This lesson plan outlines a class on crisis intervention for nursing students. The class will define crisis and crisis intervention, discuss characteristics of individuals prone to crisis and types of crises including developmental, situational, and social crises. The plan details specific objectives, content, teaching methods such as lecture and discussion, learning activities, and evaluation. The content will cover defining crisis and crisis intervention, characteristics of crisis-prone individuals, and types of crises including developmental, situational, and social crises. Students will participate in lecture, discussion and take notes to meet the objectives of understanding crisis intervention concepts and types of crises.

1. ESIC COLLEGE OF NURSING, KALABURAGI
THIRD YEAR BASIC B Sc NURSING
MENTAL HEALTH NURSING
LESSON PLAN ON
CRISIS INTERVENTION
SUBMITTED BY, SUBMITTED TO
Mrs Bemina JA The Principal
Assistant Professor ESIC College of Nursing
ESIC College of Nursing Kalaburagi

2. LESSON PLAN ON CRISIS INTERVENTION
NAME OF THE TEACHER : MRS. BEMINA JA
PROGRAMME : B SC NURSING
SUBJECT : MENTAL HEALTH NURSING
UNIT : MANAGEMENT OF EMERGENCY CONDITIONS
TOPIC : CRISIS INTERVENTIONVENUE:LECTURER HALL
DATE :
TIME : 9 AM- 10 AM
DURATION : 1 HOUR
NUMBER OF STUDENTS : 40
METHOD OF TEACHING : LECTURER CUM DISSCUSSION
A.V.AIDS : BLACK BOARD, CHART, POWER POINT,VEDIOS
PREVIOUS KNOWLEDGE OF THE STUDENTS : NIL
SIGNATURE OF THE TEACHER :

3. GENERAL OBJECTIVES:
Enable the students to acquire knowledge about crisis intervention and develop desirable attitude and
practice this knowledge in clinical and community settings
SPECIFIC OBJECTIVES:
By the end of the class, the student will be able to,
Define crisis intervention
Enlist the purpose and principles of crisis intervention
Enumerate the characteristics and types of crisis
Describe the approaches to crisis intervention
Mention the crisis intervention model
Illustrate the nursing management of crisis intervention

4. Sl.
N
o
Specific
Objectives
Duration
Contents
TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
01
To Define
Crisis
To Define
Crisis
Intervention
1min
1min
INTRODUCTION
Black Tuesday that ripped apart soul wet only in Mumbai but the
whole nation could be best way of describing the concept of crisis
what followed later was helplessness, anxiety, shock, and
disbelief, which further produced a state of crisis for all people
staying in MUMBAI as well as in INDIA .
DEFINITION OF CRISIS:-
A sudden event in one’s life that disturb homeostasis during which
usual coping mechanism cannot resolve the problem
- LANGERQUIST
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
1982
DEFINITION OF CRISIS INTERVENTION:-
It is a specific type of brief psychotherapy with prescribed steps.
-AQUILERA 1998
Crisis intervention is a short term therapy focused on solving the
immediate problem, usually limited to 6 weeks.
DISCUSSION
Lecture cum
Discussion
Lecture cum
Discussion
Listening
Takes
down
notes
Black
Board
LCD
LCD
Asking
questions
Define crisis
Define Crisis
Intervention

5. 02
GENERALLY:-
Crisis intervention is an intervention designed to help an
individual or client to cope up, with a sudden problem and
encourage at a level of functioning equal to or higher than pre-
crisis state.
Crisis intervention is more directive than traditional psychotherapy
or counseling and can be used by any member of the health
member of the health care team who has been trained in its
techniques. The basic approach is problem solving and focuses
only on the problem presented by the crisis.
CRISIS PRONENESS:
HENDRICKS (1985) suggests that certain individuals are
more prone to crisis than others .the following are
characteristics often found in individuals who are regarded as
being more susceptible to crisis:-
 Dissatisfaction with employment or lack of employment.
 History of unresolved crisis.
 Poor self-esteem, unworthiness.
 Superficial relationship with others.
 Difficulty in coping with everyday situations.
 Under utilization of resources and support systems.
 Aloofness and lack of caring.
It is important to note that individual personality crisis must also be
considered in conjunction with these characteristics .crisis is defined
by the individuals what is a crisis for one is merely an occurrence for
another .this factors is a critical component that must be evaluated in
relation to crisis prone characteristics as well as personality traits.
Discusses
the crisis
proneness

