptly at the time of arrival. Once lethality is determined one should establish rapport with the victim(s) whom the clinician will be working with. The next phase is to identify major problem(s), including what in their life has lead to the crisis at hand. During this stage is it is important that the client is given the control and power to discuss their story in his or her own words. While he or she is describing the situation the intervention specialist should develop a conceptualizat conceptualization ion of the clients “modal coping style”, which will most likely need adjusting as more information unfolds, this is referred to as stage three. As a transition is made to stage four feelings will become prevalent at this time thus deal with those feelings will be an important aspect of the intervention. While managing the feelings the counselor must allow the client(s) to expres expresss his or her story, story, and explor exploree feeli feelings ngs and emoti emotions ons through through active active listen listening ing and validation. Eventually, the counselor will have to work carefully to respond to the client using challenging responses in order to help him or her work past maladaptive beliefs and thoughts, and and to thin think k about about other other optio options ns.. At step step five five,, the the vict victim im and and coun counse selo lorr shou should ld begi begin n to collaboratively generate and explore alternatives for coping. Although this situation will be unlike any other experience before the counselor should assist the individual in looking at what has worked in the past for other situations; this is typically the most difficult to achieve in crisis counseling. Once a list has been generated a shift can be made to step six, development of a treatment plan that serves to empower the client. The goal at this stage it to make the treatment plan as concrete as possible as an attempt to make meaning out of the crisis event. Having
meaning in the situation is an important part of this stage because it allows for gaining mastery. Finally, step seven, the intervention specialist is to arrange for follow-up contact with the client to evalu evaluat atee his his or her her post post cris crisis is condi conditi tion on in orde orderr to make make certa certain in reso resolu luti tion on towar towards ds progressing. The follow up plan may include “booster” sessions to explore treatment gains and potential problems. After the situation has been assessed and crisis interventions have been applied the aim is at eliminating PTSD symptoms, symptoms, thus treating treating the traumatic traumatic experience. A comprehensi comprehensive ve view of how to treat the trauma consists of ten stages outlined by Lerner and Shelton (2001). These steps relate similarly to the crisis intervention steps. The first step is to assess for danger/safety for self and others, this means for the victim, counselor, counselor, and others others who may have been effected effected by the trauma. trauma. Then the counselor counselor should should consider consider the physical and perceptual perceptual mechanisms mechanisms of injury. Once injury is assessed the victim’s level of responsiveness should be evaluated and any medical needs should be addressed. Each individual who witnessed or is experiencing a crisis should be observed to identify his or her sign’s of traumatic stress. After the assessment of the situation is completed the interventionist should introduce his or her self, state their title and role, and begin building rapport. Building this relationship allows for a more fluid approach to grounding the individual, this can be done by allowing him or her to tell his or o r her story. Again, the counselor is encouraged to provide support through active and empathetic listening, normalize, validate, and educate. Finally, the intervention specialist is to bring the person to the present, describe future events, and provide referrals as needed.
The relationship relationship between transactional model of stress/ adaptation and Caplan’s Caplan’s phases in the development of crisis. Precipitating event Predisposing factors
Genetic influences Family history Past experiences
Phase 1
Previously used prob-lem solving techni.
Cognitive appraisal
Existing conditions
Primary
Coping mechanisms
Stress appraisals
Support systems Harm/loss
Threat
Challenge
Secondary
Availability of coping strategies
Phase 2
Perceived effectiveness of coping strategies Perc Percei eive ved d abi abili lity ty to use use cop copin ing g str strat ateg egie iess eff effec ecti tive vely ly
Phas Phasee 3
Quality of response
Adaptive (No crisis)
Maladaptive (Crisis) Phase 4
CONTINUM OF CRISIS RESPONSES In describing the phases of a crisis, it is important to consider the balancing factors shown as follow. These include the individual’s perception of the event, situational supports and coping mechanisms. Successful resolution of the crisis is more likely if the person has a realistic view of event, if situational supports are available to help solve the problem and if effective coping mechanisms are present (Aguilera 1998).
