Crisis Intervention MSN -II

1. PREPARED BY:
Netra Gautam
M. Sc. Nursing 2nd year,
SNSR, SHARDA UNIVERSITY

2. GENERAL OBJECTIVE: At the end of the topic the students will be able to understand crisis intervention and will apply the knowledge in clinical field.
SPECIFIC OBJECTIVES: at the end of the topic the students will be able:
• To define crisis
• to describe the crisis proneness characteristic
• to enumerate the types of crisis.
• To enlist the sign and symptoms of crisis.
• To state the process of crisis.
• To define crisis intervention.
• To enlist the goals of crisis intervention
• To enumerate the aims of crisis intervention.
• To elaborate the purpose of crisis intervention.
• To enumerate the principle of crisis intervention.
• To state the requisites for crisis intervention.
• To describe the length time for crisis intervention.
• To explain the key element of management for crisis intervention
• To explain the phases of crisis intervention.
• To describe the steps in crisis intervention
• To explain the modalities of crisis intervention.
• To elaborate crisis intervention program and its benefit
• To summarize

3. Introduction:
• Any stressful event or hazardous situation has the potential for precipitating 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. A crisis differs from stress
in that a crisis results in a period of severe disorganization resulting from the failure
of individual’s usual coping mechanism or the lack of usual resources or both.

4. Definition of crisis:
• The dictionary meaning of crisis is a crucial or decisive point or situation; a
turning point.
• A crisis (derived from the “krisis” which means critical) is any event that is, or
is expected to lead to, an unstable and dangerous situation affecting an
individual, group, community, or whole society.
• Crisis as a dramatic emotional or circumstantial upheaval in a personal life and
a stage in a sequence of events at which the trend of all future events,
especially for better or determined, a turning point.

5. Definition of crisis:
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.

6. Crisis proneness characteristics (causes)
• Dissatisfaction with employment or lack of employment, retirement
• History of unresolved crisis
• Poor self-esteem, unworthiness, homeless
• Difficulty in coping with everyday situations
• Under-utilization of resources and support systems
• Aloofness and lack of caring ( adolescence)
• Menopause
• Change of role: e.g. getting married, having a child.
• Relationship problems
• Conflict: usually due to difficult choice where neither alternative is acceptable
• Serious injury or loss of limb or sudden worsening of health conditions.

7. Types of crisis
There are three types of crisis
1.Maturational or developmental crisis
2. Situational crisis
3. Adventitious crisis (social crisis)
4. Financial crisis
5. Technological crisis
6. Natural crisis
7. Crisis of malevolence
8. Socio-cultural crisis

8. 1. Maturational or developmental crisis
• Developmental crisis (also referred to as maturational or internal crisis) may
occur at any transitional period in normal growth and development.
• The transitional periods where individuals move into successive stage often
generate disequilibrium, individuals are required to make cognitive and
behavioral changes that accompany development, precipitate factors are
normal stress of development (e.g. Adolescence retirement, marriage and
parenthood.

9. 2. 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.
• Events that can participate situational crisis are sudden traumatic event.
• Eg. Unexpected job loss, serious car accidents, loss of spouse, academic
failure, birth of a child with a disability or diagnosis with a chronic or
terminal illness) affects how people perceive themselves.

10. 3. Adventitious crisis
• Social crisis is accidental, uncommon and unanticipated and result in
multiple losses and radical environmental changes.
• An adventitious crisis occurs outside the person precipitate by an unexpected
event. (E. G. Natural disaster, fires, floods, war etc.).
• These crises affect many people who experience both acute and post-
traumatic stress reaction.
• This type of crisis is unlike maturational and situational crisis because it
doesn’t occur in the lives of all people.

11. 4. Financial crisis
These are the crisis that occur in an organization due to its prevailing financial
conditions. Losses, increase in costs, non-availability of funds, unable to pay
back loans, etc.
5. Technological crisis
Technological crisis are caused by human application of science and technology.
This occurs when technology becomes complex and the system breaks down.
E.g. Software failures, industrial accidents etc.
6.Natural crisis
Natural crisis, are natural disasters considered as 'acts of god,' are such
environmental phenomena. E.G. Earthquakes, volcanic eruptions, tornadoes and
hurricanes, floods, landslides, tsunamis, storms, and droughts etc.

