CRISIS and crisis interventions for nursing students

the document includes definition, characteristics, types, phases, crisis proneness, resolution and crisis interventions and nurses role

1. CRISIS 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 Crisis is a sudden event in one’s life that disturbs homeostasis, during which usual mechanisms cannot resolve the problem. - Lagerquist , 2012

2. Characteristics of crisis Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology. Crises are precipitated by specific identifiable events. Crises are personal by nature. What may be considered a crisis situation by one individual may not be so for another. Crises 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.

3. TYPES of CRISIS Maturational Crisis / Developmental crisis Situational Crisis / Dispositional crisis Social Crisis Crises Reflecting Psychopathology

4. CONT.. Maturational Crisis / Developmental crisis The transition points where individuals move into successive stage often generate disequilibrium. For example: adolescence, marriage, parenthood, midlife and retirement. Individuals are required to make cognitive and behavioral changes and to integrate those physical changes that accompany development.

5. CONT.. Situational Crisis / Dispositional crisis A situational crisis is one that is precipitated by an unanticipated stressful event that creates disequilibrium. Examples of events that can precipitate situational crises are premature birth, status and role changes, death of a loved one, physical or mental illness, divorce, change in geographic location and poor performance in school.

6. CONT.. 3. Social Crisis Social crisis is accidental, uncommon, and unanticipated and results in multiple losses and radical environmental changes. Social crises include natural disasters like floods, earthquakes, violence, nuclear accidents, mass killings, contamination of large areas by toxic wastes, wars, etc.

7. CONT.. Crises Reflecting Psychopathology A crisis that is influenced or triggered by preexisting psychopathology. Examples of psychopathology that may precipitate crises include personality disorders, anxiety disorders, bipolar disorder and schizophrenia.

8. Crisis Proneness Dissatisfaction with employment or lack of employment. History of substance abuse. Poor self-esteem, unworthiness. Superficial relationship with others. Difficulty in coping with everyday situations. Lack of support systems. Emotional a loofness.

9. phases of CRISIS Phase 1: The individual is exposed to a precipitating stressor that generates increased anxiety. Previous problem-solving techniques are employed. if unsuccessful, the individual moves into phase 2.

10. CONT.. Phase 2: When previous problem-solving techniques do not relieve the stressor, anxiety increases further. 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 reduction, the individual enters phase 3.

11. CONT.. Phase 3: All possible resources, both internal and external are called on to resolve the problem and relieve the discomfort. The individual may try to view the problem from a different perspective. New problem-solving techniques may be used, if effective, resolution may occur at this phase. If problem solving is unsuccessful, further disorganization occurs and the individual is said to have entered phase IV.

12. CONT.. Phase 4: If resolution does not occur in previous phases, anxiety may reach to the panic levels. Profound cognitive, emotional and physiological changes may occur. Referral to further treatment resources is necessary.

13. Signs and Symptoms of Crisis Anxiety D epression, anger and guilt. I ncapability of taking care of individual’s daily needs Neglect his/ her responsibilities. The individual become irrational and blame others for what has happened to him .

14. Factors affecting crisis resolution The individual’s perception of the event. The availability of the situational support The availability of adequate coping mechanism.

15. Types of crisis resolution Pseudo-resolution Unsuccessful Resolution Successful Resolution

16. CONT.. Pseudo-resolution: In this, the individual uses repression and pushes out of consciousness the incident and the intense emotions associated with it. But in future, if and when a crisis occurs, the repressed feelings may influence the feelings aroused by the new crisis.

17. CONT.. 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 is prolonged grief reaction, which results in depression.

18. CONT.. Successful Resolution In 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 individual develops better skills and problem solving ability, which can be used in various crisis situations in future.

19. 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.

20. Aims of crisis intervention To provide a correct cognitive perception of the situation To assist the individual in managing the intense and overwhelming feelings associated with the crisis.

21. Principles of crisis intervention Be specific, use concise statements. Listen for facts and feelings: seeking clarification, paraphrasing and reflection are effective strategies. Allow sufficient time for the individuals to process information. Help patients legitimize feelings by letting them know that others in similar situations have experienced comparable emotions. Assist the person in confronting reality. Encourage the person to focus on one implication at a time. Empower person by allowing them to make informed choices.

22. Techniques of Crisis Intervention Catharsis: The release of feelings that takes place as the patient talks about emotionally charged areas. Clarification: Encouraging the patient to express more clearly the relationship between certain events. Manipulation: Using the patient's emotions, wishes or values to benefit the patient in the therapeutic process.

23. Techniques of Crisis Intervention Reinforcement of behavior: Giving the patient positive reinforcement to adaptive behavior. Support of defenses: Encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or maladaptive. Exploration of solutions: Examining alternative ways of solving the immediate problem.

24. Phases of crisis intervention / role of Nurse Phase 1: Assessment Whether the person is in crisis or not Precipitating event or stressor Assessment of three factors Patient’s perception of the event or stressor Nature and strength of the patient's support systems Adequate coping resources: identification of strength and weakness of the person.

25. CONT.. Phase 1: Assessment Assessment of need of the patient Biological and physiological need Safety and security needs Role performance need Self-esteem need Dependency need

26. CONT.. Phase 2: Planning Based on facts of the situation, formulate goal for the resolution of the stressor. Alternative solutions to the problem are explored. Determine risk and benefits of each alternative solution. Select the best alternative solution. 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.

27. CONT.. Phase 3: Intervention Environmental Manipulation: It includes interventions that directly change the patient's physical or interpersonal situation. These interventions may remove 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 temporarily removed from that stressful situation. General Support: The nurse uses warmth, acceptance, empathy and reassurance to provide general support to the patient.

28. CONT.. Phase 3: Intervention Generic Approach: It applies a specific method to all individuals faced with a similar type of crisis (for example, in social disasters). Debriefing is a method of generic approach. In debriefing method disaster victims are helped to recall events and clarify the traumatic experiences. Individual Approach: It is similar to the diagnosis and treatment of a specific problem in a specific patient. It is particularly useful in combined situational and maturational crises.

29. CONT.. Phase 4: Evaluation The nurse and patient review the changes that have occurred. Signs and symptoms are eliminated Precipitating factors gone away Needs are fulfilled New coping strategies learnt. If the goals have not been met, the patient and nurse can return to the first step-assessment and continue through the phases again.