INTRODUCTION :- “ Crisis intervention” is the emergency and temporary care given an individual who,

because of unusual stress in his or her life that renders them unable to function as they normally would,
in order to interrupt the downward spiral of maladaptive behavior and return the individual to their
usual level of pre crisis functioning.

DEFINITION:-

Crisis:- Crisis can be defined as one’s perception or experiencing of an event or situation as on

intolerable difficulty that exceeds the person’s current resources & coping mechanism.

Crisis Intervention:-

I) “Crisis Intervention” refers to the methods used to after immediate short- term
help to individuals who experience an event that produces emotional, mental,
physical & behavioral distress or problems.
II) “Crisis Intervention” is emergency psychological care aimed at assisting individuals
in a crisis situation to restore equilibrium to their bio psychosocial & to minimize the
potential for psychological drama.
III) “Crisis Intervention” is a psychotherapeutic technique directed at counselling at the
time of an acute life crisis & limited in aim to helping resolve the crisis.

Purposes of crisis Intervention:- It has several purposes, following-----

i) It aims to reduce the intensity of an individuals emotional, mental, physical & behavioral
reactions to crisis.
ii) It help individuals return to their level of functioning before crisis.
iii) Crisis intervention helps the individual to cope with future difficulties. Through talking
about what happened, while developing ways to cope & solve problem.
iv) Crisis Intervention aims to assist the individuals in resolving from the crisis & to prevent
serious long-term problems from developing.

TYPES OF CRISIS :-

I) Financial crisis : -This could be any crisis that reduces short-term tiquidity or cash flow or
that leads to bankruptcy.
II) Natural disaster / physical threats :- Fire,hurricans,tornadoes,floods.
III) Operational crisis :- minor crisis of running the organization & serving the individual with
good management.These can be avoided & promptly resolved.
IV) Sudden crisis :- These are even that occur unexpectedly & have a major effect on the
organization .These include – natural disaster ,vital services ,such as power ,water or
computers.
V) Potential crisis :- Potential crisis are serious problems that grow longer over time & become
critical if they are not addressing..
 Developmental crisis
  Situational crisis
 Complex crisis.
v) Other types :-bomb threat,civil disorders,crime,cyclone,disease,earth quake,fire,flood,land
slide,radiation,terrorism,thunderstorm,tornado,Tsunami,typhoon,volcano,war,death.

COMMON FEATURES OF CRISIS :-

The common features of crisis includes ……………..

 The situation materialism unexpectedly

 Decision are required urgently
 Time is short
 Specific threats are identified
 Urgent demands for information are received
 There is sense of loss of control
 Pressures build difficult
 Routine become difficult
 Communications are different to manage.

PHASES OF CRISIS :-

There are five phases in crisis……….

Phase- 1 ) the triggering event :-

The triggering event avoids triggering an event that could lead to a crisis situation where possible &
where appropriate.

Phase -2) : Escalation :-

Deal with person using normal communication skills.

Phase -3) : Crisis :-

Assess the danger of the situation ,know that it is OK to walk away.

Phase - 4) : Recovery :-

If you are still around the person continue to treat them as if they are still potentially dangerous ,e.g.
physical distance, monitoring their actions & behavior.

Phase – 5 ): post – crisis depression :-

This period usually follows a crisis situation .During this time it is important to be mindful that the
person is at risk of harming themselves or others.

PHASES OF CRISIS INTERVENTION :- There are seven phases of crisis intervention ……

 I) Introductory remarks :- team sets ehe tone & rules for dicussion,encourages,participants &
cooperation.
II) Fact phase :- Participants describe what happened during the incidence.
III) Thought phase :- Participants state the first & main thoughts while going through the
incident.
IV) Reaction phase :- participants discuss the elements of the situation that were worst.
V) Symptom phase :- Participants describe the symptoms of distress experienced during or
after the incident.
VI) Teaching phase :- Team provides information & suggestion that can be used to reduced the
impact of stress.
VII) Re-entry phase :- Team answers,participants question & makes summary & comments.