12. 7.Crisis of malevolence
When opponents or miscreant individuals use extreme tactics for the purpose of
expressing anger or seeking gain from, a company or economic system, perhaps
with the aim of destroying it. E.g. Product tampering, kidnapping, malicious rumors,
terrorism etc.
8. Socio-cultural crisis
Social crisis is one arising from the cultural values that are embedded in the social
structure. Eg: the loss of job stemming from discriminatory practices based on age,
race, sex, sexual preference or class is a primary example of a socio-cultural crisis

13. Signs and symptoms of crisis
• Anxiety
• Incapable of even taking care
• Irrational blaming
• Guilt
• Depression

14. CRISIS INTERVENTION
Introduction:
Crisis intervention refers to the methods used to offer immediate, short term help
to individual who experience an event that produces emotional, mental, physical
and behavioral 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.
Definition:
• Crisis intervention is a technique used to help an individual or family to
understand and cope with the intense feelings that are typical of a crisis.

15. 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.

16. AIMS OF CRISIS INTERVENTION
1.To assist the individual in recovery from the crisis and to prevent serious long
term problem.
2.To reduce the intensity of an individual’s emotional, mental, physical and
behavioral reaction to a crisis.
3.To help the individuals return to their level of functioning before the crisis.
4.To provide a correct cognitive perception of the situation.
5.To assist the individual in managing the intense and overwhelming feelings
associated with the crisis.

17. PURPOSE OF CRISIS INTERVENTION
1.To reduce the intensity of an individual’s emotional, mental, physical and
behavioral reaction to a crisis.
2.To help the individuals return to their level of functioning before the crisis

18. PRINCIPLES OF CRISIS INTERVENTION
1.Be specific, use concise statements, and avoid over whelming the patient with irrelevant
questions or excessive detail.
2.Encourage the expression of feelings.
3.A calm, controlled presence reassures the person that the nurse can help.
4.Listen for facts and feelings, seeking clarification, paraphrasing and reflection are effective
strategies.
5.Allow sufficient time for the individuals involved to process information and ask questions.
6.Help patients legitimize feelings by letting them know that others in similar situations have
experienced comparable emotions.
7.Clarify distortions by getting persons to look at the situation realistically.
8.Empower person by allowing them to make informed choices.
9.Assist the person in confronting reality.
10. Encourage the person to focus on one implication at a time.

19. REQUISITES FOR CRISIS INTERVENTION
• 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.

20. 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 centre’s, mental health clinics school and social service agencies
and crisis centre’s.

21. Key element of management
• Management will depend on the severity and causes of the crisis as well as the
individual circumstances 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 behavior/ 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 therapist develops.
• The risk of suicide and self-harm must be assessed at presentation and each
review.

22. PHASES OF CRISIS INTERVENTION
First phase (immediate crisis intervention):
• It involves establishing a rapport with the victim, gather information for short
term assessment and service delivery and averting a potential state of crisis.
Immediate crisis intervention also includes caring for the medical, physical,
mental health and personal need of the victim and providing information to the
victim about local resources or services.

23. Second phase:
• The second phase of crisis intervention involves an assessment of needs to
determine the service and resources required by the victim in order to provide
emotional support to the victim.
• The purpose of second phase is to determine how the crisis affects the victim’s
life, so that a plan for recovery can be developed, allowing the victims to begin
towards the future.
Third phase:
• Recovery intervention helps victims re stabilize their lives and becomes healthy
again. It also involves helping the victim prevent further victimization from the
criminal justice system or other agencies, the victim may come into contact with
in the aftermath of victimization.

24. STEPS IN CRISIS INTERVENTION (NURSE ROLE)
Steps to provide a correct cognitive perception
• Assessment of the situation
• Defining the event
• Develop a plan of action
Steps to assist the victim in managing the intense feelings
• Helping the individual to be aware of the feelings.
• Help the individual to attain mastery over the feelings

25. STEPS IN CRISIS INTERVENTION (NURSE ROLE)
Aguilera (1982) list four steps in the process of crisis intervention. They are
follows:-
1. Assessment
2. Planning therapeutic intervention
3. Implementing techniques of intervention
4. Resolution of the crisis and anticipatory planning

26. 1. 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.
• E. g. an overweight adolescent girl may be the only girl in the class not invited
to a dance. This may have threatened her self-esteem.

27. Coping mechanism:
• In this step the nurse assess the patient‘s strengths and previous coping
mechanisms.
• How has the patient handled other crisis?
• How was anxiety relieved?
• Besides exploring the previous coping mechanisms, the nurse should also
note the absence of other possible successful mechanisms.

28. 2. 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.
• This process is outlined in the patient education plan for coping with crisis.
• The expected outcome if the nursing care is that the patient will recover from
crisis event and return to a pre -crisis level of functioning and improved quality
of life.
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.

29. Therapeutic techniques while performing crisis intervention
• Therapeutic techniques for crisis intervention.
• Display acceptance and concern and attempt to establish a positive relationship.
• Encourage the person to discuss present feelings, i.e;nial, 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.
• Set limits on destructive behaviors.
• Clarify fantasies, contrasting them with facts.
• Emphasize the person’s responsibility for behavior 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.