6. Sr
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no
Specific
Objectives
Duration
Contents TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
03 To Enumerate
and explain the
types of crisis
intervenion
TYPES OF CRISIS SITUATION:-
DEVELOPMENTAL/MATURATIONAL CRISIS
SITUATIONAL CRISIS
ADVENTITIOUS/SOCIAL CRISIS
1. DEVELOPMENTAL/MATURATIONAL CRISIS:-
Predictable events in the normal course of life and formerly
used coping mechanisms no longer work.
Examples:
o Passing from school-age to adolescence.
o Passing from adolescent to adult.
o Leaving home
o Getting married
o Having a baby
o Beginning a career
Maturational Crisis
 New coping mechanisms yet to be developed.
 While individual is without effective coping methods
they have anxiety which may affect behavior.
 The way these crisis are resolved affects the ability to
pass through subsequent stages.
 Alcohol and drug addiction can interrupt passage thru
these stages.
This appears when the client enters a new stage of life
development and is unable to make changes which are necessary
to function .eg inability to change with marriage, birth of the child
Enumerates
and explains
the types of
crisis
intervenion
Listens
Takes
notes
Black
Board
LCD
Enumerate the
types of crisis
intervenion

7. or death of a parent.
A maturational crisis is a stage in a person’s life where adjustment
and adaptation to new responsibilities and life patterns are
necessary.
The transition points where individuals more into successive stage
often generate disequilibrium .individuals are required to make
cognitive and behavioural changes and to integrate those physical
changes that accompany development.
The extent to which individual’s experience success in the mastery
of these tasks depends on previous successes availability of
support systems ,influence of role models and acceptability of new
role by others.
The transitional periods or events that are commonly identified as
having increased crisis potential are adolescence, marriage,
parenthood, midlife and retirement.
This relates to the process of matuaration and passing various
stages of the life cycle.coping skills used earlier may no danger be
helpful and appropriate .this leads to anxiety or crisis –adolescence
,marriage, to be parent, and retirement are some examples of
maturational crisis.
 Erickson's theory of personality development, which our
personality continues to develop through life. Sudden change
is a kind of function of how a certain individual deal each
stage of development.
 Stages of Social-Emotional Development In Children and
Teenagers.
 Erikson’s Psychosocial Development
The following stages are called as crucial points in the cycle of human
being:

8. a. PRENATAL PERIOD :-
Pregnancy can causes stress to the women .they need helps not
only for their physical as well as emotional wellbeing which
ultimately has an effect on the physical and emotional
wellbeing of the fetus.
b. FIRST FIVE YEARS OF LIFE:-
The roots of mental health get set in early childhood .the infant
and young child should experience, a warm intimate and
continuous relationship with his mother and father .it is this
relationship that underlines the development of mental health.
E.g. Broken homes, lack of affection, battered children all
these lead to behaviour disorder in children.
c. SCHOOL AGE:-
Everything which happen in the school affects the mental
health of the child .The program and practices of the school
may satisfy or frustrate the needs of the child .from this stand
point , child mental health as shown in effectiveness in
learning .proper teacher pupil relationship and climate of the
class rooms are very important to the mental health
d. ADOLESCNCE:-
This is the transitional stage from ad
olescence to adulthood .this is otherwise called as stormy
phase .when dangers exist in the form of mental ill health .e.g.
Juvenile delinquency
Following needs should be met
 The need to be needed by others
 The need for increasing independence
 The need for achieve adequate adjustment with
opposite sex

9. e. OLD AGE:-
Mental health problems of elderly individual need more
attention in the developing countries .the course of mental
illness are organic condition of the brain, economic insecurity,
lack of home and poor status.
2. SITUATIONAL CRISIS:-
A situational crisis is one that is precipitated by an
unanticipated stressful event that creates disequilibrium by
threatening one’s sense of biological, social or psychological
integrity.
Unanticipated or sudden events arising from an external source
that threaten the individual’s integrity
Examples: Job Loss, Death Of Loved One, Abortion, Job
Change, Financial Change, Divorce, Pregnancy, Severe
Illness.
Other examples of events that can precipitate situational crisis
are premature birth status and role changes, death of a loved
ones, physical or mental illness, divorce ,change in geographic
location and poor performance in school.
3. SOCIAL CRISIS/ADVENTITIOUS CRISIS:-
An unplanned, accidental event that is not part of everyday
life.
May be a natural disaster flood, fire or earthquake
National disaster, war, riot
Crime of violence rape, murder, spousal or child abuse.
Also known as crisis of disaster, adventitious crisis is a
situation that is not a part of everyday life.
It is unplanned and accidental. Various examples of

10. adventitious crisis include earthquake, flood, airplane crashes,
rape, murder, war, riots and terrorism. These are unexpected
occurrences that necessitate changes in a person because they
involve a severe threat of self esteem or physical safety.
Examples are rape, disturbance like cyclones, earthquakes,
flood etc. Here not only an individual alone is involved, a
community or locality or a population, its adjacent
environment are also involved .so here change not only takes
place in individual, but also in his environment also.
Social crisis is accidental ,uncommon and unanticipated and
results in multiple losses and radical environmental changes
,social crisis include natural disasters like floods, earthquakes,
violence, nuclear accidents, mass killings, contamination of
large areas by toxic wastes ,wars etc.
This type of crisis is unlike maturational and situational crisis
because it does not occur in the lives of all people. Because of
the severity of the effects of social crisis coping strategies may
not be effective. individual confronted with social crisis
usually do not have previous experience from which to draw
expertise .support systems may be unavailable because they
may also be involved in similar situations .mental health
professionals are called upon to act quickly and provide
services to large number of people and in some cases ,the
whole community.
There are certain psychiatric illnesses, which need immediate
attention in order to make changes in the individual condition.