PRINCIPLES OF CRISIS INTERVENTION :-

I) Be specific ,use concise statements & avoid over whelming the patient with irrevant
question or excessive detail.
II) Encourage the expression of feelings.
III) A calm,controlled presence reassures the person that the nurse can help.
IV) Listen for facts & feelings – seeking clarifications,paraphrasing & reflection are effective
strategies.
V) Allow sufficient time for the individuals involved to process information & ask question.
VI) Help patients legitimize feelings by letting them to know that others in similar situations
have experienced comparable emotions.
VII) Clarify distortions by getting persons to look at the situations realistically,focus on what can
be changed versus what cannot.
VIII) Empower persons by allowing them to make informed choices.
IX) Assist the persons in confronting reality.
X) Encourages the persons to focus on one implication at a time.

TECHNIQUES OF CRISIS INTERVENTION :- There are various approaches to supporting individuals in

crisis,for example,using non-counselling methods such as psychological first aid,more technical models
involving strategies for listening ,assessing & acting in crisis intervention ,or activities related to
responding to trauma.The guidance in this section describes intervention that require specific
skills,development training & supervision .

Information alone is not sufficient for shelter staff to be able to apply these techniques,&
individuals should not conduct crisis intervention without proper training & supervision.

Effective crisis intervention must follow ethical principles,this involves good communication
skills ,demonstrating empathy ,among other support provided by shelter workers.
i) Strategies for listening in person :- Listening involves focusing ,observing,understanding &
responding with empathy,genuineness ,respect,acceptance,non- judgement & sensitivity.A
number of specific strategies can be used to promote effective listening during crisis
intervention .These include ………
 Using open-ended questions -- what or how questions.They are used to encourage
sharing of informations from a women or girl about her feelings,thoughts, &
behaviours,& are particularly useful when exploring problems during a crisis.Open-
ended questions encourages the women to provide a greater depth of information
including what situation or events mean to her.
 Using close – ended questions that seek specific details & are designed to
encourage a women or girl to share information about behaviors ( such as the
abuser’s specific actions or behavioural coping strategies used by the women),as
well as ‘yes’ or ‘no’ responses. Closed-ended questions usually begins with action
words such as ,’do’,’does’.’can’ ,’have’,’had’, ‘will’ ,’are’ ,’is’ & ‘was’. These
questions can be used to gather specific information or to understand the women’s
willingness to commit to a particular action (e.g. to complete a safety plan ).
 Restating & clarifying what the women has said can help the shelter staff
conducting the crisis intervention to clarify whether she has an accurate
understanding of what the women intended to say,feel ,think & do . Restating can
also be used to focus the discussion on a particular topic,event or issue.
 Owning feelings & using statements that start with ‘I’ in crisis intervention can help
to provide direction by being clear about what will occur ( e.g. I ,am going to
explain the steps we will take today),what is being asked of the women (e.g. I would
like to ask whether you agree to the steps I have described ).Staff can be trained in
various skills for practicing ‘I’ statement in order to support clear & effective
communication with women in crisis.For example ,these statements can also help
to acknowledge confusion or convey understanding of what is being discussed
( e.g. I am not sure I understand what happened when you left the house ‘or I hear
how nervous you felt on the day you left home ).
 Facilitative listening is a strategy which helps to build trust & strengthen
relationships with women .It involves focusing entirely on the womens experienced
by………
 Noticing the womens verbal & non-verbal communication.For example,’I
noticed that when you talked about the time you spent with your
daughter ,your eyes lit up & there was excitement in your voice’.
 Using non-verbal cues to show that you are listening (e.g. by nodding the
head ,making eye contact,facing the women).
ii) Assessing in crisis intervention :-
Assessment is an intentional practice that occurs throughout the
crisis intervention process & involving seeking information from a women or girl ( although
practices for engaging child survivors are distinct from those working with
adults ),actively listening & interpreting what she shares in order to understand her
 emotional state ,level of emotional mobility or immobility ,options for action,coping
mechanism, support system & other resources.
Assessment allows staff to draw conclusions about the individual situation &
responses to it, in order to plan & offer ways to assist him/her. During crisis
intervention ,shelter workers should seek to understand individuals:-
 Emotional state :- Emotional distress is often an initial sign that a individual is
experiencing a crisis,which may appear as though she is emotionally ‘out of control’
or severely withdrawn. Shelter staff can be trained to help a individual to regain
control & emotional mobility by assisting individual to express her specific feelings
using language that accurately reflects the emotions .
 Behavioral functioning . Observing a individuals behavior can help to understand
individuals ability to cope with the situation the individual is experiencing.For
example,noticing whether she is pacing the floor,having difficulty in breathing ,or
sitting calmly.& whether individuals appears withdrawn or
unresponsiveness.Shelter workers can be trained to assist the individuals to take
positive actions tha she can be able to complete in that moment.For
example,asking her to breath slowly.
 Cognitive state :-determining the individuals thinking patterns is essential in
assessing her current ability to cope with the situation she/he is
experiencing .When listening to what individuals is saying ,staff can be trained to
consider whether her verbal communication is coherent & logical& whether her
words make sense.
iii) Acting in crisis intervention :-
Taking action in crisis intervention involves intentionally responding
to the assessment of the individuals situation & needs in one of three ways-
nondirective,collaborative or directive.
Non-directive counseling is preferable when a individual is able to plan &
implement actions on her own & she chooses to take.In this case ,the shelter workers role
is to assist the individual in mobilizing her existing capacity to solve her own
problem .Comments that support a helpful in this situation ,such as,’what do you want to
have happen ?is there anyone that could support you with this plan ?
Colllaborative counseling involves working together with individual to evaluate
the problem,Collaborative counseling approaches are helpful when a woman is able to
participate in planning & taking actions ,but is not able to complete the entire process on
her (individual) own.e.g. ‘you are saying that you have decided to leave your partner ,but
you are unsure of the legal options available.Let’s explore together where you could go for
legal advice.
Directive counseling is necessary when a individual ia assessed as being
immobilized by her (individual ) experience to the extent that she is unable to cope with
the crisis.Shelter staff can be trained to use directive counseling to take temporary control
& responsibility for the situation.e.g. what I want you to do right now is breathe with
me.Thats good ,breathe in for a count of 6 & out for a counts of 6.In these
 situations ,shelters workers may move back & forth between directive counseling as the
individual shows sign of decreased anxiety & increased ability to participate in the process.
It is particularly important for staff to have sufficient training in ,in this area in
order to ensure that directive counseling is used only when necessary .

