Crisis Intervention Flashcards
Types of Crisis Situations
- Situational
- Maturational
- Adventitious
Maturational Crisis
▪A process of maturation occurs across the life cycle
▪Examples include starting school, experiencing puberty, leaving home, getting married, becoming a parent, losing physical youthfulness & entering retirement.
Situational Crisis
▪A situational crisis is a response to a traumatic event that is usually sudden & unavoidable.
▪It usually follows the loss of an established support or role.
▪The threat or loss of a role viewed as necessary to maintain self-image usually will lead to a crisis state.
▪Situations that affect the way people perceive themselves include loss of a job, failure in school, loss of a spouse, birth of a retarded child, or diagnosis of a terminal or chronic illness.
Adventitious Crisis
- Crisis of disaster, unplanned and/or accidental.Natural disaster (earthquake, flood, fire)
- National disaster (acts of terrorism, war, riots, airplane crash)
- Crime of violence (rape, assault or murder, bombing, spousal or child abuse
Adventitious Crisis: Post Traumatic Stress
▪Person experiences or witnesses a traumatic event and responds with intense fear, helplessness, or horror.
▪May experience flashbacks, or recurrent and intrusive recollections of the event.
▪Conversely, it can lead to greater self-knowledge, improved coping skills, stronger social ties, and changes in values and perspectives.
▪Critical incident debriefing is crucial - cannot be overstressed.
Critical Incident Stress Debriefing
▪A critical incident stress debriefing (CISD) is a group-level crisis intervention carried out very soon following a traumatic event
▪Individuals involved in or witnessing the event (e.g., those in a school, workplace, or emergency responder group) are brought together in a safe and confidential environment to talk about what happened, discuss feelings and behavioural responses, and obtain health education about the crisis process for early intervention purposes
4 Phases of Crisis
Phase 1
▪Response: increased anxiety
▪Behaviour: mobilising problem-solving techniques and defence mechanisms
Phase 2
▪If usual defensive responses fail and the threat persists
▪Response: anxiety continues to rise and produces feelings of extreme discomfort. Individual functioning becomes disorganized
▪Behaviour: Trial-and-error solutions in an effort to restore a normal balance begin.
Phase 3
▪If the trial-and-error attempts fail
▪Response: anxiety can escalate to the severe or panic level
▪Behaviour: mobilize automatic relief behaviours, such as withdrawal and flight. Some form of resolution (e.g., compromising needs or redefining the situation to reach an acceptable solution) may be made in this stage.
Phase 4
▪If the problem remains unresolved and new coping skills are ineffective
▪Response: a state of overwhelming anxiety that can lead to serious personality disorganization, depression, confusion, and behavioural disturbances. This becomes a mental health emergency
▪Behaviour:
▪risk for self-care limitations (e.g., lack of nutrition, exposure to physical risks)
▪risk of self-harm behaviour (e.g., substance abuse, risk of suicide)
▪risk of violence against others
Goals for Crisis Intervention
- rapid resolution of the immediate crisis to prevent further deterioration,
- to understand the power of one’s perception,
- to establish a level of emotional equilibrium equal to or better than the pre-crisis level i.e. ↓ anxiety or distress
- to achieve at least a pre-crisis level of functioning (social, occupational, cognitive & behavioural)
- to promote growth and effective problem solving
- to recognize danger signs to prevent negative outcomes.
▪Specific goals need to be identified by the client and nurse together.
▪
▪The nurse acts as a supporter, educator, advisor, always keeping in mind that it is the client who solves the problem; not the nurse.
▪Do not take over and make decisions unless the person is suicidal or homicidal.
▪The nurse can help the client gain new perspectives on the situation by discussing options and collaborating with the client to find constructive ways to solve the problem.
Self Assessment
▪Monitor YOUR personal feelings and thoughts when dealing with a client in crisis.
▪Know when you are unable to deal effectively with a client’s situation.
▪Eye contact, a non-judgmental attitude, and confidentiality are essential to establishing a therapeutic trusting relationship.
▪Mental health care providers may experience psychological distress from working with traumatized populations, a phenomenon called secondary traumatic stress or vicarious traumatization
▪Supervision and critical incident stress debriefing are strategies that support nurses’ ability to cope with overwhelming violent and disastrous situation
Assessment
▪In your initial assessment, you must assess the potential for suicide or homicide, particularly if there are verbal and/or behavioral indicators.
Rationale: possible need for hospitalization if danger to self or others.
If the client is suicidal or homicidal:
▪Hospitalization - provide a safe non-stimulating environment (low sensory input). May need to be in seclusion.
▪Call the client by name, using a low calm tone of voice
▪Sedatives
▪Check for potential weapons
▪Obtain a “no self-harm” contract
Assess Perception of the Event
▪It is essential to determine the reason the client is seeking help at this time.
▪“Can you tell me what happened that brought you here today.” A chronological approach to the story of the crisis provides order and structure to the event.
▪Collect information that is relevant and aids in understanding the nature of the crisis, which is often involves a theme of loss (loss of control, loss of nurturance, loss of social role, etc).▪“What does this mean to you?”
▪“What impact has this event had on your life right now?”
▪“How has this crisis affected your family life, friendships, and your physical health?”
Assess Situational Support
▪Assess the availability of support systems.
▪“Who do you talk with when you feel sad or overwhelmed?” “Who is available to help you?” “Who is currently the most important person in your life?” “What supports have been helpful in the past?”
▪Rationale: it is important for the nurse to determine if the client has a support system such as family or friends that the client trusts and can turn to now to offer support i.e. shelter, finances, love & affection.
Assess Personal Coping Skills
▪Assess coping skills and patterns of coping. Are they adaptive or maladaptive?
▪Maladaptive coping i.e. overeating, drinking, drugs, fighting, yelling, withdrawing, previous suicidal attempts, etc.
▪Adaptive coping i.e. seeking out someone to talk to, physical activity, relaxation techniques
▪Are they still functioning in life i.e. with a job, school or family?
▪“What do you do when you have a problem?”
▪“What helped you through difficult times in the past?”
▪“What do you do to usually make yourself feel better?”
Crisis Intervention: Mobilize Internal Resources
▪The client’s perception of the event is the factor most amenable to change▪It is important to note that the method of change has to do with how the event is perceived rather than with making a change in the event itself.
▪Examples:
▪Thought stopping (self-directed behavioural approach used to gain control of self-defeating thoughts)
▪Cognitive re-framing (seeing the crisis in a different light).
Allow for expression of feelings:
▪Venting emotions (grief, denial, guilt, anger), journal writing.
▪Anxiety reduction:
▪Stress management techniques to reduce anxiety.
Examples:
▪progressive relaxation
▪breathing exercises
▪guided imagery
▪physical exercise
▪humour
Support systems / Resources:
▪Whether a client emerges stronger or weaker from a crisis is usually based upon the access to and kind of immediate help received during the crisis i.e. family, friends, financial aid.
▪If resources are unavailable, the nurse or counselor acts as a temporary support system while relationships with individuals or groups in the community are established.
▪Another approach to care includes a crisis team - psychiatrist, psychologist, social worker, pastoral services.
Evaluation
▪Have the patient’s expectations been met?
▪Have the therapeutic goals been met?
▪Does the plan need to be re-evaluated?
▪Does the patient require additional or alternative links to community resources and supports?
▪Important to have measurable outcomes
▪Take the opportunity to provide positive reinforcement - it encourages and empowers clients to take responsibility for their health.
▪Assist the client/family to learn from the experience and use feedback to enhance future plans.