11. Sr
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no
Specific
Objectives
Duration
Contents TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
04 To Explain the
phases of Crisis
5min PHASES OF CRISIS:-
CAPLAN (1964) has described four phases of crisis :-
1. PHASE I:-
o Threatens self-concept
o Increased feelings of anxiety
o Problem-solving techniques and defense mechanisms
are stimulated to lower anxiety.
o Persons experiencing a crisis are usually distressed &
likely to seek help.
o They are ready to learn new coping skills to relieve
distress.
Perceived threat acts as a precipitatant that generates increased
anxiety .normal coping strategies are activated and if unsuccessful,
the individual moves into PHASE II.
When faced with a problem that seems to be unresolvable,
‘TENSION’ starts and anxiety mounts. The person’s attempts
more and more to solve the situation.
2. PHASE II:-
o The usual defense mechanisms tend to fail and anxiety
continues to rise.
o The individual becomes disorganized.
o Trial and error problem solving begin.
The effectiveness of the PHASE I coping mechanisms leads to
further disorganization .the individual experiences a sense of
vulnerability .the individual may attempt to cope with the situation
in a random fashion. If the anxiety continues and there is no
Explains
the phases
of Crisis
Listens
Asks
doubts
Takes
notes
Black
Board
LCD
Explain the
phases of crisis

12. reduction, the individual enters PHASE III.
Anxiety increases further improvement of function and results in
disorganization and distress .if anxiety and arousal are in excess, it
hinders coping behaviour.
3. PHASE III:-
o If trial-and-error attempts fail, anxiety escalates to severe
panic levels.
o Uses relief behaviors such as withdrawal & flight.
o Some resolution may occur (compromising needs, redefine
situation to make more acceptable).
Redefinition of crisis is attempted and the individual is most
amenable to assistance in this phase. New problem solving
measures may also affect a solution .return to precrisis level of
functioning may occur .if problem solving is unsuccessful,
further disorganization occurs and the individual is said to
have entered PHASE IV. Emergency measures are taken and
new coping skills are tried.
4. PHASE IV:-
If problem unsolved, anxiety continues at severe or panic
level, serious personality disorganization occurs (confusion,
immobilization, and violence against others, suicide attempts,
aimless running and shouting.
Severe to panic levels of anxiety with profound cognitive,
emotional and physiological changes may occur .referred to
further treatment resources is necessary. Failure to resolve the
crisis leads to further disorientation, disorganization &
decompensation.

13. Sr
.
no
Specific
Objectives
Duration
Contents TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
05
06
To Enlist the
signs and
symptoms of
crisis
To discuss the
resolution of
crisis
I
1min
3min
i
SIGN AND SYMPTOMS OF CRISIS:-
 The major feeling in a crisis situation is anxiety .the individual
experiences a heavy burden of free floating anxiety.
 The anxiety may be manifested through depression ,anger and
guilt .the victim will attempt to get rid of the anxiety using
various coping mechanism ,healthy or unhealthy .
 The individual may become incapable of even taking care of
his daily needs and may neglect his responsibilities.
 The individual may become irrational and blame others for
what has happened to him.
RESOLUTION OF CRISIS :-
Healthy resolution of crisis depends upon the following three factors
1. Realistic appraisal of the precipitating event , i.e.
recognition of the relationship between event and feelings of
anxiety is necessary for effective problem solving to occur.
2. Availability of support systems
3. Availability of coping measures over a life-time. A person
develops successful coping strategies that enables him to
identify and resolve stressful situations.
The individual may resolve the crisis by three ways:-
PSEUDO-RESOLUTION:-
In this , the individual uses repression and pushes out of consciousness
the incident and the intense emotions associated with it .so there will
not be any change in the level of functioning of the individual.ut in
future ,if and when a crisis occurs ,the repressed feelings may surface
Enlists the
signs and
symptoms
of crisis
Discusses
the
resolution of
crisis
Listens
And
visualises
Takes
notes
Listens
Takes
notes
Charts
LCD
Enlist the signs
and symptoms
of crisis
Enlist the three
factors for
healthy
resolution

14. and influence the feelings aroused by the new crisis. In such a
situation ,the particular crisis may be ,more difficult to resolve
because the feelings associated with the earlier crisis are neither
expressed nor handled that time.
UNSUCCESSFUL RESOLUTION:-
In this , the victim uses pathological adaptation at any phase of crisis,
resulting in a lower level of functioning .the victim rather than
accepting the loss and reorganizing his life ,keeps ruminating over the
loss.
An example prolonged grief reaction, which results in depression.
SUCCESSFUL RESOLUTION:-
I n this the victim may go through the various phases of crisis ,but
reaches PHASE III where various coping measures are utilized to
resolve the crisis situation. The individuals develops better skills and
problem solving ability which can be and will be used in various crisis
situations in future.