GENERAL APPROACH FOR CRISIS INTERVENTION :- A general approach of crisis intervention integrates
numerous assessment tools & triage procedures; Roberts 7 stage crisis intervention model & trauma
management protocol creates one comprehensive model for responding to crisis that can be utilized in
most all crisis situations.

The ‘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).

The first step is the assessment stage ,this is done by determining the needs of
victims ,other involved person ,survivors,their families,& grieving family members of possible victims &
making appropriate referrals when needed.

Three types of assessment need to be conducted:-

i) The first triage assessment ,which is an immediate assessment to determine lethality &
determine appropriate referral to one of the following ;emergency inpatient
hospitalization,outpatient treatment facility or private therapist,or if no referral is needed.
ii) A crisis assessment also needs to be completed which consists of gathering information
regarding the individuals crisis state,environment,& interpersonal relationship s in order to
work towards resolving the current crisis.This step helps facilitate development of an
effective & appropriate treatment.
iii) The last area of assessment includes a biosocial & cultural assessment .This would be
completed by using systemic assessment tools to ascertain the client’s current level of
stress,situation,presents problem & severe crisis episode.
The goal of the crisis intervention stage of ‘ROBERT-ACT model’ is to
resolve the client’s presenting problem ,stress,psychological trauma, & emotional
conflicts.This is to be done with a minimum number of contacts,as crisis intervention is
intended to be time limited & goal directed.
The 7 steps is following:-
1) Intake & assessing the person who is in crisis / suffering from the aftereffects of
crisis :- stsge one of the seven step approach focuses on assessing lethality .The
clinician is to plan & conduct a thorough biopsychosocial & lethality/immitent danger
assessment; this should be done promptly at the time of arrival.Once lethality is
determined one should establish rapport with the victims whom the clinician will be
working with.
2) Exploring the crisis situation of the person :- The next phase is to identify major
problems,including what in their life has led to the crisis at hand.During this stage it is
 important that the client is given the control & power to discuss their story in his/her
own words.
3) Understanding the coping style employed by the preson :- While he or she is
describing the situation ,the intervention specialist should develop a conceptualization
of the client’s ‘modal coping style’ ,which will most likely need adjusting as more
information unfolds.This is referred to as stage three.
4) Confronting feelings ,exploring emotions & challenging the maladaptive coping style :-
As a transition is made to stage four,feelings will become prevalent at this time,so
dealing with those feelings will be an important aspect of the intervention .While
managing the feelings ,the counselor must allow the clients to express his/ her
story,& explore feelings & emotions through active listening &
validation .Eventually ,the counselor will have to work carefully to respond to the client
using challenging responses in order to help him / her work past maladaptive beliefs &
thoughts ,& to think about other options .
5) Exploring solutions & educating the client in best practices of coping :- At step 5 ,the
victim & counselor should begin to collaboratively generate & 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
situation,this is typically the most difficult to achieve in crisis counseling.
6) Developing a concrete treatment plan/ structure of activities & reassuring the clients
newly gained healthy perspective :- Once a list has been generated ,a shift can be made
to step six; development of a treatment plan that serves to empower the clients.The
goal at this stage is to make the treatment plan as concrete as possible which could be
followed by the client & implemented as an attempt to make meaning out of the crisis
event.Having meaning of the situation is also an important part of this stage because it
allows for gaining mastery.
7) Follow-up :- step seven is for the intervention specialist to arrange for follow-up
