The document discusses crisis intervention for individuals experiencing overwhelming events. It defines a crisis as a period of severe disorganization resulting from an interaction between a stressful event and inadequate coping skills. Crisis intervention aims to provide a correct understanding of the situation, manage intense feelings, and teach new coping strategies. The summary provides an overview of the key models, phases, factors, and techniques involved in crisis intervention.

1. 1
CRISIS
INTERVENTION
C R I T I C A L C A R E U N I T

2. CONTENTS
Introduction Aims
Definition Robert-Otten’s Model
Characteristics Steps
Risk Factors Principles
Types Levels
Phases Techniques
Aguilera Model Geriatric Considerations
Sign/Symptoms Role of Nurse
Resolution of Crisis Crisis in CCU
Crisis Intervention Modalities
Factors Bibliography
2

3. INTRODUCTION
 A crisis is an overwhelming and
dramatic event that results in a
period of severe disorganization.
 As a result of crisis experience,
the individual may:
 Go down to a less healthy level
than what was before the crisis.
 Resume the same level of
functioning by repression .
 Function at a healthier level than
before as crisis may bring out new
strengths and coping mechanisms.
3

4. ●Intervention at a crisis is extremely important to
prevent mental illness.
●If proper guidance is provided at the correct time,
the victim will come out of it and be better equipped
to handle future problems in life.
●Crisis intervention is the technique used to help an
individual or family to understand and cope with the
intense feelings that are typical of a crisis.
●Thus, crisis intervention is the emergency first aid
for mental health.
4

5. DEFINITION
 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.
~ Taylor (1989)
 Crisis Intervention is an immediate and short
term emergency response to mental, emotional,
physical and behavioural distress.
5

6. CHARACTERISTICS
 A crisis is experienced as a sudden event.
 Crisis are precipitated by specific
identifiable events.
 The situation is perceived as
overwhelming or life threatening.
 Crisis are personal by nature.
 Crisis are acute not chronic & will be
resolved in one way or another within a
brief period.
 A crisis situation contains the potential
for psychological growth or deterioration.
6

7. RISK FACTORS
Employment issues
History of unresolved crisis
History of substance abuse
Poor self-esteem
Superficial relationships with
others
Difficulty in coping with everyday
situations
Underutilization of resources
Lack of support systems
Lack of caring
Aloofness
7

8. TYPES OF CRISIS
Maturational Crisis
Situational Crisis
Social Crisis
8

9. Maturational Crisis
 Maturational crisis are developmental events
requiring role changes.
 This includes :
Adolescence
Marriage
Parenthood
Midlife
Retirement
Factors influencing nature and extent of these
role changes are previous successes, availability
of support systems and influence of role models.
9

10. Situational Crisis
 It is precipitated by an unanticipated stressful
event that creates disequilibrium by threatening
one’s sense of biological, social or psychological
integrity.
 This includes :
Loss of a job
Loss of a loved one
Physical/Mental illness
Unwanted Pregnancy
Divorce
School/Work problems
10

11. Social Crisis
 Social crisis is accidental, uncommon and
unanticipated. It involves multiple losses, radical
environmental changes and severe effects on the
lives of a large number of people.
 This includes :
Natural disasters
Nuclear accidents
Mass killings/Terrorism
Violence
Wars
Toxic waste contamination
11

12. PHASES OF CRISIS
Perceived threat
generates anxiety
Usual coping
strategies activated
Disorganization
Sense of vulnerability
Random coping
Attempted redefinition
of crisis
New coping measures
Assistance needed
Panic levels of anxiety
Profound disorganization
Referral needed
PHASE I PHASE II
PHASE IV PHASE III
12

13. AGUILERA MODEL
13
 According to author and RN Donna Aguilera, 3 factors
affect an individual’s way of perceiving & responding
to a stressful event.
 During crisis, one/more of these factors is out of
balance and interventions focus on re-establishing
equilibrium among these factors to resolve crisis.
Perception
of the event
Situational
support
Coping
mechanism

14. 14
Human organism
State of equilibrium
State of disequilibrium
Need to restore equilibrium
Resolution of problem
Adequate
coping
mechanism
Adequate
situational
support
Realistic
perception
of event
Problem unresolved
No coping
mechanism
Inadequate
situational
support
Distorted
perception
of event
Equilibrium regained Disequilibrium continues
No Crisis Crisis
Stressful
event
Stressful
event
Balancing
Factors
Present Absent

