Crisis intervention

Crisis intervention

1. CRISIS INTERVENTION Presenter: Aruna Shastri M.Sc Nsg1 st yr.

2. Stressful situation are part of everyday life. Any stressful situation can precipitate crisis. Crisis Problem Emergency Introduction

3. According to Larngerquist Crisis is a sudden event in one’s life that disturbs homeostasis, during which the individual’s usual coping mechanisms cannot resolve the problem. Definition

4. Crisis occurs in all the individuals. Its is not always related to psychopathology. Crisis are precipitated by specific identifiable events. It’s an integral component of everyday life situations. Characteristics of crisis

5. Crises are personal by nature. Crises are acute and it gets resolved by within a brief period. A crisis situation contains the potential for psychological growth or deterioration. Characteristics of crisis

6. By Hendricks… Lack of employment Poor self-esteem, unworthiness Superficial relationship Difficulty in coping Under utilization of resources Aloofness and lack of caring History of unresolved crisis and drug abuse. Crisis proneness

7. Phase 1:The individual is exposed to a precipitating stressor Anxiety increases and the previous problem solving techniques are used Phases in the development of a crisis

8. When the previous problem solving techniques do not relieve the stressor ,anxiety increases further . The individual begins to feel great deal of discomfort at this point. Coping techniques that have worked in the past are attempted . When they are not successful ,that will create feeling of helplessness. Phase 2

9. All possible resources both internal and external ,are called on to solve the problems and relieve the discomfort . The individual may try to look at the problem from different perspectives. New problem solving techniques are used. If it is effective the individual will come out of the stressful situation Phase 3

10. If resolution does not occur ,the tension mounts beyond then threshold and individual reaches to a breaking point. Anxiety will reach to a panic level. Cognitive functions get disordered. Behavior may reflect psychotic thinking. Phase 4

11. Baldwin in 1978 has identified six classes of emotional crisis. Class 1: Dispositional crisis It is an acute response to an external situational stressor. E.g. physical and verbal abuse from husband. Types of crisis

12. Maturational crisis Normal life cycle transitions that may be anticipated but over which the individual may feel a lack of control. Eg : becoming a parent Class 2

13. Crisis resulting from traumatic stress. Crisis precipitated by unexpected external stresses over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated. Eg :victim of a rape Class 3

14. Maturational or developmental crisis It occurs in response to situations that trigger emotions related to unresolved conflicts in one’s life. These crisis are of internal origin and reflect underlying developmental issues that involve dependency , sexual identity , capacity for emotional intimacy etc.. Class 4

15. Crisis reflecting psychopathology Emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crises. Or psychopathology may complicates the adaptive resolution Eg :borderline personalty,neuroses etc Class 5

16. Psychiatric emergencies Crisis situation in which general functioning has been severely impaired. Individual is unable to assume personal responsibility. Eg : suicidal individuals, alcohol intoxication etc Class 6

17. Social Crisis Accidental, uncommon, and result in multiple losses. eg : Floods, earthquakes, violence and mass killings etc.

18. Heavy burden of free floating anxiety. Depression. Anger. Incapability in ADL. Irrational and blaming others. Signs and symptoms of crisis

19. Factors responsible for an individual’s experience of a crisis The individual’s perception of the event. The availability of situational support. The availability of adequate coping mechanisms Balancing factors

20. The effect of balancing factor in a stressful event Realistic Adequate effective Unrealistic Inadequate ineffective Balancing factors Individual’s perception of the event Support system Coping mechanisms Problem is resolved No crisis Problem is unresolved Crisis Precipitating event

21. Pseudo-resolution Uses repression Relapsing of feelings Types of Resolution

22. Unsuccessful resolution pathological adaptation eg : prolonged grief leads to depression Types…

23. Successful resolution

24. Technique used to help an individual or family to understand and cope with the intense feelings that are typical of a crisis. Crisis intervention

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

26. a) Assessment of the situation direct questioning support systems strengths and limitations 1. Steps to provide a correct cognitive perceptions

27. b) Defining the event review of incidents to make aware of the event Step 1…

28. c) Develop a plan of action Include all the support Step 1…

29. a) Helping the individual to be aware of the feelings identify his own feelings appropriate communication techniques observe verbal and non verbal behavior . 2. Steps to assist the victim in managing the intense feelings

30. b) Helping the individual to attain mastery over the feelings Avoid false re assurance Not encourage to blame others Prevent too much dependency Environmental manipulation Follow up

31. Phase 1 : Assessment Gather information regarding the precipitating stressor Resulting crisis that prompted the individual to seek help. Role of the nurse in each phases

32. Describe the event that precipitated crisis? When it occurred? Assess physical and mental status Determine whether the individual has experienced this stressor before? If ,how did he cope? Have these methods been tried this time? Questions to be asked

33. Assess suicide or homicide? Support system? Level of pre-crisis functioning? Individual’s perception of personal strengths and limitations? H/o substance use? Contd …

34. Risk for injury Anxiety Fear Disturbed thought process Risk for post trauma syndrome Ineffective community coping Risk for self or other directed violence Possible nursing diagnoses

35. Selects appropriate nursing action for the identified nursing diagnoses The type of crisis and individual’s strength and available resources for support are taken into consideration Phase 2 Planning of therapeutic interventions

36. Environmental manipulation General support Generic approach Debriefing Individual approach Phase 3 Interventions

37. Catharsis Clarification Manipulation Reinforcement of behavior Support of defences Increasing self esteem Exploration of solutions Techniques of crisis interventions

38. Reassessment is made to see if the stated objectives were achieved Have positive behavioral changes occurred ? New coping strategies have been effective? Phase 4 : Evaluation Of Crisis Resolution

39. Has the individual gained insight out of experience? Does the individual believe that he could respond with healthy adaptation in future stressful situation to prevent the development of crisis? Can he describe a plan for dealing with similar stress in the future? Phase 4 : Evaluation Of Crisis Resolution

40. Mobile crisis programs For individuals, families and communities Modalities of crisis interventions

41. Telephone contacts Modalities….

42. Group work Modalities ….

43. Disaster response Modalities ….

44. Victim outreach program Modalities ….

45. Crisis intervention centers Save India Family Foundation, Banglore . Sumaitri , Delhi Lifeline Foundation, Kolkata Maithri,Kerala Health education Modalities ….

46. Crisis intervention is more than a shoulder to cry on, a hand to hold, or an ear with which to listen. It involves skill and knowledge, combined in a simple but powerful way, providing victims with a sense of safety and security. Conclusion

47. Definition Characteristics of crisis Phases of crisis Types of crisis Balancing factors Crisis intervention and role of nurse Summary

48. Mary C Townsend,Psychiatric Mental Health Nursing,4 th edition,F.A Davis publication;page no:194 to 205 Gail W,stuart,Michele T Lararia,principles and practice of psychiatric nursing ,8 th edition,Elsevier pub;page no:222 to 237 References

49. Thank you