Crisis intervention

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1. CRISIS AND CRISIS INTERVENTION

2. Introduction 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.

3. Crisis A sudden event in one’s life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem.

4. Characteristics of crisis 1. Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology. 2. Crises are precipitated by specific identifiable events . 3. Crises are personal by nature. What may be considered a crisis situation by one individual may not be so for another. 4. Crises are acute, not chronic, and will be resolved in one way or another within a brief period. 5. A crisis situation contains the potential for psychological growth or deterioration.

5. PHASES IN THE DEVELOPMENT OF A CRISIS The development of a crisis situation follows a relatively predictable course. Caplan (1964) outlined four specific phases through which individuals progress in response to a precipitating stressor and that culminate in the state of acute crisis.

6. PHASES IN THE DEVELOPMENT OF A CRISIS Phase 1: The individual is exposed to a precipitating stressor. Anxiety increases; previous problem-solving techniques are employed. Phase 2: When previous problem-solving techniques do not relieve the stressor, anxiety increases further. The individual begins to feel a great deal of discomfort.

7. Phase 3: All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. Phase 4 : If resolution does not occur in previous phases, “the tension mounts beyond threshold or its burden increases over time to a breaking point. Major disorganization of the individual with drastic results occurs.”

8. Types of Crises Baldwin (1978) identified six classes of emotional crises , which progress by degree of se verity. Class 1: Dispositional Crises Definition An acute response to an external situational stressor. For   example: dispositional crisis  occurs when a house is under fire, or when a partner have an abusive relationship with another partner.

9. Class 2: Crisis of Anticipated Life Transitions Definition: Normal life-cycle transitions that may be anticipated but over which the individual may feel a lack of control . These are normative, developmental crises that are fairly common in our society. They may result from midlife career changes, getting married, becoming a parent, divorce, the onset of chronic or terminal illness, or changing schools.

10. Class 3: Crises Resulting From Traumatic Stress Definition: These crises result from externally imposed stress situations that are unexpected, uncontrolled, and emotionally overwhelming. Examples are rape, assault, sudden death of a loved one, sudden loss of job status, sudden onset of illness, accident, war.

11. Class 4: Maturational/Developmental Crises Definition Crises that occur in response to situations that trigger emotions related to unresolved conflicts in one’s life. These crises are of internal origin and reflect underlying developmental issues that involve dependency , value conflicts, sexual identity, control , and capacity for emotional intimacy . Examples are the repeated loss of jobs because of an inability to get along with supervisors, the intense homesickness or depression of college students away from home for the first time, and midlife crises.

12. Class 5: Crises Reflecting Psychopathology Definition Emotional crises in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution. Examples of psychopathology that may precipitate crises include personality disorders, anxiety disorders, bipolar disorder , and schizophrenia.

13. Class 6: Psychiatric Emergencies Definition: Crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility . Examples include acutely suicidal individuals , drug overdoses, reactions to hallucinogenic drugs , acute psychosis , uncontrollable anger, and alcohol intoxication.

14. Signs and symptoms of crisis Heavy burden of free floating anxiety Depression Anger, guilt Use various coping mechanisms, healthy or unhealthy. Incapable of taking care of daily needs Neglect responsibilities. Irrational and blame others for what was happened to him.

15. Resolution of crisis Healthy resolution of crisis depends upon the following three factors: 1. Realistic appraisal of the precipitating event 2. Availability of support systems 3. Availability of coping measures over a lifetime

16. There are three ways by which the individual may resolve the crisis. *Pseudo- resolution * Unsuccessful resolution * Successful resolution

17. Pseudo resolution In this the client uses repression and pushes out of consciousness the incident and the intense emotions associated with it, resulting in the individual functioning at the same earlier level. But in future any crisis may be more difficult to resolve because the feelings associated with the earlier crisis are neither expressed nor handled at that time.

18. Unsuccessful resolution The victim uses pathological adaptation at any phase of crisis, resulting in a lower level of functioning. An example is prolonged grief reaction, which results in depression.

