Crisis intervention (community health nursing specialty II)

1. Presented by,
R.Sushma,
MSC (N) II Year,
Community Health Nursing,
CON-SRIPMS,
CBE.

2.  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
making the situation more than individual can candle. A
crisis differs from stress in that a crisis resulting from
the failure of individual’s usual coping mechanism or
the lack of usual resources or both.

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.

4.  Crisis is a state of disequilibrium resulting from the
interaction of an event with the individual’s or family’s
coping mechanism, which are inadequate to meet the
demands of the situation combined with the
individual’s or family’s perception of the meaning of
event.

5.  Crisis occurs in all individuals at one time or another
and is not necessarily equated with psychopathology.
 Crisis are precipitated by specific identifiable events.
 Crisis are personal by nature, what may be considered
a crisis situation by one individual may not be so for
another.
 Crisis are acute, not chronic, and will be resolved in
one way or another within a brief period.
 A crisis situation contains the potential for
psychological growth or deterioration.

6.  Maturational or developmental
 Situational
 Social

7. Phase I
Individual is exposed to a
precipitating stressor
Anxiety increases
Previous problem solving
techniques are employed
Phase II
When previous problem solving
techniques do not relieve the
stressors, anxiety increases further.
Individual feel discomfort
Feelings of confusion and
disorganization prevail.

8. Phase III
 The individual view the problem
from a different perspective, or
even to overlook certain aspects of
it.
 New problem solving tech may be
used.
 Resolution may occur at this
phase.
Phase IV
 If resolution does not occur in
previous phase,
 Anxiety may reach panic level.
 Cognitive functions are
disorganized
 Emotions are labile
 Behavior may reflect the presence
of psychotic thinking

13.  Heavy burden of free
floating anxiety
 Depression
 Anger, guilt, tension, fear
 Neglects in performing
activities
 Irrational & blaming
others
 Panic
 Low self esteem
 Uncontrolled crying
 Lack of confidence
 Withdrawal behavior
 Irritable
 Unable to think
realistically
 Impaired judgment
 Lack of self control

15.  All forms of violence against people under 18 years
old, whether perpetrated by parents or other caregivers,
peers, romantic partners, or strangers.
 Globally, it is estimated that up to 1 billion children
aged 2–17 years, have experienced physical, sexual, or
emotional violence or neglect in the past year. (WHO)
 Experiencing violence in childhood impacts lifelong
health and well-being.

16.  In 2030 Agenda for Sustainable Development is to
“End abuse, exploitation, trafficking and all forms
of violence against, and torture of children”.
 Evidence from around the world shows that violence
against children can be prevented.

17.  Maltreatment (including violent punishment) involves
physical, sexual and psychological/emotional violence;
and neglect of infants, children and adolescents by
parents, caregivers and other authority figures, most
often in the home but also in settings such as schools
and orphanages.
 Bullying (including cyber-bullying) is unwanted
aggressive behaviour by another child or group of
children who are neither siblings nor in a romantic
relationship with the victim. It involves repeated
physical, psychological or social harm, and often takes
place in schools and other settings where children
gather, and online.

18.  Youth violence is concentrated among children and
young adults aged 10–29 years, occurs most often in
community settings between acquaintances and
strangers, includes bullying and physical assault with
or without weapons (such as guns and knives), and
may involve gang violence.
 Intimate partner violence (or domestic violence)
involves physical, sexual and emotional violence by an
intimate partner or ex-partner. Although males can also
be victims, intimate partner violence
disproportionately affects females. It commonly
occurs against girls within child marriages and
early/forced marriages. Among romantically
involved but unmarried adolescents it is sometimes
called “dating violence”.

19.  Sexual violence includes non-consensual completed
or attempted sexual contact and acts of a sexual
nature not involving contact (such as voyeurism or
sexual harassment); acts of sexual trafficking
committed against someone who is unable to consent or
refuse; and online exploitation.
 Emotional or psychological violence includes
restricting a child’s movements, criticizing, mocking,
threats, discrimination, rejection and other.

20.  Shaken baby syndrome usually occurs when a parent
or caregiver severely shakes a child in frustration or
anger, often because the child won't stop crying.
Permanent brain damage or death may result. A serious
brain injury resulting from forcefully shaking an infant
or toddler.
 Symptoms include irritability, difficulty staying awake,
seizures, abnormal breathing, poor eating, bruises and
vomiting.
 Munchausen syndrome by proxy is a mental illness
and a form of child abuse. The caretaker of a child,
most often a mother, either makes up fake symptoms
or causes real symptoms to make it look like the child
is sick.

21.  Internet crimes are unintentionally or intentionally, a
minor access an internet chat room or web site.
 Child abduction or child theft is the unauthorized
removal of a minor (a child under the age of legal
adulthood) from the custody of the child's natural
parents or legally appointed guardian.

22. INSPIRE:
Identifies a select group of strategies that have shown
success in reducing violence against children. They are:
 Implementation and enforcement of laws;
 Norms and values;
 Safe environments;
 Parent and caregiver support;
 Income and economic strengthening;
 Response and support services; and
 Education and life skills.

24.  Domestic violence continues through childhood &
adolescence and follow a women into long-term
relationship and into pregnancy. Studied shows that
between 4% and 14% adult pregnant women
experience physical violence from an intimate
partner.
 Abuse during pregnancy has been linked with
maternal health problems such as smoking, weight
loss and substance use. The fetus also endangered, with
spontaneous abortion, preterm delivery, fetal distress &
lower birth weight often seen.