15. SIGN & SYMPTOMS
Anxiety
Fatigue
Insomnia
Irritability
Doubt and mistrust
Depression
Anger
Apathy/Numbness
Social withdrawal
Forgetfulness
15

16. Under/Overeating
Crying spells
Guilt
Intrusive thoughts
Flashbacks
Nightmares
Lack of concentration
Substance abuse
Suicidal thoughts
16

17. RESOLUTION OF CRISIS
• Repression of emotions
• Feelings resurface if another crisis
occurs
Pseudo-
resolution
• Ruminating over the loss
• Prolonged grief reaction
Unsuccessful
resolution
• Adaptive coping measures during
Phase III
• Better skills; useful in future crisis
Successful
resolution
17

18. CRISIS INTERVENTION
 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.
 It is a short-term therapy to
solve immediate problems.
 It is usually limited to 6 weeks.
 The client often advances to a
higher level of growth and learns
new ways of problem solving.
18

19. FACTORS AFFECTING CRISIS
INTERVENTION
Age
Gender
Individual personality
traits
Family roles
Social relationships
Availability of support
systems
Socioeconomic status
Housing and living
conditions
Religious belief
system
Cultural attitudes
19

20. AIMS
 To provide a correct cognitive
perception of the situation
 To assist the individual in
managing the intense and
overwhelming feelings associated
with crisis
 To return to a pre-crisis level of
functioning
 To teach new and better ways of
coping with the future crisis
20

21. ROBERT-OTTEN’s MODEL
Follow up
Implement an action
plan
Generate & explore
alternatives
Deal with feelings & emotions
Identify major problems
Rapidly establish rapport
Psychosocial & lethality assessment
Crisis resolution
21
1
2
3
4
5
6
7

22. STEPS
PROVIDING CORRECT
COGNITIVE
PERCEPTION
• Assessment of the
situation
• Defining the event
• Developing a plan of
action
ASSISTING IN
MANAGEMENT OF
INTENSE FEELINGS
• Helping the client to
be aware of feelings
• Helping the client to
attain mastery over
feelings
22

23.  Providing correct cognitive
perception
 ASSESSMENT OF THE SITUATION
Direct questioning with the purpose of
identification of the problem and people involved
Identify the available support systems
Identify strengths and limitations of the victim
 DEFINING THE EVENT
As the victim may be in denial or reluctant to
talk, it may be necessary for the therapist to
review the details of the incident.
23

24. The therapist helps the victim become aware of
the precipitating event by reviewing the details for
the past 2-4 weeks.
DEVELOPING A PLAN OF ACTION
Active involvement of the victim and the people
closely associated with him.
As the victim may not be in a condition to mentally
comprehend complicated information due to the
overwhelming anxiety experienced by him, the
instructions given by the therapist must be simple
and clear, and too much information should not be
given at a time. The instruction may have to be
written down as victim may not be able to retain
information.
24

25.  Assistance in managing intense
feelings
 HELPING THE INDIVIDUAL TO BE AWARE OF
THE FEELINGS
The victim needs help in identifying his own feelings.
The therapist should use appropriate communication
technique.
The therapist should be efficient in observing verbal
& non-verbal behaviour of the victim.
 HELPING THE INDIVIDUAL TO ATTAIN
MASTERY OVR THE FEELINGS
Adequate support and guidance without any false
reassurance.
25

26. The following behaviours should NOT be
encouraged:
 Blaming others to escape from taking any
responsibility.
 Developing too much dependence on the therapist.
 Sudden recovery from feelings/ not showing
emotional reaction at all may indicate repression.
To improve coping with the situation necessary
environmental manipulation must be done in physical
or interpersonal areas.
Follow up appointment within a week to reassess,
revise & modify the plan as needed.
26

27. PRINCIPLES
Be specific, use concise statements
and avoid overwhelming 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 to facts and feelings : seeking
clarification, paraphrasing and
reflection are effective strategies.
27

28. Allow sufficient time for the individuals involved
to process information and ask questions.
Help patient legitimize feelings by letting them
know that others in similar situation have
experienced comparable emotions.
 Clarify distortions by getting persons to look at
the situation realistically, focus on what can be
changed and what cannot.
 Empower person by allowing them to make
informed choices.
 Assist the person in confronting reality.
 Encourage the person to focus on one implication
at a time.
28

29. LEVELS
Individual approach
General approach
General support
Environmental
manipulation
29

30.  Environmental Manipulation
 Interventions that directly change the patient’s
physical or interpersonal situation.
 Provide situational support & remove stress.
 Example : Taking a sick leave, going on a vacation
 General Support
 Nurse provides warmth, acceptance, empathy and
reassurance
 Conveys the feeling that the nurse is on the patient’s
side and will be a helping hand.
• Generic Approach
 Designed to reach high risk individuals and large groups
30

