Crisis Intervention

BYMUNTHALI
Introduction

 Stressful situations are a part of

everyday life. Any stressful situation
can precipitate a crisis. The event or
situation that comes at the end of the
series of stressors may be minor making
the situation more than the individual
can handle.
de

 A crisis differs from stress in that a

crisis results in a period of severe
disorganization resulting from the
failure of individuals usual coping
mechanism or the lack of usual
resources or both.
 According to the Taylor 1982 “Crisis is a
state of disequilibrium resulting from the
interaction of an event with the
individual’s or family’s coping
mechanisms , which are inadequate to
meet the demands of the situation
combined with the individual’s or family’s
perception of the meaning of the event.
 Define Crisis
 An internal disturbance caused
by a stressful event or
perceived threat to self in which
an individual’s usual coping
skills don’t work, precipitating
in an increase in anxiety.
 This event occurs when an
individual is threatened by a
certain life circumstance or
stressor that he or she cannot
effectively manage by using his
or her usual coping skills.
Stages of crisis
 The first stage of crisis occurs
when the person is confronted
by a stressor. Exposure to this
stressor would result to anxiety.
The individual then tries to
handle things by using his or her
customary coping skills.
 Second stage of crisis occurs
when the person realizes that his
usual coping ability is ineffective
in dealing with anxiety. As the
person becomes aware of his
unsuccessful effort in dealing
with the perceived stressor, he
moves on to the next.
 3rd stage of crisis where the
individual tries to deal with the
crisis using new methods of coping.
 The fourth stage of crisis takes
place when the person’s coping
attempts of resolving the crisis fail.
The individual then experiences
disequilibrium and significant
distress.
 Types of Crisis
 Maturational or developmental;
Developmental crisis (also referred to as
maturational or internal crisis) may
occur at any transitional period in
normal growth and development.
 Individuals are required to make cognitive and
behavioural changes that accompany
development
 These are predictable events in a persons life
which includes getting married, having a baby
and leaving home for the first time.
 Situational Crisis; A situational crisis
(sometimes called accidental or external
crisis) is a response to a sudden and
unavoidable traumatic event that largely
affects a person’s identity and roles.
 Includes loss of job, loss of loved one,
divorce, birth of a child with a disability or
diagnosis with a chronic or terminal illness)
 Adventitious Crisis also called social
Social crisis is accidential, uncommon and
unanticipated and result in multiple losses
and radical environmental changes.
 An adventitious crisis occurs outside the
person precipitate by an unexpected event.
 crisis: mass disasters; fire, flood,
etc. Unexpected traumatic event,
e.g. crime, rape
Crisis intervention
 Crisis intervention refers to the
methods used to offer
immediate, short-term help to
individuals who experience an
event that produces emotional,
mental, physical and
behavioural distress or
problems.
 A crisis can refer to any situation in
which individual perceives a sudden
loss of his or her ability to use effective
problem solving and coping skills
Goals of crisis Intervention

1. To decrease emotional stress and

protect the crisis victim from
additional stress.
2. To assist the victim in organizing and
mobilizing resources or support
system to meet unique needs and
reach a solution for the particular
situation that precipitated the crisis.
AIMS

 To assist the individual in recovery

from the crisis and to prevent serious
long term problem.
PURPOSE

1. The purpose of crisis intervention is to

prevent illness; both physical and
emotional.
Study of survivors of a hotel fire is basis for
this content. Researcher found that
individuals that handled the crisis without
developing an illness did some things
differently than those who got sick.
 Three Levels of Prevention

 Primary Prevention: Prevents illness

from occurring
 Secondary Prevention: Early Dx and
treatment
 Tertiary Prevention: Rehabilitate to get
patient to highest level of wellness
possible
 Balancing Factors

 Some events become crisis and

some don’t, depending on
Balancing Factors
– Perception of the Event
– Situational Supports
– Adequate coping mechanisms
 CRISIS INTERVENTION
BALANCING FACTORS

 Perception of  Perception of event

event realistic distorted
 Situational  Situational support
support adequate inadequate
 Coping  Coping mechanisms
mechanisms inadequate
adequate

No crisis Crisis
 Assessment of Balancing Factors

 Perception of Event
– Cognitive skills
– Maintains self image and sense of purpose
– Redefines the event
 Situational Supports
– How well does patient utilize other people for
support?
 Assessment of Balancing Factors

 Coping Skills
– Ability to express strong emotions
– Preferred modes: does client prefer
or have skill with actions, like
exercise, writing, crying, talking?
– Ability to tolerate uncertainty
– Problem solving ability; making
plans
 CRITICAL THINKING

 In the following scenario, compare the

balancing factors that influence each
clients’ response to the crisis situation.
 Balancing Factors:
Crisis Scenario
 There was a fire at an apartment
building which severely damaged it.
 Residents were brought to the
emergency department for evaluation
for possible smoke inhalation.
Fortunately, there were no injuries.
 Two residents in their twenties spoke
with the nurse in the ED . . . . . . . . . . .
 Same Event: Two Individuals

Client “A” Client “Z”