25.  Violence against women – particularly intimate
partner violence and sexual violence – is a major
public health problem and a violation of women's
human rights.
 Estimates published by WHO indicate that globally
about 1 in 3 (30%) of women worldwide have been
subjected to either physical and/or sexual intimate
partner violence or non-partner sexual violence in their
lifetime.

26.  Most of this violence is intimate partner violence.
Worldwide, almost one third (27%) of women aged
15-49 years who have been report that they have been
subjected to some form of physical and/or sexual
violence by their intimate partner.
 Violence can negatively affect women’s physical,
mental, sexual, and reproductive health, and may
increase the risk of acquiring HIV in some settings.
 Violence against women is preventable. The health
sector has an important role to play to provide
comprehensive health care to women subjected to
violence, and as an entry point for referring women to
other support services they may need.

27.  Intimate partner violence refers to behaviour by an
intimate partner or ex-partner that causes physical,
sexual or psychological harm, including physical
aggression, sexual coercion, psychological abuse and
controlling behaviours.
 Sexual violence is "any sexual act, attempt to obtain a
sexual act, or other act directed against a person’s
sexuality using coercion, by any person regardless of
their relationship to the victim, in any setting. It
includes rape, defined as the physically forced or
otherwise coerced penetration of the vulva or anus with
a penis, other body part or object, attempted rape,
unwanted sexual touching and other non-contact
forms".

29. Phases Types of
prevention
Goal Intervention
Pre crisis Primary Health promotion
Disease prevention
Education
Anticipatory guidance, reduce factors
that increase vulnerability, reduce
hazards in some events, reinforce
positive coping strategies, mobilize
social support and other resources
Crisis Secondary Reduction of stress
load, cure or
restoration of
function
Assist with reaction to the event &
functioning, allow behaviour,
dependence, grief, set goals with client,
refer to resources
Post
crisis
Tertiary Rehabilitation &
maintenance
Promote interdependence, reinforce
newly learned behaviour, lifestyle
changes, coping strategies, explore
application of learned behaviour to new
situation, identification and use of
additional resources.

31.  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.

32.  Crisis intervention is an active entering into life
situation of a person, family or group who is
experiencing a crisis, to decrease the impact of crisis
event and to assist the individual to mobilize his
resources and regain equilibrium
-Parad et al (1975)

33.  To decrease emotional stress and protect the crisis
victim from additional stress.
 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.

34.  To assist the individual in recovery from the crisis
and to prevent serious long term problem
 To reduce the intensity of an individual emotional,
mental, physical and behavioral reaction to a crisis.
 To help the individual return to their level of
functioning before the crisis.

35.  To reduce the intensity of an individual’s emotional,
mental, physical, and behavior reaction to a crisis.
 To help the individual’s return to their level of
functioning before the crisis.

36.  Be specific, use concise statement, and avoid over
whelming the patient with irrelevant questions or excessive
detail
 Encourage the expression of feelings.
 A calm, controlled presence reassures the person that the
nurse can help
 Listen for facts and feelings, seeking clarification,
paraphrasing and reflection are effective strategies.

37. Calm
approach
Priority
Equality
Privacy
Be
specific
Provide
understanding
Principles
Encourage
independent
function

38.  Pediatric
 Geriatric
 Adolescent
 Psychosomatic patients
 People who attempted
suicide
 Violent victims
 Accident victims
 Family crisis
 High risk families
 Severe depression &
anxiety
 Marital conflicts
 Suicide thought
 Drug abuse
 Inter group staff issues
 Client management issues

39.  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 content, 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

40.  The length of time for crisis intervention may range
from one session to several weeks, with 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 hours.

41. Hospitals:
 Outpatients unit, inwards emergency room settings
Mental health care centre:
Community setting:
 Home visit
 Outreach centers
Telephonic counseling & hotline:
 Information calls
 Suicide prevention and crisis intervention centers
 Schools, office, private practice

42.  Crisis hotline workers
 Crisis counselor
 Emergency responders
 Disaster relief worker
 Mental health professionals

43. Catharsis
Clarification
Suggestion
Reinforcement of behavior
Support of defence
Raising self-esteem
Exploration of solution

44.  Immediate crisis intervention ( rapport, gather
information, short term assessment, immediate crisis
intervention)
 Second phase ( assessment of needs, plan for recovery)
 Third phase ( return to healthy life, prevent future
victimization)

45. Assessment
Planning and
implementation
Evaluation
Health
education
Individual
approach
Generic approach
General approach
Environmental manipulation

46.  Crisis is an internal disturbance that results from
stressful event or a perceived thread to self integrity.
Crisis are dealt with by crisis intervention, it is an
community based form of brief therapy that addresses
resolution of a current stressful life events in ways
aimed at helping the person develop a new, broader
area of coping skills.

47.  Bijayalakshmi Dash (2017)- “A comprehensive
textbook of community health nursing”, 1st edition,
published by Jaypee brothers medical publishers (p) ltd.
 Shebeer P Basheer (2019)- “A concise textbook of
advanced nursing practice”- 2nd edition, published by
EMMESS medical publishers
 Mary C.Townsand (2015)- “ Psychiatric mental health
nursing”- 8the edition, published by F.A.Davis
company, Philadelphia.
 Jhaxeq-0205 (2013)- “ Crisis Intervention” retrieved
from www.slideshare.com on 28/2/24.

48.  Biegel ED ,Johnsen CA, Dyches H & Guos (2001),
assessing the impact of community based medical crisis
services on preventing hospitalization.
 Ennis E, Walker E. Experiences of a community crisis
intervention service issues Ment health nurse-2020
(43:2)96-102 doi:10.1080/01612840.2021.1953650.
pmid: 34370614.