CONTINUM OF CRISIS RESPONSES
Adaptive responses
Growth
Maladaptive responses
Precrisis functioning
Disorganization
THEORETICAL PERSPECTIVES: Erik Lindemann
In 1944, Lindemann develop a classic paper on bereavement that later evolved as a model for considering the nature and resolution of crisis in broader teams. He studied 101 patients who were in crisis as a result of personal loss. Included in this group were bereaved disaster victims and their relatives who had lost someone in the famous coconut Grove fire and those of patients who had lost a relative during therapy. Other participants in the study were the relatives of armed service men either killed or lost in World War 2 and relatives of patients who had died in the hospital. His study of their behavior provided Lindemann with the observations of normal and morbid grief, which he later formulates into a stage theory concerning grief resolution. He noted that that indivi individual dualss experi experienci encing ng a normal normal grief grief reacti reaction on suffer suffered ed from from physic physical al compla complaint ints, s, preoccupation with memories of the decreased, anger, grief, guilt, changes in pattern of activity and imitating characteristics of the decreased. Some people had more difficulty accepting the reality of the lose and other appeared to have a delayed reaction to the loss of a loved one. Distorted reactions included development of physical illness or clinical depression. Unable to integrate the experience, the individual fail to ascribe a meaning to the loss that allowed life to continue. Prolonged intense grief represented the unresolved part of the relationship. Lindemann believe that crisis intervention should have a community focus; he worked with Caplan to establish the first mental health clinic devoted to preventive psychiatry. Gerald Caplan
Caplan (1964; 1974) a colleague of Lindemann, receive credit for describing the sequence of the crisis crisis state state and for defini defining ng crisis crisis interv intervent ention ion as a distin distinct ct form form of preven preventiv tivee psychi psychiatr atric ic therap therapy. y. The crisis crisis interv intervent ention ion techni technique que develop developed ed through through his resear research ch studie studiess with with the Harvard family health clinic serve as a model for modern community mental health systems. Caplan believe that crisis represent a transitional period in a person’s life characterized by emoti emotional onal and cognit cognitive ive disequi disequilib libriu rium m forcin forcing g a reappr reapprais aisal al of previo previousl usly y held held value value and beliefs. It occurs when a person is faced with a potentially insoluble problem that has meaning
for the person. The crisis state is self limiting and usually lasting 4-6 weeks. An inability to resolve a crisis successfully makes a person more vulnerable to difficulties in resolving other life crisis. According to Caplan, a crisis state dose not develops spontaneously, nor does it unfold apart from the person in crisis. To understand fully the nature of the crisis, it is necessary to assess the context in which the crisis arises. This assessment includes information about the nature of family bond, work affiliation and other significant relationships. The patient can avoid more seriou seriouss dysfun dysfuncti ction on by alteri altering ng the unheal unhealthy thy enviro environme nmenta ntall condit condition ionss that that create create a stress stress quic quickl kly. y. Capl Caplan an’s ’s work work is part partic icula ularl rly y rele releva vant nt for for under underst stand andin ing g inte interp rper erso sona nall and developmental crisis states. Caplan (1974) recognized the important role nurses health professionals’ nurses play in crisis intervention. He states “I felt that among health professional nurses were particularly well suited to stimulate such support and to act as bridges of communication and as mediator between their patients and professional and non- professional agencies.” Erik Erikson
Ericson (1963; 1968) is important for his description of crisis as a natural part of personal matura maturatio tion. n. He viewed viewed develop developmen mental tal crisis crisis point point as critic critical al to normal normal health healthy y person personali ality ty development. Erikson used an 8 stage model of human ego development and proposed that personality growth could be divided into distinctive psychosocial developmental periods or life stages. Each psychosocial crisis marks the transition to the next life stage to stage; they are relatively similar for all members of a given society. The precise timing, however and behavioral expression of a stage reflect an individual’s culture, physical development and life circumstances such as illness or family norms. That culture plays a role is seen in the fact that societal expectation in eastern culture is quite different than they are in the West. E.g. a women’s identity in many Eastern cultures are clearly tied to family and spouse, whereas in the West, women have more more freedom freedom to expres expresss their their identi identity ty with with everever- expandi expanding ng career career and life life choice choices. s. The behavior of women in each culture reflects societal expectations. Although developmental crisis are directly related to social expectation, they also are age relate related. d. Psychos Psychosoci ocial al develop developmen mentt emerge emergess from from a ground ground plan plan that that unique uniquely ly define definess each each person’s personality. In the beginning, the ground plan is not within the individual’s conscious awareness but develops with greater clarity as the result of interactions with others and signicant life experiences. A crisis point occurs when the self understandings previously used by an individual to negotiate life on longer are sufficient to meet its social demands. Each developmental crisis is systematically related to all other and each has its own time of special focus or ascendancy. The task necessary for maturation exists in its purest form during the assigned stage but may also reappear during a later phase in a modified form. To move to the next stage of development, a person must successfully resolve each maturation crisis, the threats of which are incorporated into the higher level of psychosocial development.