15. Sr
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no
Specific
Objectives
Duration
Contents TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
07
08
09
To Define and
enlist the aims
crisis
intervention
To Explain the
model of crisis
intervention
1min CRISIS INTERVENTION:-
Crisis Intervention Is An Intervention Designed To Keep An
Individual Or Client To Cope Up With A Sudden Problem And
Encourage At A Level Of Functioning Equal To Or Higher Than Pre-
Crisis State.
Or
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.
AIMS OF CRISIS INTERVENTION TECHNIQUES:-
 To provide a correct cognitive perception of the situation.
 To assist the individual in manageging the intense or
overwhelming feelings associated with the crisis.
MODEL OF CRISIS INTERVENTION:-
Kubler-Ross described five stages of grief in her 1969 book "On
Death And Dying" that are just as relevant to the normal range of
feelings people have when they are dealing with change on an
individual level or in the workplace.
Defines
crisis
intervention
Explain the
model of
crisis
intervention
Listens
Takes
notes
Listens
and
understan
ds
Takes
notes
LCD
LCD
Vedio clips
Define crisis
intervention
Describe the
Kubler Ross
Stages of grief

16. ELIZABETH KUBLER ROSS MODEL (FIVE STAGES OF
GRIEF IN 1969)
It describes the five discrete stages, a process by which people deal
with grief and tragedy especially when diagnosed with a terminal
illness or catastrophic loss.
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
o DENIAL :-
Denial is a conscious or unconscious refusal to accept facts,
information, reality, etc., relating to the situation concerned.
It's a defense mechanism and perfectly natural. Some people
can become locked in this stage when dealing with a traumatic
change that can be ignored. Death of course is not particularly
easy to avoid or evade indefinitely. "I can't believe it", "This
can't be happening", "Not to me!", "Not again!"
Denial is usually a temporary defense that gives us time to
absorb news of change before moving on to other stages. It is
the initial stage of numbness and shock. We don't want to
believe that the change is happening. If we can pretend that the
change is not happening, if we keep it at a distance, then
maybe it will all go away. A bit like an ostrich sticking its head
in the sand.

17. o ANGER :-
Anger can manifest in different ways. People dealing with
emotional upset can be angry with themselves, and/or with
others, especially those close to them. Knowing this helps keep
detached and non-judgmental when experiencing the anger of
someone who is very upset.
"Why me? It's not fair!" "NO!I can't accept this!"
When we realise that the change is real and will affect us our
denial usually turns to anger. Now we get angry and look to
blame someone or something else for making this happen to
us.
What's interesting is that our anger can be directed in many
different directions. I've seen people angry with the boss,
themselves, or even God. In these tough economic times it's
often the economy that is blamed. It's the government, or top
management's fault for not planning properly. You might find
you are more irritable towards colleagues or family. You'll
notice others finding fault with the smallest things.
o BARGAINING :-
Traditionally the bargaining stage for people facing death can
involve attempting to bargain with whatever God the person
believes in. People facing less serious trauma can bargain or
seek to negotiate a compromise. For example "Can we still be
friends?.." when facing a break-up. Bargaining rarely provides
a sustainable solution, especially if it's a matter of life or death.
"Just let me live to see my children graduate."; "I'll do
anything, can't you stretch it out? A few more years."
This is a natural reaction of those who are dying. It's an
attempt to postpone what is inevitable. We often see the same
Enumerates the
goals of crisis
intervention

18. sort of behaviour happening when people are facing change.
We start bargaining in order to put off the change or find a
way out of the situation. Most of these bargains are secret
deals with God, others, or life, where we say "If I promise to
do this, then you make the change not happen to me". In a
work situation someone might work harder and put in lots of
overtime to prove themselves invaluable, in order to avoid
retrenchment.
o DEPRESSION:-
Also referred to as preparatory grieving. In a way it's the dress
rehearsal or the practice run for the 'aftermath' although this
stage means different things depending on whom it involves.
It's a sort of acceptance with emotional attachment. It's natural
to feel sadness and regret, fear, uncertainty, etc. It shows that
the person has at least begun to accept the reality.
"I'm so sad, why bother with anything?"; "What's the point of
trying?"
When we realise that bargaining is not going to work the
reality of the change sets in. At this point we become aware of
the losses asssociated with the change, and what we have to
leave behind. This has the potential to move people towards a
sad state, feeling down and depressed with low energy.
The depression stage is often noticeable in other ways in the
workplace.
People dealing with change at work may reach a point of
feeling demotivated and uncertain about their future. I recently
experienced a group of bank employees asking why they
should continue to give of their best at work when they were
unsure that their jobs were safe; and the bank was obviously
not committed to them. My experience is that there is an

