This document discusses counseling and crisis intervention provided by nurse practitioners. It defines counseling as a helping process where a counselor assists a client in exploring problems and identifying solutions. Key aspects of counseling covered include the counselor's role and skills, counseling techniques, principles, ethics, stages and purpose. Crisis intervention is described as a technique used to help individuals understand and cope with intense feelings during a crisis. The document outlines types of crises, signs and symptoms, and steps in crisis intervention including assessment, defining the event, developing an action plan, and helping the individual manage feelings. The overall aim of counseling and crisis intervention is to help clients modify behavior and cope effectively.

1. CHANGE THE WAY YOU SEE THINGS & THE THINGS
YOU SEE WILL CHANGE,
COUNSELLING;
THE NURSE PRACTITIONER’S
GUIDE
PRESENTER:
DR.JAYANTI DUTTA

2. INTRODUCTION
Nurse practitioners (NPs) provide high-quality primary,
acute and specialty health care services across the life
span and in diverse settings.
The nurse practitioner performs the role of counsellor to
help people focus on a goal or outcome and develop
strategies that support self-care and enable individuals
and their families to take responsibility for and participate
in decisions about their health.

4. DEFINITION
Counseling is a helping process where one
person, explicitly and purposefully gives
his/her time, attention and skill to assist a
client, to explore the situation or the problems
and to identify solutions within the limitations
of their given environment.

5. DEFINITION
According to Glenn F Smith:
Counselling is essentially a process in which the counselor assists the
counselee to make interpretations of facts relating to a choice, plan and
adjustment which he needs to make.
According to Carl Rogers:
Counselling is a series of direct contacts with the individual which aims
to offer the client assistance in changing their attitude and behaviors.

6. SCOPEOFCOUNSELLING
Adolescent identity, Concerns, teen- parent
relationship, Peer relationship.
Anxiety.
Anger management.
Depression.
Gender identity, sexuality, homosexuality.
Grief and bereavement.
Relationships: Personal and interpersonal
dynamics.
Sexual abuse recovery.
Challenges, limitations, transitions.
Spirituality.
Single: Newly single, single through
divorce and being widowed.
Stress management.
Workplace stress and relationship.
Young adult identity relationship.

7. EXAMPLESOFSCENARIOFORCOUNSELLING
CONTRACEPTIVE COUNSELLING
COUNSELLING ABOUT FEBRILE CONVULSIONS
COUNSELLING ABOUT RECENT DEATH OF A FAMILY
MEMBER
COVID RELATED COUNSELLING
COUNSELLING OF MOTHER AFTER REPEATED
ABORTIONS.

8. ELEMENTSOFCOUNSELING
THE COUNSELLOR:
A person who is professionally capable to extend help.
THE COUNSELEE:
 The person who seeks help and let himself herself be subjective for
counselling.
THE COUNSELLING ENVIRONMENT:
A place to facilitate counselling.

9. COUNSELLOR
A counsellor is a professionally trained
expert who helps people overcome their
issues after a systematic chain of
sessions.
The types of counselling vary, depending
on the needs of the clients.

10. ATTRIBUTESANDSKILLSREQUIREDOFACOUNSELLOR
1.SELF-AWARENESS AND UNDERSTANDING: A person who is aware of
his/her needs, motivation for helping, understanding his/her personal strength and
weakness, acts as a good counsellor.
2. GOOD PSYCHOLOGICAL HEALTH: Although no person is totally problem
free but a person with less problems or good psychological health can be trained to
be a good counsellor.
3.SENSITIVITY: A person who is aware of resources, limitations and
vulnerability of other person's feelings and need are considered to have sensitivity.

11. ATTRIBUTESANDSKILLSREQUIREDOFACOUNSELLOR
4.OPEN-MINDED: A person who is free from fixed or preoccupied ideas. They are
aware of their own values and beliefs and are able to distinguish them from the
beliefs and values of others.
5.TRUSTWORTHINESS: A person who is reliable, honest and does not hurt other
person. He/she keep the information to herself.
6. APPROACHABILITY: The counsellor who is friendly has non-judgemental and
positive attitudes about others, can be approached without a feeling of apprehension.

12. ATTRIBUTESANDSKILLSREQUIREDOFA
COUNSELLOR
7. INTER-TRAINING ATTRIBUTES: A counsellor need to have skills in interviewing.
In- fact without these skills a counsellor cannot counsel.
Stewart (1978) has identified six components of interviewing skills. They are:
 Greeting
 Problem focus
 Identifying an important theme
 Focusing on theme
 Directing the theme towards the goals
 Managing interaction with the individuals.

13. PURPOSEOFCOUNSELLING
To identify the problems of a person.
To exploring difficult feelings.
Helping through problem solving skills.
Improving relationships
Enhancing coping skills.
Facilitating behavioral changes.
Exploring choices and making decisions.

14. FUNCTIONSOFTHECOUNSELLOR
Reassurance
Communication
Release of emotional tension.
Clarifies thinking.
Reorientation.

15. TECHNIQUESOFCOUNSELLING
In this counselling the counsellor plays an active role as it is
regarded as a means of helping people how to learn to solve
their own problems.
This type of counselling is otherwise known as counsellor-
centred counselling.
Because in this counselling the counsellor does everything
himself i.e., analysis, synthesis, diagnosis, prognosis,
prescription and follow-up.

16. TECHNIQUESOFCOUNSELLING
Where the client is free to express and the
counselor assists the client to explorer the
problems, look for possible reasons, identify
solutions and evaluate each solution and its
suitability to his or her situation.
It is a client centered counselling.
The client plays an active role.

