1. Crisis Intervention RNSG 2213

2. Define Crisis v An internal disturbance caused by a stressful event in which an individual’s usual coping skills don’t work v Anxiety level is high and problem-solving is usually impaired v Crisis is both a danger and an opportunity v Crisis theory/principles also may be applied to groups or communities

3. Types of Crisis v Maturational or developmental; adolescence, marriage, parenthood, etc. v Situational Crisis; loss of job, loss of loved one, divorce, homelessness, acute severe illness (health crisis), etc. v Adventitious Crisis: -mass disasters: fire, flood, tornadoes, war, airline crash; -unexpected, traumatic event such as crime or rape, etc.

4. Purpose of Crisis Intervention v...to prevent illness: both physical and emotional. Illness results from being overwhelmed and from maladaptive coping

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

6. Balancing Factors v Some events become crisis and some don’t depending on Balancing Factors: – Perception of the Event – Situational Supports – Coping mechanisms

7. 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 

8. Assessment of Balancing Factors v Perception of Event – cognitive/intellectual skills – ability to maintain self-image and sense of purpose – ability to redefine the event v Situational Supports – How well does patient utilize other people for support?

9. Assessment of Balancing Factors v Coping Skills – Does client have 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

10. Balancing Factors 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 serious injuries v Two residents in their twenties spoke with the nurse in the ED....

11. Balancing Factors Scenario Client “A” v Perception : “I lost my home, but I’m safe and that’s what matters.” 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 it was a bad neighborhood. He says no wonder there was a fire.” v Coping: “Now what do I do? I can’t think straight about this.”

12. Clinical Example: Keltner v See Keltner, 6 th edition, p. 90 v Identify Adaptive, Palliative, Maladaptive and Dysfunctional coping behaviors of the client in crisis portrayed in the example.

13. Principles: Crisis Intervention v Focus is on the “Here and Now” v Past traumas may create a current crisis, BUT v Crisis counselors do NOT explore early life events v Assumption is that client will be able to cope if given necessary basic information and support.

14. Crisis Intervention Principles, cont’d v Length of crisis treatment is no more than 6 weeks v Client usually very receptive to help; May be open to change v Excellent time for teaching, referrals

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