19. 10 Enumerate the
goals of crisis
intervention
2min
increase in absenteeism at this time as people use sick leave
and take 'mental health' days.
o ACCEPTANCE:-
Again this stage definitely varies according to the person's
situation, although broadly it is an indication that there is some
emotional detachment and objectivity. People dying can enter
this stage a long time before the people they leave behind, who
must necessarily pass through their own individual stages of
dealing with the grief.
"It's going to be OK."; "I can't fight it, I may as well prepare
for it."
As people realize that fighting the change is not going to make
it go away they move into a stage of acceptance.
It is not a happy space, but rather a resigned attitude towards
the change, and a sense that they must get on with it. For the
first time people might start considering their options. I think
it's a bit like a train heading into a tunnel. "I don't know what's
in there, I have to keep going on this track, I'm scared but have
no option, I hope there's light at the end..."
This can be a creative space as it forces people to explore and
look for new possibilities. People tell me that they learn lots
about themselves, and it's always good to acknowledge the
bravery that acceptance takes.
GOALS OF CRISIS INTERVENTION:-
The goal of crisis intervention change according to the degree of
treatment you will be involved in crisis intervention for the health
care provider is obviously provided at different level that it would
be from a law of enforcement or emergency dispatch viewpoint .
We will look at the goals of crisis intervention from a health care

20. prospective.
 ENSURES SAFETY:-
Assess the situation .if you or the patient is in physical danger,
signal for help .do not leave the patient carelessly in danger to
yourself in imminent. It may sound harsh, but you will be no good
to anyone, if you are hurt or worse .take care of your own safety
first, then later care of patient safely.
 DOFFUSE THE SITUATION:-
Do this verbally, when at all possible .A person in crisis is most
likely not in control of his or her thoughts, feelings or actions.
Physical attempts at restraining or calming are best left until all
verbal attempts have been made and only when there is enough
help to do it safely for the patient and staff.
 DETERMINE THE PROBLEM:-
Attempt to find out from the patient’s viewpoint the cause of the
crisis. It is very important that you not push the patient to give you
reason and that you remain calm during the intervention.
 DECREASE THE ANXIETY LEVEL:-
Your adrenaline level will be probably at all time high, but it
won’t be even close to that of person in crisis. Make every attempt
to reassure the patient that he or she in a safe place. Let the person
know you are concerned and want to help. Gently but firmly tell
him or her that you will do whatever you can make the situation
more comfortable but that you do need his or her help and co-
operation.

21. CAUTION:-Be very careful with physical contact at this point.
Touch as a nonverbal communication skill may be interpreted
inaccurately as aggression sexual intimacy by a person whose
thoughts are in turmoil.
 RETURN PATIENT TO PRECRISIS (OR BETTER)
LEVEL OF FUNCTIONING:-
You may be able to calm the person to the point that he or she
is able to understand what just happened; you may not .it
might take a longer term session of treatment to help the
person gain that kind of insight. No matter what level of
intervention the patient requires, the ultimate goal is for him or
her to learn the skills necessary to cope up with stress in a
more positive way than was used before the crisis.

22. Sr
.
no
Specific
Objectives
Duration
Contents TEACHING
ACTIVITY
LEARNING
ACTIVITY A V AIDS EVALUATION
11 To Explain the
steps in crisis
intervention
2min STEPS IN CRISIS INTERVENTION:-
A. STEPS TO PROVIDE A CORRECT COGNITIVE
PERCEPTION:-
ASSESSMENT OF THE SITUATION:-
This may be achieved by direct questioning with the purpose
of identification of the problem and the people involved.
It is necessary to identify the support systems available and to
know the depth in which the individuals feelings are affected
Assessment should also be done to identify the strengths and
limitations of the victims.
DEFINING THE EVENT:
The victim at times may not be able to identify the
precipitating event because of possible denial or due to
reluctance to talk about it.
It may be necessary for the therapist to review the details of
the incidents in the past 2 to 4 weeks in order to identify the
event that precipitated the crisis such as a review will help the
victim becoming aware of the precipitating event .
DEVELOP A PLAN OF ACTION :-
The victim and the people closely associated with him should
have active involvement in developing the plan of action.
The therapist must be aware that the victim may not be aware
that the victim may not be in condition to mentally
comprehend.
Explains the
steps in
crisis
intervention
Takes
notes
Black
board
LCD
Explain the
steps in crisis
intervention

