Crisis Intervention RNSG 2213

Define Crisis v An internal disturbance caused by a stressful event or perceived threat to self in which an individual’s usual coping skills don’t work, precipitating in an increase in anxiety. v Crisis in both a danger and an opportunity v In Chinese, the characters are the same.

Types of Crisis v Maturational or developmental; adolescents, marriage, parenthood v Situational Crisis; loss of job, loss of loved one, divorce, v Adventitious Crisis: mass disasters; fire, flood, etc. Unexpected traumatic event, e.g. crime, rape

Purpose of Crisis Intervention v The purpose of crisis intervention is to prevent illness; both physical and emotional. v Study of survivors of a hotel fire is basis for this content. Researcher found that individuals that handled the crisis without developing an illness did some things differently than those who got sick.

Three Levels of Prevention v Primary Prevention: Prevents illness from occurring v Secondary Prevention: Early Dx and treatment v Tertiary Prevention: Rehabilitate to get patient to highest level of wellness possible

Balancing Factors v Some events become crisis and some don’t, depending on Balancing Factors – Perception of the Event – Situational Supports – Adequate coping mechanisms

CRISIS INTERVENTION BALANCING FACTORS  Perception of event realistic  Situational support adequate  Coping mechanisms adequate No crisis  Perception of event distorted  Situational support inadequate  Coping mechanisms inadequate Crisis

Assessment of Balancing Factors v Perception of Event – Cognitive skills – Maintains self image and sense of purpose – Redefines the event v Situational Supports – How well does patient utilize other people for support?

Assessment of Balancing Factors v Coping Skills – Ability to express strong emotions – Preferred modes: does client prefer or have skill with actions, like exercise, writing, crying, talking? – Ability to tolerate uncertainty – Problem solving ability; making plans

CRITICAL THINKING v In the following scenario, compare the balancing factors that influence each clients’ response to the crisis situation.

Balancing Factors: Crisis Scenario v There was a fire at an apartment building which severely damaged it. v Residents were brought to the emergency department for evaluation for possible smoke inhalation. Fortunately, there were no injuries. v Two residents in their twenties spoke with the nurse in the ED

Same Event: Two Individuals Client “A” v Perception: “I lost my home but I still have my health and my work.” v Supports: “My church is already taking up a collection.” v Coping: “The first thing I’m going to do when I leave here is blog about this incredible experience.” Client “Z” v Perception: “I lost everything that means anything to me.” v Supports: “My Dad always told me to move out. He says no wonder there was a fire.“ v Coping: “Now what do I do? I can’t think straight about this. It is too much.”

Principles: Crisis Intervention v Crisis counselors do NOT explore early life events v Focus is on the “Here and Now” v Past traumas may create a current crisis v Crisis therapists assume that clients will be able to cope if given information and support.

Crisis Intervention Principles, cont’d v Length of crisis treatment is usually no more than 6 weeks v Clients often very receptive to help. v Excellent time for teaching, referrals

Primary and Secondary Prevention : Community Resources v Disaster planning for vulnerable populations v Walk-in centers, Emergency services v 24 hr. Hotlines v Disaster teams, go-to mobile services

Crisis Case v Seven year old Sarah is in the hospital for asthma and respiratory infection. The nurse learns that one week prior to her hospitalization, her parents informed her they are getting a divorce and her father moved out of the home.

Crisis Intervention for Family v Perception of event v Situational Supports v Coping strategies