The document defines a crisis as a sudden, stressful event that disrupts homeostasis and usual coping mechanisms. It describes 4 phases of a crisis where usual coping fails, new resources are mobilized, and professional help is needed if not resolved. The goal of crisis intervention is resolution through support and restoration or adaptation. Assessment involves safety, biological, psychological, and social factors. The plan aims to preserve autonomy or restore functioning. Interventions include ensuring safety, reality orientation, problem solving, and identifying resources. Evaluation assesses if goals were met and evidence of growth.

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?