Solutions of the task contained within each phase of development are established as a formative seed in previous phase, worked on in the previous phase and refined in subsequent ones. E.g. the adolescent’s focus on identity actually begins much earlier as the child engaged in social role behaviors during play and later developed fundamental skills in peer relationship with schoolmates. In old age, mature adults reflect back on the meaning of their lives and share their insights with the younger generation. The environment plays an important role in the development of a psychosocial crisis because it presents an individual with new defining characteristics about expected modes of behavior for each time period that is qualitatively different from the social expectations that preceded it rather than describing a psychosocial crisis as a purely situational response, Erikson (1963) viewed its development as an internal psychological process, “ a necessary turning point, a crucial moment, when development must move one way or another, marshaling resources of growth, recovery and further differentiation. TYPES OF CRISIS Mainly there are 2 types of crisis: 1. Situa ituati tion onal al 2. Mat Maturat uratio iona nall 1) Situational: It refers to an extraordinarily stressful event such as the terrorist attacks or “beltw “beltway ay sniper sniper”” incide incidents nts that that affect affectss an indivi individual dual or family family regard regardles lesss of age group, group, socioeconomi socioeconomicc status status or sociocultu sociocultural ral status. status. E.g. economic economic difficulti difficulties, es, medical medical or psychiatr psychiatric ic illness, rape, workplace or school violence, divorce etc.
Maturational Crisis: On the other hand, is an experience such as puberty, adolescence, 2) young adulthood, marriage or the aging process- in which one’s lifestyle is continually subject to change. These are the normal process of growth and development that evolve over an extended period and require the person to make some type of change. A process of maturation occurs throughout the life cycle. Erikson identified eight stages of growth and development in which specific maturational tasks must be mast master ered ed.. Each Each of this this stag stage e cons consti titu tute tes s a cris crisis is in pers person onal al grow growth th and and development. The eight stages and their tasks as defined by Erikson are:
Beldwin (1978) has identified six classes of emotional crisis, which progress by degree of severity. As the measure of psychopathology increases, the sources of the stressor changes from external to internal. The type of crisis determines the method of intervention selected. Class 1: Dispositional crisis Definition : An acute response to an external situational stressor.
Intervention : Nancy’s Nancy’s physical physical wounds wounds were were cared cared for in the emerge emergency ncy departm department ent.. The mental health counselor provided support and guidance in terms of presenting alternatives to her. Needs and issues were clarified and referrals for agency assistance were made. Class 2: Crisis of anticipated life transitions Definition: Normal Normal life cycle cycle transition transitionss that may be anticipated anticipated but over which the individual individual may feel a lack of control. Intervention: physical examination should be performed (physical symptoms could be caused by depres depressio sion) n) and ventil ventilati ation on of feelin feelings gs encoura encouraged ged.. Reassu Reassuran rance ce and suppor supportt should should be provided as needed. The client should be referred to services that can provide financial and other types of needed assistance. Problematic areas should be identified and approaches to change discussed. Class: 3 Crisis resulting from traumatic stress Definition: Crisis precipitated by unexpected external stresses over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated.
E.g. Rape Intervention: The nurse should encourage the patient to talk about the experience and to express the feelings associated with it. The nurse should offer reassurance and support; discuss stages of grief and how rape causes a loss of self- worth, triggering the grief response; identify support systems that can help the patient to resume her normal activities and explore new methods of coping with emotions arising from a situation with which the patient has had no previous experience Class: 4 Maturational/ developmental crisis Class: 5 Crisis reflecting psychopathology Definition: Emotional crisis in which preexisting psychopathology has been instrumental in preci precipit pitati ating ng the crisis crisis or in which which psychop psychopath atholo ology gy signif significa icantl ntly y impair impairss or compli complicat cates es adaptive resolution. Examples of psychopathology that may precipitate crisis include borderline personality, severe neuroses, characterological disorders or schizophrenia. Intervention : Someone stay with her and reassure her for safety and security. After the feelings of panic have subsided, she should be encouraged to verbalize her feelings of abandonment. Regres Regressiv sivee behavi behaviors ors should should be discou discourag raged. ed. Posit Positive ive reinfo reinforce rcemen mentt should should be gives gives for independent activities and accomplishments. Class: 6 psychiatric emergencies Definition : crisis crisis situatio situation n in which which genera generall functi functioni oning ng has been been severe severely ly impai impaired red and indivi individual dual render rendered ed incomp incompete etent nt or unable unable to assume assume person personal al respo responsi nsibil bility ity.. E.g. E.g. acutel acutely y
suicidal suicidal individual individuals, s, drug overdoses, reaction to hallucinogen hallucinogenic ic drugs, acute psychosis psychosis and alcohol intoxication. Intervention : the crisis team monitored vital signs, ensure maintenance of adequate airway, initiated gastric lavage and administered activated charcoal to minimize absorption. The situation was explained to relatives and they were we re encouraged to stay with their patients.