17. TECHNIQUESOFCOUNSELLING
It is a style of therapy that uses techniques drawn from
several different schools of thoughts.
It is a more flexible approach that allows the therapist to
adapt to each client’s individual needs.
It is a multi -model approach.
It is a combination of directive and non- directive
approach.

18. PRINCIPLESOFCOUNSELLING
Unconditional regard and acceptance of the person.
Empathy.
Staying non-judgemental.
Confidentiality.

19. ETHICSINCOUNSELLING
BENEFICENCE:
Take action that promote the wellbeing of patients.
Whatever is done, is done in the interest of the patient.
One must do all one can do to benefit the patient.
All procedures and treatments must be recommended to benefit the
patient.

20. ETHICSINCOUNSELLING
JUSTICE
 All patients should be treated
equally.
 Fair distribution of scarce
resources and treatment should be
given.
 Respecting and upholding
applicable laws and legislations.
CONFIDENTIALITY
 Respecting and maintaining the confidentiality of patient’s
information.
 Some of the exceptions are when the patient can harm
themselves or others.
 Patients suffering from a disease that can spread to the
family or society. For example, suppose the patient suffers
from a sexually transmitted diseases and refuses to disclose
it to the spouse. In that case, the treating nurse can take a
call and inform the family to safeguard them against
infection.

21. STAGESOFCOUNSELLING
1.RAPPORT BUILDING
2.ASSESSMENT AND ANALYSIS OF THE PROBLEM
3.GOAL SETTING
4.INTERVENTION
5.TERMINATION AND FOLLOW UP.

22. 1.RAPPORTBUILDING
Establishing a rapport by being genuine and extend warm welcome to the
client.
Give introduction and orient the client.
Assure confidentiality of the issues.
Outline the counselling process for the client like content, duration, testing
option and procedure.
Facilitated by good atmosphere, adequate privacy, seating arrangement and
establishing eye contact with the client.

23. HOWTOBUILDQUICKRAPPORT?
 Prompt attention.
 Greet the patient.
 Smile if appropriate.
 Offer place to sit.
 Introduce yourself.
 Ask for patient’s introduction.
 Small talk before a big talk.
 Demonstrate interest and
respect.

24. 2.ASSESSMENTANDANALYSISOFTHEPROBLEM
Defining and focusing specially
on the problem.
Identifying and assessing the
gravity of the client’s problem.
SKILLS HELPFUL IN GATHERING INFORMATION:
 Start with open ended questions. Ask one question at a time.
 Allow the patient to narrate his or her story. Listen attentively.
 During listening, note down key points do not rely on
memory.
 Establish dates and sequence of events.
 Clarify patient’s statement.
 Summarise periodically.
 Don’t interrupt. Facilitate responses verbally and nonverbally.
 Maintain eye contact.
 Use silence and pause.
 Observe patient’s expressions and body languages.
 Explorer patient’s perspective.

25. 3.GOALSETTING
Like any other activity, counselling must have focus.
Goals are the result or outcome that client wants to achieve at the end of
the counselling. Sometimes you hear both counsellor and client complaints
that the counselling session is going nowhere. This is where goals play an
important role in giving direction.
It involves making a commitment to a set of objectives.

26. 4.INTERVENTION
There are different points of view concerning what a good counsellor should
do with clients depending upon the theoretical position that the Counsellor
subscribes to.
For example, the person cantered approach suggests that the counsellor gets
involved rather than intervenes by placing emphasis on the relationship.
The behaviour approach attempts to initiate activities that helps client to
alter their behaviour.

27. 5.TERMINATIONANDFOLLOWUP
The counselling process will have to be conducted with sensitively.
Review what has been discussed. Teach back. “Tell me what we have
discussed”
Counsellor is always mindful of avoiding fostering dependency and is
aware of own needs. Preparation for termination begins long before.
Open door: Plan for possibility of future needs.

28. REMEMBERTHEPOINTSINCOUNSELLING
Listen carefully
Demonstrate empathy
Don not make judgments.
Understand emotions/feelings behind the story of the person being counselled.
Use appropriate body language.
Do not show superiority or patronage.
Question with care
Ask open ended questions
Reflect back, summarize and paraphrase so that the understanding is correct and complete.

29. CRISISINTERVENTION
Crisis intervention is a technique used to help
an individual or family to understand and go
with the intense feelings that are typical of a
crisis.

30. CRISIS
Crisis is a state of disequilibrium resulting from the interaction
of an event with the individuals or families, coping
mechanisms which are inadequate to meet the demand of the
situation combined with the individuals or family’s perception
of the meaning of the event.
Taylor,1982

31. TYPESOFCRISIS

32. SIGNSANDSYMPTOMS
Anxiety
Incapable of even taking care
Irrational blaming
Guilt
Depression.

33. PROCESSOFCRISIS
(RESOLUTIONOFCRISIS)

34. CRISISINTERVENTIONSTEPS
I] ASSESSMENT
OF THE
SITUATION
II] DEFINING THE
EVENT
III] DEVELOP A
PLAN OF
ACTION
A- steps to provide a correct cognitive perception

35. CRISISINTERVENTIONSTEPS
B. Steps to assist the victim in managing the intense feelings
I] HELPING THE
INDIVIDUAL TO BE
AWARE OF THE FEELINGS.
II] HELP THE INDIVIDUAL
TO ATTAIN MASTERY
OVER THE FEELINGS.

36. CONCLUSION
Counselling is a process not merely a technique, through which clients are
helped to modify their behaviour and cope with their status effectively.
Crisis intervention is a specific body of professional knowledge and skills.
The aim of crisis intervention is to enable a person faced with crisis to
cope up with the immediate, acute and stressful demand being made by
circumstances and to restore normal functioning so that the subject can
take up the task of seeking a satisfactory resolution of his/her own crisis.