23. 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 ata a time
.the instructions may have to be written down ,as the victim
may not be able to retain all the information.
B. STEPS TO ASSIST THE VICTIM IN MANAGING THE
INTENSE FEELINGS:-
Helping the individual to be aware of the feelings
The victim needs help in identifying his own feelings ,which is
first step in handling them .
The therapist should use appropriate communication technique
so that the victim will feel comfortable to express his feelings
without the fear of being judged or criticized .
The therapist should also be efficient in observing verbal and
nonverbal behaviour of the victim ,so that he will be able to
make a careful assessment of his feelings .
HELP THE INDIVIDUAL TO ATTAIN MASTERY
OVER THE FEELINGS:-
The individual should be given adequate support and guidance
through the therapeutic process in order to handle feelings
associated with crisis but special care should be taken not to
give any false reassurance.
He should not in any way be encouraged to blame others , as
this will be encouraged to blame others ,a s this will only let
him escape from taking any responsibility.
Care must be taken to ensure that the individual does not
develop too much dependency on the therapist ,which is
unhealthy .

24. After the victim and support groups prepare the plan of action
under the guidance of the therapist ,it should be discussed with
the victim and the concerned others ,so that they will have a
clear understanding of the methods of implementation of the
plan.
To improve the coping with the situation necessary
environmental manipulation must be done in physical or
interpersonal areas.
it is advisable to have another appointment for the victim to
visit the therapist within a week ,in order to assess how the
plan is working out, if needed ,to revise and modify the plan
ROLE OF THE NURSE IN CRISIS
INTERVENTION:-
Nurses responds to crisis situations on a daily basis .crisis can
occur in any unit for example in general hospitals, home
settings ,community health centers ,schools ,offices and in
private practice .indeed nurses may be called upon to function
as crisis helpers in any situation.
Knowledge of crisis intervention techniques is thus an
important clinical skill of all regardless of the setting or
practice specialty.
NURSING ASSESSMENT:-
The first step of crisis intervention is assessment .during this phase
the nurse collects data regarding following factors :-
 Precipitating event or stressors
 Patients perception of the event or stressor
 Nature and strength of the patients support systems. Coping
resources
 Level of psychological stress patient is suffering from and

25. degree of impairment he is experiencing.
 Patients previous strengths and coping mechanisms
During this phase, the nurse begins to establish positive working
relationship with the patient.
In a disaster or mass casualty situation, different systems for triage
have been developed. One system is known as START (Simple
Triage and Rapid Treatment). In START, victims are grouped into
four categories, depending on the urgency of their need for
evacuation. If necessary, START can be implemented by persons
without a high level of training. The categories in START are:
 the deceased, who are beyond help
 the injured who could be helped by immediate transportation
 the injured with less severe injuries whose transport can be
delayed
 those with minor injuries not requiring urgent care.
Another system that has been used in mass casualty situations is
an example of advanced triage implemented by nurses or other
skilled personnel. This advanced triage system involves a color-
coding scheme using red, yellow, green, white, and black tags:
 Red tags - (immediate) are used to label those who cannot
survive without immediate treatment but who have a chance of
survival.
 Yellow tags - (observation) for those who require observation
(and possible later re-triage). Their condition is stable for the
moment and, they are not in immediate danger of death. These
victims will still need hospital care and would be treated
immediately under normal circumstances.

26.  Green tags - (wait) are reserved for the "walking wounded"
who will need medical care at some point, after more critical
injuries have been treated.
 White tags - (dismiss) are given to those with minor injuries
for whom a doctor's care is not required.
 Black tags - (expectant) are used for the deceased and for
those whose injuries are so extensive that they will not be able
to survive given the care that is available.
PLANNING :-
In planning the previously collected data is analysed and
specific interventions are proposed .during this phase the nurse
will undertake the following activities
 Dynamics underlying the present crisis are formulated
 Alternative solutions to the problem are explored .
 Steps for achieving the soluations are identified .
 Environment 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.
IMPLEMENTATION:-
The following interventions are carried out to resolve the
crisis:
ENVIRONMENTAL MANIPULATION:-
Environmental manipulation includes interventions that
directly change the patients physical or interpersonal

27. situations. These interventions may resolve stress or provide
situational support. For example, a patient having difficulty in
his job may take a week of sick leave so that he can be
removed temporarily from that stress.
GENERAL SUPPORT :-
The nurse uses warmth ,acceptance ,empathy and reassurance
to provide general support to the patient.
GENERIC APPROACH:-
The generic approach is deigned to reach high risk individuals
and large groups as quickly as possible .it applies a specific
method to all individuals faced with a similar type of crisis
.(e.g. in social disasters)
Debriefing is a method of generic approach .in debriefing
method ,disaster victims are helped to recall eventsand clarify
traumatic experiences .it attempts to place the traumatic event
in persprective ,allows the individual to relive the event in a
factual way,encourages group support,and provides
information on normal reaction to critical events .the goals of
debriefing is to present the maladaptive responses that may
result if the trauma is suppressed.
INDIVIDUAL APPROACH:-
The individual approach is a type of crisis intervention similar
to the diagnosis and treatment of a specific problem in a
specific patient.it is particularly useful in combined situational
and matuarational crisis and also benedficial when symptoms
include homicidal and suicidal risk.the nurse must use the
interventions that is most likely to help the patient develop an