contact with the client to evaluate his/her post crisis condition in order to make certain
resolution towards progressing. The follow-up plan may invlude ‘booster’sessions to
explore treatment gains & potential problems.

ROLE OF NURSE IN CRISIS INTERVENTION :- Nurses respond to crisis on a daily basis.Crisis can occur in
any unit,for example,in general hospitals,home setting,community health centers,schools,offices,& in
private practice.Indeed ,nurses may be called upon to function as crisis helpers in any situation.

Knowledge of crisis intervention techniques is thus an important clinical skill of all

nurses .regardless of the setting or practice speciality.

 NURSING ASSESSMENT :- the first step of crisis intervention is assessment.During this phase
the nurse collects data regarding the following factors:
 Precipitating event or stressors
 Patient’s perception of the event or stressors
 Nature & strength of the patients support system ,coping resources.
  Level of psychological stress patient is suffering from & degree of
impairment he/she is experiencing
 Patient’s previous strength & coping mechanism
During this phase the nurse begins to establish a positive working
relationship with the patient.
 NURSING DIAGNOSIS :- The primary nursing diagnoses in crisis intervention are-
 Ineffective individual coping
 Ineffective family coping
 Altered family process
 Post-trauma responses
 Ineffective individual coping refers to the inability to ask for help,problem
solving or meet role expectations
 Ineffective family coping occurs when the family’s support system are not
successful & family ‘s economic or social well being is threatened
 Altered family processes result when family members are unable to adapt to
the traumatic experience constructively
 Post-traumatic response is a sustained painful response to an overwhelming
traumatic event.
 PLANNING :- In planning the previously collected data is analyzed & specific interventions are
proposed .During this phase the nurse undertakes the following activities:-
 Dynamics underlying the present crisis are formulated
 Alternative solutions to the problem are explored
 Steps for achieving the solution are identified
 Environmental support needed to help the patient is decided upon ,coping
mechanisms that need to be developed & those which need to be strengthened are
identified.
 IMPLEMENTATION :- the following are carried out to resolve crisis :-
 Environmental manipulation :- it includes interventions that directly change the
patients physical or interpersonal situation.These interventions may remove stress or
provide situational support.For example.a patient having difficulty in his job may take a
week of sick leave so that he can be temporarily removed from that stress situation.
 General support :- The nurse uses warmth,acceptance,empathy,& reassurance to
provide general support to the patient.
 Generic approach :- The generic approach is designed to reach high risk individuals &
large groups as quickly as possible.It applies a specific method to all individuals faced
with a similar type of crisis (for example,in social disasters ).Debriefing is a method of
generic approach .In debriefing method, disaster victims are helped to recall events &
clarify traumatic experiences.It attempts to place the traumatic events in
perpective,allows the individual to relive the events in a factual way, encourages group
support,& provides information on normal reaction to critical events.The goal of
debriefing is to prevent the maladaptive responses that may result if the trauma is
suppressed.
  Individual approach :- The individual approach is a type of crisis intervention similar to
the diagnosis & treatment of a specific problem in a specific patient.It is particularly
useful in combined situational & maturational crises & also beneficial when
symptoms include homicidal & suicidal risk.The nurse must use the intervention that
is most likely to help the patient develop an adaptive response to the crisis.
 Evaluation :- The nurse & patient review the changes that have occurred.The nurse
should give credit for successful changes to patients so that they realize their
effectiveness & understand that what they learnt from crisis may help in coping with
future crisis.If the goals have not been met,the patient & nurse can return to the first
step assessment & continue through the phases again.

