Crisis Intervention LECTURE NO.8

Learning Objectives Define crisis Name the types of crisis Describe the various phases of crisis Describe various steps in the nursing process in relation to crisis

Definitions Crisis is an acute, short-lived and overwhelming emotional reaction to a situation or an event. A sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem.

Types of Crisis MaturationalSituationalAdventitious

Maturational Crisis This relates to the process of maturation and passing through various stages of the life cycle. Coping skills used earlier may no longer be helpful and appropriate. This leads to anxiety or crisis. Adolescence, marriage, becoming a parent and retirement are some of the examples of maturational crises.

Situational Crisis Is precipitated by various life events and is not anticipated Change of job, loss of job, divorce, financial loss, death of a loved one and major physical illnesses are some of the life events that can lead to situational crisis.

Adventitious Crisis 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 adventitious crisis include earthquake, flood, airplane crashes, rape, murder, war, riots and terrorism.

Phases of Crisis Caplan (1964) described four phases of crisis: i.When faced with a problem that seems to be unsolvable, ‘tension’ starts and anxiety mounts. The person attempts more and more to solve the situation.

Phases of Crisis (cont.) ii.Anxiety increases further with impairment of function and results in disorganization and distress. If anxiety and arousal are in excess, it hinders coping behaviour. iii.Emergency measures are taken and new coping skills are tried. iv.Failure to resolve the crisis leads to further deterioration, disorganization and decompensation.

Application of the Nursing Process 1. Nursing Assessment –Determine the severity of the crisis –Assess the risk for suicide/homicide –Assess patient’s perception of the precipitating events –Assess the patient’s coping skills –Assess the available support system

Application of the Nursing Process (cont.) 2. Nursing Diagnosis Various nursing diagnosis in a patient with crisis include: –Anxiety –Ineffective coping –Inability to meet role expectations –Inability to carry out routine activities

–Decreased socialization –Low self-esteem –Risk to self Application of the Nursing Process (cont.)

3. Nursing Outcome –Set short-term and long-term goals with patient and the family –Goals should be realistic, culturally relevant and meet the patient’s level of functioning –Nursing Outcome Classification (NOC) can be used to help set the outcome goals.

Possible Outcome Criteria in Crisis Intervention Short Term Refrains from harming self or attempting suicide Level of anxiety goes down Sleeps better Becomes more coherent and organized Interacts better with others Able to see some hope in life Long Term Feels safe even when alone Sleep and appetite patterns are back to pre-crisis level Learns new coping skills Able to carry out roles at home and at the workplace Has confidence in self to handle life and problems effectively

Application of the Nursing Process (cont.) 4. Nursing Intervention –Crisis intervention is a brief psychiatric treatment to forestall the process of mental decompensation in severe emotional stress. –Two basic aims of crisis intervention are safety and anxiety reduction. –Nursing interventions in a crisis can be carried out at three levels.

Levels of Crisis Intervention Primary level: promotes mental well- being and reduces the incidence of crisis Secondary level: works towards preventing prolonged anxiety, diminished efficacy and personality disorganization. Tertiary level: aims at providing support to patients recovering from a crisis

Application of the Nursing Process (cont.) 5. Evaluation –To judge the effectiveness of the crisis intervention strategies used –Usually carried out 4–8 weeks after the initial assessment –Nurse may decide to follow up with patient or refer to other agencies

Crisis Stabilization People with mental illness are more prone to crisis. The nurse can adapt the crisis model by taking the following steps: –Clarify the reality of the situation –Make the patients aware of own capabilities and social support available

–Set realistic goals according to level of functioning –Take up responsibility and help the patient for the initial period Crisis Stabilization (cont.)