28. adaptive response to the crisis.
LEVELS OF CRISIS INTERVENTION:-
1. INDIVIDUAL APPROACH:-
It is similar to diagnosis and treatment of a specific problem in a
specific patient.
2. GENERIC APPROACH:-
It is designed to reach high-risk individual and large group as
quickly as possible .It applies a specific method to all individuals
faced with similar type of crisis.
3. GENERAL SUPPORT:-
Includes interventions that convey the feelings that therapist is on
the patients side and will be a helping person.
INDIVIDUAL
APPROACH
GENERIC APPROACH
GENERAL APPROACH
ENVIRONMENTAL MANIPULATION

29. 4. ENVIRONMENTAL MANIPULATION:-
Involve interventions that directly change patient physical or
interpersonal situation. These intervention provides situational
support or remove stress.
TECHNIQUES OF CRISIS INTERVENTIONS:-
1. CATHARSIS:-
The release of feelings that takes place as the patient talks about
emotionally charged areas.
2. CLARIFICATION:-
Encouraging the patient to express more clearly the relationship
between certain events in their life.
3. MANIPULATION:-
Using the patient’s emotions ,wishes or values to beliefs the
patient in the therapeutic process.
4. REINFORCEMENT OF BEHAVIOUR:-
Giving the patient a positive re-inforcement to develop adaptive
behavior.
5. SUPPORT OF DEFENCES:-
Encouraging the use of healthy adaptive defenses.
Discourage unhealthy and maladaptive defenses.
6.INCREASING SELF ESTEEM:-
Raising self esteem and helping the patient to regain feeling of self
worth and selecting the best available alternative way for evolving
the immediate problem.
7.EXPLORATION OF SOLUTIONS:-
Examining alternative ways of solving the immediate problem.
EVALUATION:-
The nurse and patient reviews the changes that have occurred

30. .the nurse should give credit for successful changes to patients
so that they realize their effectiveness and understand that
what they learnt from crisis may help in coping with future
crisis.if the goals have not been met ,the patient and nurse can
return to the first step assessment and continue through the
phases again.
GENERAL GUIDELINES:-
 The nurse listens carefully to the client and the affective quality of
client presentation
 She uses a strait forward approach to understand the whole
situation including the thoughts, feelings and event.
 She listens carefully without any judgment, altitude, attitude,
feeling and events.
 In case the client talk is not congruent, she allows more time to
enable the client to express what he or she wanted to express.
 She uses language, verbal and nonverbal to demonstrate active
listening.
 She avoids over involvement, wherein on other hand, she avoids
detachment by keeping boundaries between the nurse and client.
SPECIFIC GUIDELINES:-
1. If the client is clearly on the verge of total collapse or self
destructiveness, she initiates emergency interventions but also
only for a necessary to sustain life.
2. In case the client is in distress but not in danger of death
a) She makes the client further clarity and focus on major
problems
b) She elicits from the client experience that might successfully
solves the problem

31. c) She supports the ideas of the client, if they are correct ones.
d) She mutually decides with the client upon a time table for
appointments and an action on the problems.
e) She elicits ideas from the client about possible action.
NURSING INTERVENTIONS FOR CRISIS:-
1. BASIC NEEDS
Provide license to social agencies.
2. PHYSICAL DEFICIT
Attend the physical emergency
Refer to other health care provider as necessary
3. PSYCHOLOGICAL EFFECTS
Shock –listens attentively to crisis impact
Confusion-give nurturing support ,permits regression
Denial-permits intermittent denile,identify patient primary
concerns
Anxiety – provide structural anti anxiety activity
Lethargy- encourage sublimation and constructive activity
4. PROTECTIVE FACTORS
Coping –
Encourage patient’s favoured ,adaptive coping mechanism
Self-efficacy-
Support patient’s previous success and belief in own abilities.
Dilute irrational self deficits
Emphasis practices of expectation to provide results
Support –
Add social support to patient’s world
Provide professional support
Refer for counseling when necessary

32. MODALITIES FOR CRISIS INTERVENTION:-
Community based crisis intervention modalities have recently
been developed .they are based on the philosophy that the health
care team must be active and go out to the patients rather than wait
for the patients to come to them.
Nurses working in these modalities intervene in a variety of
community settings ranging from patients homes to street corners.
1. MOBILE CRISIS PROGRAMS:
Mobile crisis teams provide front line interdisciplinary crisis
intervention to individuals, families and communities .the
nurse who is a member of a mobile crisis team, should be able
to provide on site assessment, crisis management, treatment,
referral and educational services to patients, families and the
community at large. Nurses are thus able to ensure mental
health care for even the most underserved populations
efficiently and cost effectively.
a. Interdisciplinary crisis intervention
b. Provide on-site assessment ,crisis management
c. Treatment, referral and educational services to patient,
family.
2. TELEPHONE CONTACTS:-
Crisis intervention is sometimes practiced by telephone rather
than through face to face contacts .the nurse should have
effective listening skills to provide crisis intervention to victims.
3. GROUP WORK:-
People who have common traits on stressors will form a group.
The group provides an opportunity fro members to express
common concerns and experiences, faster hope and builds
mutual support. The nurses role in the group is active, focal and