30. 3. Implementing techniques of intervention
• Catharsis
• Clarification
• Suggestion
• Reinforcement of behavior
• Support of defenses
• Rising self-esteem
• Exploration of solution

31. 3. Implementing techniques of 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. Clarification is used when the nurse helps the patient
identify the relationship between events, behaviors, and feelings. For example,
helping a patient see that it was after being passed over for a promotion that he
or she felt too sick to go to work is clarification.

32. 3. Implementing techniques of intervention continue…
• 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. In crisis
intervention the patient is influenced to see the nurse as a confident, calm, hopeful,
empathic person who can help.
• Reinforcement of behavior: reinforcement of behavior occurs when healthy,
adaptive behavior of the patient is reinforced by the nurse, strengthens positive
responses made by the patient by agreeing with or positively acknowledging those
responses. Giving the patient positive response to adaptive behavior.

33. 3. Implementing techniques of intervention continue…
• Support of defenses: encouraging the use of healthy, adaptive defenses and
discouraging those that are unhealthy or maladaptive.
• Rising self-esteem: helping the patient regain feelings of self –worth. e.g. 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.

34. 4. 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.

35. MODALITIES OF CRISIS INTERVENTION
Mobile crisis programs: Mobile crisis teams provide front line inter disciplinary
crisis intervention to individuals, families and communities. The nurse who is a
member of a mobile crisis team may respond to a desperate person threatening to
jump off a bridge in a suicide attempt, an angry person who is becoming violent
toward family members at home etc.
• Telephone contacts: Crisis intervention to sometimes practice by telephone
rather than through face to face contacts. Listening skills must therefore be
emphasized in the nurse‘s role.

36. MODALITIES OF CRISIS INTERVENTION continue..
• Disaster response:
• As a part of the community, nurses are called on when adventitious crisis strike
the community floods, earthquakes, air plane crashes, fires, nuclear accidents and
the natural and unnatural disaster. It is important that nurses in the immediate
post disaster period go to places where victims are likely together, such as
morgues, hospitals and shelters.

37. CRISIS INTERVENTION PROGRAMME:
• The crisis intervention team program is a community effort enjoining both the
police and the community together for common goals of safety, understanding,
and service to the mentally ill and their families.

38. PROGRAM BENIFITIS
• Arrests and use of force is decreased.
• Underserved consumers are identified by officers and provided with care.
• Patient violence and use of restraints is decreased. Officers are better trained
and educated in verbal de-escalation techniques.
• Officer‘s injuries during crisis events have declined.
• Officer recognition and appreciation by the community is increased.
• Less -victimless / crime arrests.
• Decrease in liability for health care issues in the jail.
• Cost- saving.

39. HEALTH EDUCATION
• The nurse plans the intervention to teach the patent how to avoid other similar
crisis.
• E.G.: The nurse helps the patent to identify the feelings thoughts, and behaviors
experienced following the stressful event.
• During the evaluation period the nurse & the patient summarize what has
occurred during the intervention. The review what the individual has learnt &
anticipate how he or she will respond in the future. A determination is made
regarding follow up therapy, if needed the nurse provides referral information.

40. SUMMARY
• So, today we discussed definition of crisis and crisis intervention, its types,
signs and symptoms of crisis, process of crisis, goals, aims, purpose,
principle requisites, time period, its elements for management, phases, steps,
crisis intervention modalities, crisis intervention program, program benefits
and health education on crisis intervention

41. CONCLUSION:
Crisis intervention is a specific body of professional knowledge and skills. The
aim of crisis intervention is to enable a person faced with a crisis to cope with the
immediate acute and stressful demands being made by circumstances and to
restore normal functioning so that the subject can take up the task of seeking a
satisfactory resolution to his own crisis. The priority of crisis intervention and
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. Crises
are temporary, usually with short span, no longer than a month, although the
effects may become long-lasting.

42. References
• Mary C. Townsend,psychiatric mental health nursing, concepts of care in evidence based practise, 5th edition, F.A.
Davis company, pp. 237-251
• Gail w.Stuart,michelle T.Lauria, principles and practise of psychiatric nursing,8th edition,mosby publications,page
no.267-271
• Mohr.K.Wanda; psychiatric mental health nursing( evidence based concepts skills and practices), 7th edition,
lippincott , williams & willies ,wolters, kulwer ;page no.752-758.
• R sreevani, a guide to mental health and psychiatric nursing, 3rd edition,jaypee publications, page no 267 - 270
• Https://www.Scribd.Com/document/160498529/cri
• Https://www.Scribd.Com/document/65032498/ crisis-intervention
• Https://en.Wikipedia.Org/wiki/crisis_intervention
• Https://www.Ncbi.Nlm.Nih.Gov/books/NBK559081/