CRISIS PARADIGM The paradigm set by Aguilera (1994) suggests that whether or not an individual experiences in the past. If a crisis in response to a stressful situation to a stressful situation depends on the following 3 factors: 1. The individual’s perception of the event: If the event is perceived realistically, the individual is more likely to draw on adequate recourses to restore equilibrium. If the per perce cept ptio ion n of the the event event is dist distor orte ted, d, atte attemp mpts ts at probl problem em solv solvin ing g are are like likely ly to be ineffective and restoration of equilibrium goes unresolved. 2. The availability of situational supports: Aguilera states, “Situational supports are those persons who are available in the environment and who can be depended on to help solve the proble problem.” m.” Witho Without ut adequat adequatee situat situation ional al suppor supports ts during during a stress stressful ful situat situation ion,, an individual is most likely to feel overwhelmed and alone. 3. The availability of adequate coping mechanisms: When a stressful situation occurs, indivi individua duall draw draw on behavio behavioral ral strate strategie giess that that have have been been succes successfu sfull for these these coping coping strategies work, a crisis may be diverted. If not, disequilibrium may continue and tension and anxiety may increase.
State of equilibrium Description of crisis Stressful event : A young couple is told that their son has inoperable cancer State of disequilibrium occurs: the impact of their son’s illness results in feeling of increased anxiety, tension and helplessness. They experienced a threatened loss: their son’s life. Need to restore equilibrium : parents recognize the need to decrease feelings of anxiety, tension and helplessness so that they can handle their own feelings and their son’s illness.
BALANCING FACTORS PRESENT
DISTURBANCE IN ONE OR MORE BALANCING FACTOR
Realistic perception of the event:
Prognosis of illness is poor because
Distorted perception of the events
Question seriousness of illness.
the cancer is inoperable. Adequate situational support :
Inadequate situational support: No
Receive support of pastor, parent’s
religious af affiliation: de d ecline he help fr from the hospital chaplain; poor IPR with
And close friends.
Both sets of parents; no close friends to Turn to for help.
Adequate defense and/or coping skills:
Inadequate defense and/or coping skills:
Able to discuss their feelings and
unable to communicate openly with
thoughts with each other, family
each other; each blames the other for
members and friends.
Not recognizing signs of their son’s illness earlier.
Resolution of problem : able to apply
Problem unresolved : uncertain what to
Problem solving process.
Do about son’s illness; confusion, anxiety
Decide to: 1. Stay with their son and make
& feelings of helplessness persist. Usual
The most of their time together as a
coping mechanisms do not alleviate the
Family.
Fear of a threatened loss. They avoid
2. Provide the best medical care possible
reality with over activity.
to keep their son comfortable. Anxiety lessens after the problem Solving process applied. Crisis resolving:
Achieving equilibrium
Crisis not resolving : experiencing severe or
extraordinary stress that is precipitated by son’s illness.
Crisis situation paradigm
COMMONLY USED THERAPEUTIC TECHNIQUES IN CRISIS INTERVENTION 1. Displaying Displaying acceptanc acceptancee and concern and attempti attempting ng to establish establish a positive positive relationsh relationship. ip. 2. Encouraging the client to discuss present feelings, such as denial, guilt, grief or anger. 3. Helping the client to confront the reality of the crisis by gaining and intellectual- as well as emotional- understanding of the situation; not encouraging the person to focus on all the implications of the crisis at once.