31. as quickly as possible.
Debriefing method : Disaster victims are helped
to recall events and clarify traumatic experiences
Group support, information on normal reaction.
•Individual Approach
Useful in combined situational and maturational
crisis
Also beneficial when symptoms include homicidal &
suicidal risk
Nurse understands the specific patient’s
characteristics with interventions aimed to
facilitate cognitive and emotional processing of the
traumatic experience.
31

32. TECHNIQUES
Catharsis Clarification Suggestions
Reinforcement
of behaviour
Support of
defences
Raising self-
esteem
Exploration of
solutions
32

33. • CATHARSIS :The release of feelings that takes
place as the patient talks about emotionally charged
areas.
Eg. “Tell me how you have been feeling since the
accident.”
●CLARIFICATION : Encouraging the patient to
express more clearly the relationship between
certain events.
Eg. “I have noticed that after the calamity, you have
been avoiding places near water.”
●SUGGESTION : Influencing a person to accept an
idea or belief, particularly the belief that the nurse
can help and the person will feel better in time.
33

34. Eg. “Many people have found it helpful to talk about
this and I think you will too.”
●REINFORCEMENT OF BEHAVIOUR : Giving
positive responses to adaptive behaviour.
Eg. “That is the first time you expressed your
feelings regarding the incident. I appreciate that.”
SUPPORT OF DEFENCES : Encouraging the use of
healthy/adaptive defences and discouraging those
that are unhealthy/maladaptive.
Eg. “Going for exercise when you were so angry was
helpful because when you returned, you were able to
34

35. talk things through with your family.”
●RAISING SELF-ESTEEM :Giving the patient
positive reinforcement to adaptive behaviour
Eg. “You are a very strong person to be able to
manage the family all this time. I think you will be
able to handle this situation too.”
EXPLORATION OF SOLUTIONS: Examining
alternative ways of solving the immediate problem.
Eg. “An occupational rehabilitation program can help
you in regaining functional capacity.”
35

36. Geriatric Considerations
 Older persons who were successful at
adapting to losses earlier in life will
cope more adaptively with the losses
and grief inherent in aging.
 The elderly persons who experienced
more losses are unable to complete the
grief process resulting in bereavement
overload.
 Such people are less able to adapt and
reintegrate physical & mental health,
and are prone to depressive disorders.
36

37. ROLE OF NURSE
37

38. Assessment
 The nurse collects data regarding the
following factors:
 Precipitating event or stressor
 Patient’s perception of event or
stressor
 Nature and strength of patient’s
support systems, coping resources
 Level of psychological stress patient is
suffering from and degree of
impairment he/she is experiencing
 Patient’s previous strengths and coping
mechanisms
38

39. Nursing Diagnosis
Ineffective
individual
coping
Ineffective
family
coping
Dysfunction
al family
process
Post trauma
response
39

40. Planning
 Dynamics underlying the present crisis
are formulated.
 Alternative solutions to the problem
are explored.
 Steps for achieving the solutions are
identified.
 Environmental support needed to help
the patient is decided upon, coping
mechanisms that need to be developed
and those which need to be
strengthened are identified.
40

41. Implementation
 Interventions at various levels :
i. Environmental manipulation
ii. General support
iii. Generic approach
iv. Individual approach
 Restore psychological safety
 Provide adequate information
 Correct and support effective coping
 Ensure social support
41

42. Evaluation
 The nurse and patient review the
changes that have occurred.
 Nurse should give credit for
successful changes to patients
so that they realize their
effectiveness.
 If the goals have not been met,
the patient and nurse can return
to the first step (assessment)
and continue through the phases
again.
42

43. CRISIS IN CCU
Critically
ill patient
Family
and
friends
Health
care
personnel
43

44. Critically ill patient
44
●Being critically ill for a long time or a
battle with a chronic terminal illness
can result in failure of coping
mechanisms, prolonged distress and a
state of crisis.
●Furthermore, the patient’s need for
psychological support is oftentimes
neglected due to priority to other
critical needs.
●Thus, it is crucial to provide crisis
intervention to the patient in distress.