33. focused on the present .the nurse and the group help the patient
solve the problem and reinforce new problem and reinforce new
problem solving behavior.
a. Group work as a support system
b. Help patient to solve problem and reinforce the patient
problem solving ability
4. DISASTER RESPONSE:-
As part of the community ,nurses are called on when an
adventitious or social crisis strikes the community.flood
earthquakes,airplane crashes ,fires,nuclear accidents etc
precipate large number of crisis .the nurses has an important
role in dealing with psychosocial problems of disaster
victims.the nurses participates in crisis operations and acts as a
case finder for persons suffering from psychosocial stress.it is
important that nurses in the immediate post disaster period go
to places where victims are likely to gather ,such as hospitals
,shelters,morques.during this period nurses use the generic
approach of crisis intervention so that as many people as
possible can receive help in a short duration of time.
4. VICTIM OUTREACH PROGRAMS:-
Victim outreach programs use crisis intervention techniques to
identify the needs of victims and then to connect them with
appropriate referral and other resources.
Nurse often works in victim outreach programs, where victims
are often seen immediately after the crisis. These victims need
through evaluation, empathetic support and information and
help with large system and social networking system.
5. CRISIS INTERVENTION CENTERS:-
Crisis intervention centers provide emergency psychiatric care and

34. counseling to victims , experiencing extreme stress or conflict
,often involving suicide attempts or drugs or alcohol abuse.these
centers ,which are usually self contained units within a hospital or
community health center,provide services 24 hours a day.the
services may be delivered directly on the premises or counselling
may be provided over the telephone .the primary objective of
crisis intervention centers is to help the person cope with
immediate problem and to offer quidance and support for long-
term therapy.
6.HEALTH EDUCATION:-
Nurses are involved in identifying people who are at high risk for
developing crisis and in teaching coping strategies to avoid the
development of crisis.the public also needs education so that they
can identify those needing crisis services ,be aware of available
services ,change their attitude .so that people will feel free to seek
services and obtain information about how others deal with
potential crisis producing problems.
NURSING DIAGNOSIS:-
The primary nursing diagnoses in crisis intervention are
 Ineffective individual coping
 Ineffective family coping
 Altered family process
 Post trauma response
 Ineffective individual coping refers to the inability to ask for
help ,problem solving or meet role expectations.
 Ineffective family coping occurs when the family’s support
systems are not successful and family’s economic or social
wellbeing is threatened.
 Altered family processes result when the family members are
unable to adapt to the traumatic experiences constructively.
 Posttraumatic response is a sustained response to an

35. Sr.
no
Specific
Objectives
Durati
on
Contents TEACHING
ACTIVITY
Learning
ACTIVITY A V AIDS EVALUATION
16 To conclude the
topic
SUMMARY AND CONCLUSION:-
Today we have discussed meaning of crisis, definition of crisis
intervention, types of crisis and phases of crisis. We also discussed
model, level and techniques of crisis intervention and role of nurse in
crisis situation.
BIBLIOGRAPHY:-
 Fundamental of Mental Health Nursing, Kathy Neeb, F.A
Devis Company. Ppa-Copyrigh4 1-997. Pg. NO; l5215,
158, 289:
 Advanced Practice of Psychiatric Nursing, Ann Wolbert
Burgers, Copyright 1998. Simon & Schuster Company.
Pg. No. 456 -457.
 Review and study Guide. Psychiatric Nursing ( Promoting
Mental Health). Elaine R Zimbler. Copyright 1997, Simon
& Schuster Company, Pg. No. 263 -268.
 Gelden. Michael, Dennis Geth and Richard May on,
Oxford textbook of Psychiatric, 2’ edition, 1989. Pg. No.
705—706.
 Suzane, Lego, The American Handbookof Psychiatric
Concludes
the topic
Listens
overwhelming traumatic event.

36. Nursing, J.B. Lippincot Company, Philadelphia, 1998.
Pg,No. 235 -240.
 Park, J.E and K.Park, Textbookof Preventive and Social
Medicine, Copyright 2001, lXth edition.
 Shah and Henen Shah. A hand bookof Psychiatric, 2m1
edition, J.B Pñnter, Bombay, 1988. Pg.No.84 -86.
 The Nursing Journal of India, Vol.XCVI No.3 April
2000.