8. Crisis Intervention

Question 1

• …it is a disturbance caused by a stressful event or a perceived threat.
• …it is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.

Answer 1

A Crisis

Question 2

Characteristics of a Crisis:

Answer 2

• Time limited: Generally lasting no more than six weeks.
• Typical phases:
• Traditional attempt to solve problem
• Attempts to try alternative methods
• Disorganization
• People are more open to change
• Opportunity to resolve previously unresolved issues
• Successful experience

Question 3

Types of Crises:

Answer 3

• Maturational
• Situational
• Adventitious (rare/unexpected/disastrous)

Question 4

• …this type of crisis has to do with the predictable transitions individuals experience as they move from one stage of human development to another.

Answer 4

Maturational crisis

• Transitional periods during adolescence, parenthood, marriage, midlife, and retirement are key times for the onset of maturational crisis.

Question 5

• …this type of crisis arises from an external source and are events or circumstances that threaten the physical, social, and psychological integrity of individuals.
• These events may originate in the physical body as a result of disease or injury or in social or emotional situations, such as the loss of a job or the death of a child.

Answer 5

Situational crisis

Question 6

• …..this type of crisis has been called events of disaster. They are rare, unexpected happenings that are not part of everyday life and may result from:

1) Natural disasters, such as floods, fires, and earthquakes.

2) National disasters, such as airplane crashes, riots, and wars.

3) Interpersonal disasters, such as assault and rape.

4) Acts of terrorism.

Answer 6

Adventitious crisis

Question 7

Personality disorganization:

Answer 7

If the problem is not resolved and new coping skills are ineffective, anxiety may overwhelm individuals and lead to serious disorganization, confusion, depression, or violence against themselves as suicide or others.

Question 8

At the end of the crisis period there are 2 outcomes:

Answer 8

- Disorganization which can lead to bad health.

- Growth due to past balance.

Question 9

• Crisis intervention is a:
• The goal of crisis intervention is:

Answer 9

- …..short-term therapy focused on solving the immediate problem. It is usually limited to 6 weeks.

• It is also an emergency first aid for mental health , It requires that the person experiencing the crisis receive timely and skillful support to help cope with his/her situation before physical or emotional deterioration occurs.

GOAL

• ….for the individual to return to a pre-crisis level of functioning.
• To stabilize the family situation and restore to their pre-crisis level of functioning.
• Opportunity to develop new ways of perceiving, coping, and problem-solving.
• The intervention is time limited and fast paced.
• Nurse must take an active and directive approach.
• The age of the survivors is also important for the nurse to consider when providing crisis intervention.

Question 10

Crisis intervention therefore involves three major components:

Answer 10

• The actual crisis – victim’s perception of an unmanageable situation.
• The individual in crisis
• The helper who provides aid

Question 11

What is the process of crisis intervention?

Answer 11

1. Assessment

2. Intervention

3. Termination

Question 12

This is the first step of crisis intervention process & includes:

• Conducting the interview
• Observations during the interview
• Collecting data
• The skill and technique most essential at this stage is that of focusing while allowing the client to ventilate and express the overwhelming flood of emotions.

Answer 12

Assessment

• Individuals with pre existing psychological problems may have more post disaster health problems.

Question 13

A number of balancing factors are important in the development and resolution of a crisis and should be assessed:

Answer 13

• Precipitating event or stressor
• Patient’s perception of the event or stressor
• Nature and strength of the patient’s support systems and coping resources
• Patient’s previous strengths and coping mechanisms

Question 14

What are the examples of coping mechanisms/techniques used in crisis intervention?

Answer 14

• Catharsis
• Clarification
• Suggestion
• Reinforcement of behavior
• Support of defenses
• Raising self esteem
• Exploration of solutions

Question 15

• The release of feelings that takes place as the patient talks about emotionally charged areas. As feelings about the events are discussed, tension is reduced.
• Example: “Tell me about how you have been feeling since you lost your job.”

Answer 15

Catharsis

Question 16

• Used when the nurse helps the patient identify the relationship among events, behaviors, and feelings.
• Example: “I’ve noticed that after you have an argument with your husband you become sick and can’t leave your bed.”

Answer 16

Clarification

Question 17

• Influencing a person to accept an idea or belief.
• Example: “Many other people have found it helpful to talk about this and I think you will, too.”

Answer 17

Suggestion

Question 18

Reinforcement of behavior

Answer 18

• Occurs when healthy, adaptive behavior of the patient is reinforced by the nurse, who strengthens positive responses made by the patient by agreeing with or positively acknowledging those responses.
• Example: “That’s the first time you were able to defend yourself with your boss, and it went very well. I’m so pleased that you were able to do it.”

Question 19

• Helping the patient regain feelings of self-worth by communicating confidence that the patient can find solutions to problems.
• Example: “You are a very strong person to be able to manage
  the family all this time. I think you will be able to handle this
  situation, too.”

Answer 19

Raising self-esteem is a particularly important technique.

Question 20

Exploration of solutions

Answer 20

• It is essential because crisis intervention is geared toward solving the immediate crisis.
• The nurse and patient actively explore solutions to the crisis. Answers that the patient had not thought of before may become apparent during conversations with the nurse as anxiety decreases.
• For example, a patient who has lost his job and has not been able to find a new one may become aware of the fact that he knows many people in his field of work whom he could contact to get
  information regarding the job market and possible openings.

Question 21

TRUE/FALSE

• The goal of intervention is to restore the person to pre-crisis level of equilibrium, not of personality changes.

Answer 21

TRUE

Question 22

Nursing Diagnoses for Patient in Crisis

Answer 22

Insomnia
Disturbed sleep pattern
Sleep deprivation
Acute confusion
Disturbed personal identity
Powerlessness
Risk for powerlessness
Hopelessness
Risk for loneliness
Situational low self-esteem

Disturbed body image
Impaired social interaction
Fear
Anxiety
Ineffective coping
Risk for injury
Risk for other-directed violence
Risk for self-directed violence
Risk for suicide