19. Successful resolution The victim may go through the various phases of crisis, various coping measures are utilized to resolve the crisis situation. The victim develops better skills and problem solving ability, which can be used in various crisis situations in future.

20. Crisis Intervention Crisis intervention refers to the methods used to offer immediate, short-term help to individuals who experience an event that produces emotional, mental, physical, and behavioral distress or problems.

21. Goal of Crisis intervention The goal of crisis intervention is the resolution of an immediate crisis. Its focus is on the supportive, with the restoration of the individual to his pre-crisis level of functioning or possibly to a higher level of functioning . The therapist’s role is direct, supportive, and that of an active participant.

22. Principles of crisis intervention Be specific Encourage the expression of feelings Allow sufficient time for the individuals to process information and ask questions . Assist the person in confronting reality. Encourage the person to focus on one implication at a time.

23. Techniques of crisis intervention Catharsis: the process of releasing, and thereby providing relief from, strong or repressed emotions. Clarification: the action of making a statement or situation less confused and more comprehensible. Manipulation: the action of improving the skills of a person Support of defenses Reinforcement of behaviors Increasing self –esteem Exploring solutions

24. Three major components of Crisis intervention: A stressful event alone does not constitute a crisis; rather, crisis is determined by the individual’s view of the event and response to it. ( Smead , 1988). The actual crisis – victim’s perception of an unmanageable situation, The individual in crisis, and The helper who provides aid.

25. PHASES OF CRISIS INTERVENTION: THE ROLE OF THE NURSE Phase 1. Assessment In this phase, the crisis helper gathers information regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help.

26. Some nursing diagnoses that may be relevant include: ● Ineffective coping ● Anxiety (severe to panic) ● Disturbed thought processes ● Risk for self- or other-directed violence ● Rape-trauma syndrome ● Post-trauma syndrome ● Fear

27. Phase 2. Planning of Therapeutic Intervention In the planning phase of crisis intervention, 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 pre-crisis level of functioning.

28. Phase 2. Planning of Therapeutic Intervention Objectives: 1. The client experiences minimal or no injury to self. 2. Demonstrates behaviors necessary to protect self from further injury. 3. Maintains anxiety at manageable level 4. Expresses beliefs and values about spiritual issues. 5. Demonstrates ability to deal with emotional reactions in an individually appropriate manner.

29. Phase 3. Intervention During phase 3, the actions that were identified in phase 2 are implemented. The following interventions are the focus of nursing in crisis intervention: Use a reality –oriented approach Remain with the individual who is experiencing panic anxiety. Establish a rapid working relationship by showing unconditional acceptance, by active listening, and by attending to immediate needs. Discourage lengthy explanations, promote an atmosphere for verbalization of true feelings.

30. Set limits on aggressive, destructive behaviors. Assess for any suicidal/ homicidal thoughts or plans. Determine degree of anxiety Determine presence of physical symptoms Identify psychological responses Engage client in learning new coping behaviors- progressive muscle relaxation, thought-shopping. Encourage use of techniques to manage stress. Give positive feedback when client demonstrates better ways to manage anxiety .

31. Phase 4: Evaluation of crisis resolution and anticipatory planning . During this period the nurse and client summarize what has occurred during the intervention. A determination is made regarding follow –up therapy; if needed, the nurse provides referral information

32. MODALITIES OF CRISIS INTERVENTION 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.

33. 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.

34. Group work People who have common traits on stressors will form a group. The group build mutual support. The nurse and the group help the patient solve the problem and reinforce new problem solving behavior.

35. Disaster response Nurse are called on when an adventitious or social crisis strikes the community . 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.

36. Victim outreach program Uses crisis intervention techniques to identify the needs of the victims and then to connect them with appropriate referrals and other resources.

37. Crisis intervention centers It provide emergency psychiatric care and counseling to victims, experiencing extreme stress or conflict , often involving suicide attempts or drug or alcohol abuse. These centers provide services 24 hours a day .

38. Health Education Nurses identify the people are at risk for developing crisis and in teaching coping strategies to avoid the development of crisis.