MODALITIES OF CRISIS INTERVENTION :- Community based crisis intervention modalities have recently
been developed.They are based on the philosophy that the health care team must be active & go out to
the patients rather than wait for the patients to come to them.Nurses working in these modalities
intervene in a variety of community settings,ranging from patient’s homes to street corners.

 Mobile crisis programme :- Mobile crisis team provide front-line interdisciplinary crisis
intervention to individuals,families & communities.The nurse ,who is a member of a
mobile crisis team,should be able to provide on site-assessment ,crisis
management,treatment,referral & educational services to patients,families & the
community at large.Nurses are thus able to ensure mental health care for even the most
underserved populations efficiently & cost effectively.
 Telephone contacts :- Crisis intervention is sometimes practiced by telephone rather than
through face –to-face contacts.The nurse should have effective listening skills to provide
crisis intervention to victims.
 Group work :- People who have common traits on stressors will form a group .The group
provides an opportunity for members to express common concerns & experiences,foster
hope & build mutual support.The nurse’s role in the group is active,focal & focused on the
present.The nurse & the group help the patients solve the problem & reinforce new
problem solving behavior.
 Disaster response :- As part of the community,nurses are called on when an adventitious
or social crisis strikes the community.Floods,earthquakes,airplane crashes,fires,nuclear
accidents etc.Precipitate large number of crises.The nurse has an important role in dealing
with psychosocial problems of disaster victims.The nurse participates in crisis operations &
acts as a case-finder for persons suffering from psychosocial stress.It is important that
nurses in the immediate post disaster period go to places where victims are likely to
gather ,such as hospitals ,shelters ,morgues.During this period nurses use the generic
approach of crisis intervention so that as many people as possible can receive help in a
short duration of time.
 Victim outreach programs :- It is use crisis intervention techniques to identify the needs of
victims & then to connect them with appropriate referrals & other resources.
 Nurses often work in victim outreach programs,where victims are often seen
immediately after the crisis.These victims need thorough evaluation,empathic support, &
information & help with the large system & social networking system.
 Crisis intervention centers :- It provide emergency psychiatric care & counseling to
victims,experiencing extreme stress or conflict,often involving suicide attempts or
drug or alcohol abuse.These centers,which are usually self-contained units within a
hospital or community health care center,provides services 24 hours a day.The
services may be delivered directly on the premises ,or counseling may be provided
pver the telephone.The primary objective of crisis intervention centers is to help
the person cope with immediate problem & to offer guidance & support for long
term therapy.
 Health education :- Nurses are involved in identifying people who are at high risk
for developing crisis & in teaching coping strategies to avoid the development of
crisis.The public also needs education so that they can identify those needing
crisis services,& obtain information about how others deal with potential crisis
producing problems.