 Perception: “I lost my home  Perception: “I lost
but I still have my health everything that means
anything to me.”
and my work.”
 Supports: “My Dad always
 Supports: “My church is told me to move out. He
already taking up a says no wonder there was a
collection.” fire .“
 Coping: “The first thing I’m  Coping: “Now what do I
going to do when I leave do? I can’t think straight
here is blog about this about this. It is too much.”
incredible experience.”
REQUIESITES FOR THE EFFECTIVE CRISIS
INTERVENTION

 In addition to being nonjudgmental,

flexible, objective, empowering,
supportive, following are considered to
be essential requisites for service
providers to enable and individual to a
journey from a vulnerable crisis .
 Ability to create trust via confidentially and
honesty.
 Ability to listen in an attentive manner
 Provide the individual with the opportunity
to communicate by talking less.
 Being attentive to verbal and non verbal cues.
 Pleasant, interested,intonation of voice.
 Maintaining good eye contact, posture and
appropriate social distance if in a face to face
situation.
 Remaining undistracted, open honest, sincere.
 Asking open ended questions.
 Asking permission, never acting on
assumptions.
 Checking out sensitive cross-cultural factors.
LENGTH OF TIME FOR CRISIS
INTERVENTION

 The length of time for crisis

intervention may range from one
session to several weeks, with the
average being four weeks.
 crisis intervention is not sufficient for
individuals with long standing
problems and it may range from 20
minutes to 2 or more than 2 hour.
PLACE OF INTERVENTION

 It can take place in a range of setting

such as hospital emergency room,
counselling centres, mental health
clinics school and social service
agencies and crisis centres.
KEY ELEMENT OF MANAGEMENT

 Management will depend on the

severity and causes of the crisis as well
as the individual circumtances of the
patient.
 Many relatively minor crises can be
managed by providing friendly support
in primary care without referral.
 However more severe crisis will require
referral to counsellors or the local
mental health team.
 Crisis therapy includes short term
behaviour/ cognitive therapy and
counselling.
 Involvement of family and other key
social network very important.
 Therapy should be relatively intense
over a short period and discontinued
before dependence on the therapiest
develops.
 The risk of suicide and self harm must
be assessed at presentation and each
review
 The aims of treatment are to-
 Reduce distress
 Help to solve problems
 Avoid maladaptive coping strategies
eg. Self harm
 Improve problem solving strategies
TECHNIQUES OF CRISIS INTERVENTION

 Catharsis: The release of feelings that

takes place as the patient talks about
emotionally charged areas.
 Clarification: Encouraging the patient
to express more clearly the relationship
between certain events.
 Suggestion: Influencing a person to
accept an idea or belief, particularly the
belief that the nurse can help and that
person will in time feel better.
 Reinforcement of behaviour: Giving
the patient positive response to
adaptative behaviour.
 Support of defences: Encouraging the
use of healthy, adaptive defences and
discouraging those that are unhealthy
or maladaptive.
 Rising self esteem: Helping the patient
regain feelings of self worth eg;- you are
very strong person to be able to manage
the family all the time.
 Exploration of solution: Examining
alternative ways of solving the
immediate problem.
 STEP IN CRISIS INTERVENTION

 Aguilera (1982) list four steps in the process

of crisis intervention. They are follows:-
 Assessment
 Planning therapeutic intervention
 Implementing techniques of intervention
 Resolution of the crisis and anticipatory
planning
 ASSESSMENT
 The assessment process attempts to
answer questions such as-
 What has happened? (Identification of
problem)
 Who is involved?
 What is the cause?
 How serious is the problem?
 The crisis worker determines the
following during the assessment
process.
 Onset of the crisis
 Precipitating factors (including who,
what, when and where) of the situation.
 PLANNING THERAPEUTIC INTERVENTION
 The person should be involved in the
choice of alternative coping methods.
 The needs and reactions of significant
other must be considered.
 THERAPEUTIC INTERVENTION
Therapeutic intervention depends on
prelisting skills, the creativity and flexibility
of the crisis worker and rapidity of the
person’s response.
 The crisis worker helps the person to
establish an intellectual understanding of
the crisis by noting the relationship between
the precipitating factors and the crisis.
 RESOLUTION AND ANTICIPATORY PLANNING
 During the evaluation phase or step of
crisis intervention, reassessment must
occur to ascertain that the intervention is
reducing tension and anxiety.
 Assistance is given to formulate realistic
plans for the future, and the person is
given the opportunity to discuss how
present experiences may help in coping
with future crises.
MURRAY’S(1979) THERAPEUTIC TECHNIQUES
WHILE PERFORMING CRISIS INTERVENTION

 Display acceptance and concern and attempt

to establish a positive relationship.
 Encourage the person to discuss present
feelings, such as denial, guilt,grief or anger.
 Help the person to confront the reality of the
crisis by gaining an intellectual as well as an
emotional understanding of the situation.
 Explain that the person’s emotions are a
normal reaction to the crisis.
 Avoid giving false reassurance.
 Clarify fantasies, contrasting them with
facts .
 Set limits on destructive behaviours.
 Emphasize the person’s responsibility
for behaviour and decisions.
 Assist the person in seeking help with
everyday activities of daily living until
resolute occurs.
 Nursing intervention is evaluated and
modified as necessary.
QUESTIONS!