4. Explaining Explaining that the the client’s client’s emotions emotions are are normal normal reaction reaction to the crisis crisis.. 5. Avoi Avoidi ding ng fals falsee reass reassur uran ance. ce. 6. Clarifying fantasies; contrasting them with facts. 7. Not encouraging the client to place the blame for the crisis on others because such encouragement prevents the client from facing the truth, reduces the client’s motivation to take responsibility for behavior and impedes or discourages adaptation during the crisis.
8. Settin Setting g limits limits on destr destruct uctive ive behavi behavior. or. 9. Emphasizing Emphasizing the the client’s client’s respon responsibil sibility ity for for behavior behavior and decisi decision. on. 10. Assist Assisting ing the client client in seekin seeking g help help with with the activiti activities es of daily daily livin living g until until resolu resolutio tion n occurs. 11.Evaluating and modifying nursing interventions as necessary.
Application of the Nursing Process Assessment •
•
•
•
•
Determine if the person is really in crisis (tears, anger & being upset don’t always mean crisis) What is their perception of the stressful event? How threatened are they? Is the perception realistic or distorted? If there is great anxiety, the person cannot think clearly or identify solutions – is helpful to have them talk about what immediately preceded the distress à it frequently calms people to talk. Focus on the immediate problem not the history à people will reach out for help even if the event occurred in the last 14 days, sometime within 24 hours. Ask the person to describe their feelings & frustrations (accept them without judgement & it helps the client to accept them). Experiencing pain is also beneficial to the person – although it may be difficult for the nurse to see someone crying. It is important that you know that nurses are not suppose to have all the answers for patient patient à we provide the support support & feedback feedback while the patients solve their own problem and in this way they grow…
•
•
•
Assess the availability of support systems – which can provide continued support. Who do they trust? Who is your best friend? Who are you close to? (Children cope better if they are with their parents) Do they have a religious beliefs & support? Assess coping skills. Are they adaptive or maladaptive? Are they still functioning in life (i.e. with a job, school or family)? Assess the potential for self-harm. Are they having thoughts of hurting themselves? Most patients will not volunteer this information – but will readily talk about suicidal thoughts when asked. If there is a history or specific plan of suicide the patient must be watched closely.
Possible Nursing Diagnosis • • • • •
Anxiety, Altered Thought Processes, Ineffective Individual Coping Impaired Social Interaction, Social Isolation Self Esteem Disturbance.
Planning •
•
The major The major goal goal of crisis crisis inter interve venti ntion on is to assis assistt the patie patient nt in reest reestabl ablish ishing ing equilibrium. The goals of crisis intervention are different form the goals of other therapies.
Interventions •
•
•
• •
Assist the patient to reexamine any feelings that might block adaptive coping & realize the potential for growth. Teach the patient that it is alright to ask for help, people who place high value on independence may have difficulty. Enco Encour urag agee adapt adaptiv ivee copi coping ng meth method odss such such as expr expres essi sion on of feel feelin ings gs,, progr progres essi sive ve relaxation, and physical exercise, as well as drinking warm milk or herbal tea to aid in relaxation & sleep. Assist the patient to focus on the problem & specific goals leading to its resolution. Another approach to care includes a crisis team – possibly consisting of a psychiatrist, nurse, psychologist, social worker, aide, minister & students. The disadvantage of this approach is a possible loss in continuity of care – which should be monitored closely.
Crisis Groups • •
•
•
•
Crisis Groups are an option to one-on-one crisis intervention. Groups may work best for people who have difficulty with interpersonal relationships (feel more comfortable in a group), and those who have difficulty accepting information from psychiatric professionals or people in positions of authority. Advantages are - people feel less isolated, make social contact, see others have similar problems - which help them to open up about their problems. Disadvantages are - an inability to focus on one patient’s problems & suggestions of maladaptive or destructive coping methods by g roup members. Groups are usually 5-7 people that meet 1 ½ to 2 hours once a week for 6 weeks.
•
A closed group does not accept new members after it is formed & continues for a specified time.
Summary: Crisis means a turning point. In the crisis intervention the goal is to assist the person in distress to resolve the immediate problem & regain emotional equilibrium. Your role as the nurse or intervener is one of active participation . Intervention is a partnership & the belief is that with help people can help themselves. Nurse helps the person analyze the event, encourages expression of feelings, affirms the right to those feelings no matter what they are, reinforces strengths & abilities, explore other ways to deal with the stressors & encourages support from family, friends & other resources.
