1. Chapter 13

2.  Definition
 A sudden event in one’s life that disturbs homeostasis,
during which usual coping mechanisms can not resolve the
problem.
 Characteristics
 Universal
 Precipitated by identifiable event
 They are personal in nature – what is crisis for you may not
be for me
 They are acute and will be resolved in one way or another
within a brief period of time

3.  Phase 1
 Exposure to the precipitating stressor /mount usual coping
mechanisms. Perception of the event is pivotal
 Phase 2
 Usual problem solving mechanisms fail
 Phase 3
 Mobilize new resources
▪ Internal – try new personal coping mechanisms
▪ External – family, friends, and professional
 Phase 4
 If crisis not resolved, results is panic, disorganized thought,
psychosis. Some use the term “Nervous Breakdown”.
Professional help essential – hospitalization indicated

4.  Dispositional – Stressor with an acute response by the experiencing
person
 Anticipated – An event that you can anticipate is going to cause you
stress (ie nursing school – you know you will face time demands)
 Traumatic – Serious, unexpected event (ie, rape). Causes significant
mental impact and requires heightened support/tx
 Developmental – Unresolved developmental issue earlier in life serves
as the source of crisis (ie, Erikson/failure to achieve trust in infancy).
Key is to address unresolved issue, not he behavior in front of you*
 Psychopathology – Underlying D/O (ie Depression) is the etiology of
the crisis. Key is to address D/O, not the behavior in front of you*
 Emergency – Function severely impaired (ie Suicide, Violence,
Psychosis, Substance Abuse). Key is ABC’s (physiologic and safety) ,
then psychosocial
*unless the behavior in front of you is a threat to safety, then prioritize

5. Goal
Primary goal is resolution of the
immediate crisis
Do not make this a lengthy process
This is not the time for processing
in depth
Actions include support, restore to
pre-existing state or adaptation to
current state

6.  Assessment - Gather Information
 Perception of the Crisis Event
 Precipitating Events to the Crisis
 Usual Coping Mechanisms Employed? How Effective?
 New Coping Mechanisms Tried? How Effective?
 Bio-Psych-Social State (Review pg 142-147 Townsend)
▪ Safety First – Assess Harm to self or others? Psychotic – loss of
touch with reality, hallucinations?
▪ Bio - General Survey, VS, PA (Stimulation of sympathetic system?)
▪ Psych – (Relationship with self )– self esteem, self concept,
perceptions, coping strategies, use of substances
▪ Social – (Relationship with others) - Social Support Systems

7.  Nursing Diagnosis – based on assessment
findings, possible Nursing diagnosis
 Ineffective Coping
 Fear
 Disturbed Thought Processes
 Violence
 PTSD
 Rape Syndrome

8.  Plan
 Unless the client is a threat to self or others,
negotiate a plan with client – preserve autonomy
 Ask the client, “who, what, when, how, where”
 Consider carefully the clients pre-existing state –
Clients may have a compromised pre-existing
state.
 Focusing on restoration of pre-existing state, or
maximum level of functioning

9.  Intervention
 Pre-Introductory – Consider own, attitudes, values
beliefs – nonjudgemental
 Physical Safety First- Always ABCs, then psych-
soc
 Reality Orientation - With altered cognition
 Focus Conversation – limit ramblings
 Impose Professional Boundaries

10.  Intervention
 Guided Problem Solving
▪ Help client to identify the source of the crisis
▪ Help client to identify realistic changes to make
▪ Help client to see what they can not change
▪ Help client to identify alternatives to what they are
currently doing
▪ Help client to identify, or nurse to suggest alternate
resources and support systems

11.  Evaluation
 Was the identified goal met, partially met, not
met?
 Was there a positive behavior change?
 Are there adaptive coping mechanisms?
 Evidence of growth?
 Are there elements the client can use in the
future?