Crisis intervention

1. By:- Sandhyarani Behera,Sr. Tutor
Dept. psychiatric nursing ,
MHI(COE),SCBMCH,Cuttack
CRISIS INTERVENTION

2. Stressful situations are a part of everyday
life. Any stressful situation can precipitate a crisis.
Crises result in a disequilibrium from which many
individuals require assistance to recover. Crisis
intervention requires problem- solving skills that
are often diminished by the level of anxiety
accompanying disequilibrium. Assistance with
problem solving during the crisis period
preserves self esteem and promotes growth
with resolution.
INTRODUCTION

3. 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.
MEANING OF CRISIS

4. “A sudden event in one’s life that
disturbs homeostasis, during which
usual coping mechanisms cannot
resolve the problem.”
-LAGERQUIST, 2006
DEFINITION

5. Types of crisis
Thereare three types ofcrisis
(1)Maturational or developmental crisis
(2)Situational crisis
(3)Adventitious crisis

6. 1)Developmental crisis (also referred
to as maturational or internal crisis)
.
 It may occur at any transitional period in
normal growth and development
 The transitional periods where individuals
move into successive stage often generate
disequilibrium.

7.  Individuals are required to make
cognitive and behavioural changes that
accompany development,
 precipitate factors are normal stress
of development (e.g. Adolescence,
marriage, parenthood and retirement,)

8.  Successful progression from early
childhood to middle childhood requires
the child to become socially involved
with people outside the family with the
more from adolescence to adulthood,
financial responsibility is expected.
Both social and biological pressure to
change can precipitate a crisis.

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.

10.  Examples of 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.

11. (3)Adventitious crisis (social 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.
 eg.Natural disaster,fires,floods,war etc.)

12. These crises affect many people who
experience both acute and post
traumatic stressreaction.
This type of crisis is unlike maturational
and situational crisis because it doesn’t
occur in the lives of all people.

17. FANI AT ODISHA

21. CRISIS INTERVENTION
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
behavioural distress or problems.

22. Acrisis 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

23. 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

24. AIMS
Toassist the individual in recovery from the
crisis and to prevent serious long term
problem..

25. (1)To reduce the intensity of an
individual’s emotional, mental,
physical, and behavioural reaction
to a crisis.
(2) To help the individuals return to
their level of functioning before
the crisis.

26. 1. Be specific, use concise statements ,and avoid
overwhelming the patient with irrelevant
questions or excessive detail.
2. Encourage the expression of feelings.
3. A calm, controlled presence reassure 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 questions.

27. 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

28. 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.

30. Key element of management
1.Management will depend on the severity and
causes of the crisis as well as the individual
circumstances of the patient.
2. Many relatively minor crises can be managed
by providing friendly support in primary care
without referral.
3.However more severe crisis will require referral
to counsellors or the local mental health team.

31. 4.Crisis therapy includes short term
behaviour/ cognitive therapy and
counselling.
5.Involvement of family and other key
social network very important.
6.Therapy should be relatively intense over
a short period and discontinued before
dependence on the therapist develops.

32. 7.The risk of suicide and self harm must be
assessed at presentation and each review.
8. Theaims of treatment are to-
Reduce distress
Helpto solveproblems
Avoid maladaptive coping strategies e.g. Self
harm
Improve problem solving strategies

33. Phases of crisis intervention:
The role of nurse
Phase I: assessment
Phase II: Planning therapeutic intervention
Phase III: Implementing technique of intervention
Phase IV: Evaluation of crisis resolution and
anticipatory planning

34. Phase I: Assessment
1.Ask the individual to describe the event that
precipitated this crisis.
2.Determine when it occurred.
3. Assess the individual’s physical and mental status.
4.Determine if the individual has experienced this
stressor before. If so, what method of coping was
used? Have these methods been tried this time?
5.If previous coping methods were tried, what was the
result?

35. 6. If new coping methods were tried, what was the
result?
7. Assess suicide or homicide potential, plan, and
means.
8. Assess the adequacy of support systems.
9.Determine level of precrisis functioning.
Assess the usual coping methods, available
support systems and ability to problem solve.
10.Assess the individual’s perception of personal
strengths and limitations.

38. PhaseII:Planning therapeutic
interventions:
In the planning phase of the nursing process, the
nurse selects the appropriate nursing actions for
the identified nursing diagnoses. In planning the
interventions, the type of crisis, as well as the
individual’s strengths and available resources for
support, are taken into consideration. Goals are
established for crisis resolution and a return to, or
increase in, the precrisis level of functioning.

40. Phase III: Implementing techniques of
interventions:
1.Use a reality oriented approach. The focus of the
problem is on the here and now.
2.Remain with the individual who is experiencing
panic anxiety.
3.Establish a rapid working relationship by
showing unconditional acceptance, by active
listening, and by attending to immediate
needs.
4.Discourage lengthy explanations or
rationalizations of the situations; promote an
atmosphere for verbalization of true feelings.

41. 5.Set firm limits on aggressive, destructive
behaviors. At high levels of anxiety, behavior is
likely to be impulsive and regressive. Establish
at the outset what is acceptable and what is not,
maintain consistency.
6.Clarify the problem that the individual is
facing. The nurse does this by describing
his/her perception of the problem and
comparing it with the individual’s perception of
the problem.
7.Help the individual determine what he or she
believes precipitated the crisis.

45. Phase IV: Evaluation of crisis resolution and
anticipatory planning
 Have positive behavioral changes occurred?
 Has the individual developed more adaptive coping
strategies? Have they been effective?
 Has the individual grown from the experience by
gaining insight into his or her responses to crisis
situations?
 Does the individual believe that he or she could respond
with healthy adaptation in future stressful situations to
prevent crises development?
 Can the individual describe a plan of action for dealing
with stressors similar to the one that participated this
crisis?

48. Techniques of crisis intervention
Catharsis: The release of feelings that takes place as
the patient talks about emotionally charged
areas.{crying is a great catharsis for releasing pain
and anger}
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: When healthy, adaptive
behaviors of the patient is reinforced by the nurse.

49. 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 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.

50. 1.Crisis intervention is a brief, active therapy
with the goal of returning the individual to a
precrisis level of functioning.
2.In assessing a patient the nurse should
identify the patient's behaviors, precipitating
event, perception of the event, support
systems and coping resource, and previous
strengths and coping mechanisms.
3.The expected outcome of nursing care is that
the patient will recover from the crisis event
and return to a precrisis level of functioning.
Levels of crisis intervention include
environmental manipulation, general support,
generic approach, and individual approach.
summary