45. Family
45
 The critical care family needs inventory is a tool
used by many nursing staff to ensure that nurses
meet family’s need when their loved one is in ICU.
 The 3 most important needs consistently
identified by clients and families are :
Proximity Assurance Information

46. 46
•TOP 9 PRIORITIES FOR FAMILIES IN
CRITICAL SETTINGS :
To be assured that the best care is being given to
their family member by health personnel/team.
To feel that there is a hope.
To know the prognosis and outcome.
To understand the mode of treatment.

47. 47
To be assured that it is alright to leave for a while.
To feel accepted by hospital staff.
To feel someone is concerned with family’s health.
To feel hospital staff care about the patient.
To give time to time information in terms that can
be understood by the family.

48. Personnel
48
 As the CCU staff feels obliged to respond to the
critical situation but is unable to cope with the
demands of the situation, it leads to distress,
direct deterioration of quality of life as well as
quality of service provided.
 Factors responsible for personnel crisis in CCU:
 Increased patient care demands
 Excessive and extended workload
 Equipment related challenges
 Emotional trauma
 Lack of training in crisis management
 Biorhythm disturbance

49. 49
•Manifestations include:
Emotional exhaustion
Depersonalization
Sense of reduced personal achievement
Depression
High Absenteeism/sickness rates
Drug/alcohol dependence
Chronic physical complaints
• Red Flag signs :
∆ The disappearing act (not answering bleeps, frequent
sick leave, being late)
∆ Low work rate (slowness in doing procedures)
∆ Ward rage (burst of temper, shouting)
∆ Rigidity (poor tolerance to healthy criticism, inability to
compromise)

50. 50
∆ Bypass syndrome (colleagues tend to avoid the
affected staff)
∆ Career problems (uncertainty about career choice)
 Management:
Meeting regular needs on a daily basis (regular eating,
drinking and sleep schedule)
Taking designated breaks and relaxation techniques
(music, warm bath, dance, deep breathing, meditation)
Keeping in touch with friends and family, communication
with colleagues
Limiting media exposure
Appreciating the “superhero” status of your profession –
taking care of those most in need.
Taking professional help when necessary.

51. MODALITIES
Mobile Crisis
Programs
Telephone
Contacts
Group Work
Disaster
Response
Victim
Outreach
Programs
Crisis
Intervention
Centres
Health
Education
51

52. MOBILE CRISIS PROGRAMS
 Mobile crisis teams provide frontline
interdisciplinary crisis intervention to individuals,
families and communities.
 Nurse provides on-site care to ensure mental
health.
TELEPHONE CONTACTS
 Crisis Intervention is sometimes practiced over
telephone rather than face to face contacts.
 Nurse should have effective listening skills.
52

53. CRISIS INTERVENTION
CENTRES
 These provide emergency care and counselling to
victims experiencing extreme stress or conflict,
often involving suicide attempts or drug abuse.
 These centres, which are usually self contained
units in a hospital or CHC provide services 24 hours
a day.
VICTIM OUTREACH PROGRAMS
 Victim outreach programs use crisis intervention
techniques to identify needs of victims and connect
53

54. them with appropriate referrals and other
resources.
 Nurses often work in these programs, where
victims are often seen immediately after the crisis.
DISASTER RESPONSE
 During social crisis (floods, earthquakes, airplane
crashes, fire, etc.), the nurse acts as the case
finder for persons suffering from psychosocial
stress.
 She/he visits hospitals, shelters, morgues , etc.
where victims are likely to gather in the immediate
post disaster period and uses generic approach of
crisis intervention.
54

55. GROUP WORK
 People who have common traits on stressors will
form a group.
 It provides an opportunity for members to express
common concerns & experiences and build mutual
support.
HEALTH EDUCATION
 Nurses are involved in identifying people who are at
high risk for developing crisis and in teaching coping
strategies.
 The public also needs to be educated for awareness
regarding available services.
55

56. BIBLIOGRAPHY
56
 BOOKS
• Sreevani.R, “A Guide to Mental Health and Psychiatric Nursing”,
Edition : 4th, JayPee Publishers, Page = 332-339
• Sharma Suresh, “Communication and Educational Technology in
Nursing”, Edition : 3rd , Elsevier Publishers, Page = 117-123
• Ansari Javed, Kaur Davinder, “Medical Surgical Nursing-I”, Edition:
2015, PeeVee Publishers, Page =
• Chugh SL, “
 WEBSITES
• https://en.wikipedia.org › wiki › Crisis_intervention
• https://www.researchgate.net › publication ›
331783539_Crisis_Intervention
• https://journals.lww.com › indianjpsychiatry › Fulltext › 2021 › 63060

57. 57