Crisis intervention

CRISIS INTERVENTION

1. By :- Sandhyarani Behera,Sr. Tutor Dept . psychiatric nursing , M HI(COE),SCBMCH,Cuttack CRISIS INTERVENTION

2.  Stressful situations are a part of everyday life. Any stressful situation can precipitate a crisis. Crises result in a disequilibrium from which many individuals require assistance to recover. Crisis intervention requires problem- solving skills that are often diminished by the level of anxiety accompanying disequilibrium. Assistance with problem solving during the crisis period preserves self esteem and promotes growth with resolution. INTRODUCTION

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. MEANING OF CRISIS

4.  “ A sudden event in one’s life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem.” -LAGERQUIST, 2006  DEFINITION

5. Types of crisis There are three types of crisis (1)Maturational or developmental crisis (2)Situational crisis (3)Adventitious crisis

6. 1)Developmental crisis (also referred to as maturational or internal crisis) .  It may occur at any transitional period in normal growth and development  The transitional periods where individuals move into successive stage often generate disequilibrium.

7.  Individuals are required to make cognitive and behavioural changes that accompany development,  precipitate factors are normal stress of development (e.g. Adolescence, marriage, parenthood and retirement,)

8.  Successful progression from early childhood to middle childhood requires the child to become socially involved with people outside the family with the more from adolescence to adulthood, financial responsibility is expected. Both social and biological pressure to change can precipitate a crisis.

9. (2)SITUATIONAL CRISIS A situational crisis (sometimes called accidental or external crisis) is a response to a sudden and unavoidable traumatic event that largely affects a person’s identity and roles.

10.  Examples of events that can participate situational crisis are sudden traumatic event.(eg.unexpected job loss ,serious car accidents, loss of spouse, academic failure, birth of a child with a disability or diagnosis with a chronic or terminal illness) affects how people perceive themselves.

11. (3)Adventitious crisis (social crisis)  Social crisis is accidental, uncommon and unanticipated and result in multiple losses and radical environmental changes.  An adventitious crisis occurs outside the person precipitate by an unexpected event.  eg.Natural disaster,fires,floods,war etc.)

12.  These crises affect many people who experience both acute and post traumatic stress reaction.  This type of crisis is unlike maturational and situational crisis because it doesn’t occur in the lives of all people.

13. FANI AT ODISHA

14. CRISIS INTERVENTION 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 behavioural distress or problems.

15. A crisis can refer to any situation in which individual perceives a sudden loss of his or her ability to use effective problem solving and coping skills

16. 1. To decrease emotional stress and protect the crisis victim from additional stress. 2 .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

17. AIMS To assist the individual in recovery from the crisis and to prevent serious long term problem ..

18. To reduce the intensity of an individual’s emotional, mental, physical, and behavioural reaction to a crisis. ( 2) To help the individuals return to their level of functioning before the crisis.

19. 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 reassure the person that the nurse can help. Listen for facts and feelings ,seeking clarification, paraphrasing and reflection are effective strategies. Allow sufficient time for the individuals involved to process information and questions.

20. Length of time for crisis intervention  The length of time for crisis intervention may range from one session to several weeks, with the 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 hour

21. Place of intervention It can ta k e p l ace in a ra n ge of se t ti n g such as hospital emergency room, counselling centres, mental health clinics, school and social service agencies and crisis centres.

22. Key element of management 1 .Management will depend on the severity and causes of the crisis as well as the individual circumstances of the patient. 2. Many relatively minor crises can be managed by providing friendly support in primary care without referral. 3. However more severe crisis will require referral to c ounsellors or the local mental health team .

23. 4.Crisis therapy includes short term behaviour/ cognitive therapy and counselling . 5.Involvement of family and other key social network very important. 6. Therapy should be relatively intense over a short period and discontinued before dependence on the therapist develops.

24. 7. The risk of suicide and self harm must be assessed at presentation and each review. 8. The aims of treatment are to- Reduce distress Help to solve problems Avoid maladaptive coping strategies e.g. Self harm Improve problem solving strategies

25. Phases of crisis intervention: The role of nurse Phase I: assessment Phase II: Planning therapeutic intervention Phase III: Implementing technique of intervention Phase IV: Evaluation of crisis resolution and anticipatory planning

26. Phase I: Assessment 1. Ask the individual to describe the event that precipitated this crisis. 2.Determine when it occurred. 3. Assess the individual’s physical and mental status. 4.Determine if the individual has experienced this stressor before. If so, what method of coping was used? Have these methods been tried this time? 5.If previous coping methods were tried, what was the result?

27. 6. If new coping methods were tried, what was the result? 7. Assess suicide or homicide potential, plan, and means. 8. Assess the adequacy of support systems. 9.Determine level of precrisis functioning. Assess the usual coping methods, available support systems and ability to problem solve. 10.Assess the individual’s perception of personal strengths and limitations.

28. PhaseII:Planning therapeutic interventions: In the planning phase of the nursing process, the nurse selects the appropriate nursing actions for the identified nursing diagnoses . In planning the interventions, the type of crisis , as well as the individual’s strengths and available resources for support, are taken into consideration. Goals are established for crisis resolution and a return to, or increase in, the precrisis level of functioning .

29. Phase III: Implementing techniques of interventions: 1.Use a reality oriented approach. The focus of the problem is on the here and now. 2.Remain with the individual who is experiencing panic anxiety . 3.Establish a rapid working relationship by showing unconditional acceptance , by active listening, and by attending to immediate needs. 4.Discourage lengthy explanations or rationalizations of the situations; promote an atmosphere for verbalization of true feelings.

30. 5.Set firm limits on aggressive, destructive behaviors. At high levels of anxiety, behavior is likely to be impulsive and regressive. Establish at the outset what is acceptable and what is not, maintain consistency. 6.Clarify the problem that the individual is facing. The nurse does this by describing his/her perception of the problem and comparing it with the individual’s perception of the problem. 7.Help the individual determine what he or she believes precipitated the crisis.

31. Phase IV : Evaluation of crisis resolution and anticipatory planning Have positive behavioral changes occurred? Has the individual developed more adaptive coping strategies? Have they been effective? Has the individual grown from the experience by gaining insight into his or her responses to crisis situations? Does the individual believe that he or she could respond with healthy adaptation in future stressful situations to prevent crises development? Can the individual describe a plan of action for dealing with stressors similar to the one that participated this crisis?

32. Techniques of crisis intervention Catharsis: The release of feelings that takes place as the patient talks about emotionally charged areas.{crying is a great catharsis for releasing pain and anger} Clarification: Encouraging the patient to express more clearly the relationship between certain events. Suggestion: Influencing a person to accept an idea or belief, particularly the belief that the nurse can help and that person will in time feel better. Reinforcement of behaviour: When healthy, adaptive behaviors of the patient is reinforced by the nurse .

33. Support of defences: Encouraging the use of healthy, adaptive defences and discouraging those that are unhealthy or maladaptive . Rising self esteem: Helping the patient regain feelings of self worth e.g.- you are very strong person to be able to manage the family all the time. Exploration of solution: Examining alternative ways of solving the immediate problem.

34. 1. Crisis intervention is a brief, active therapy with the goal of returning the individual to a precrisis level of functioning. 2. In assessing a patient the nurse should identify the patient's behaviors, precipitating event, perception of the event, support systems and coping resource, and previous strengths and coping mechanisms. 3. The expected outcome of nursing care is that the patient will recover from the crisis event and return to a precrisis level of functioning. Levels of crisis intervention include environmental manipulation, general support, generic approach, and individual approach. summary