Crisis Intervention

CRISIS INTERVENTION

CRISIS INTRODUCTION

  • Definition of Crisis:

    • A crisis is an acute phenomenon that pushes a person well beyond their ability to effectively cope with it using their current coping mechanisms.

    • Crises most often resolve within 4-6 weeks.

    • Individuals with mental illness are more susceptible to crises.

  • Categories of Crises:

    1. Situational Crises:

    • Example: Loss of a limb from traumatic amputation.

    1. Maturational Crises:

    • Example: Loss of function as a normal result of aging; children moving out.

    1. Adventitious Crises:

    • Example: Loss of personal possessions from an armed robbery.

  • Goal of Crisis Intervention:

    • The primary goal is to regain the pre-crisis level of functioning.

PHASES OF CRISIS

  • Phase 1:

    • Exposure to a serious stressor leads to an increase in anxiety.

    • The increase in anxiety stimulates the use of usual coping methods and defense mechanisms to address the problem.

  • Phase 2:

    • If usual coping methods and defense mechanisms fail and the threat persists, anxiety further increases.

    • This results in disorganized functioning of the individual.

    • Individuals begin trial-and-error attempts at problem-solving and restoring balance.

  • Phase 3:

    • If trial-and-error attempts fail, anxiety can escalate to severe and panic levels.

    • The person may mobilize automatic relief behaviors like withdrawal and flight.

    • Resolution may occur at this stage, achieved by compromising needs or redefining the situation for an acceptable solution.

  • Phase 4:

    • If the problem remains unsolved and new coping skills are ineffective, anxiety can overwhelm the individual.

    • This may lead to serious personality disorganization, depression, confusion, violence against others, or suicidal behavior.

CRISIS INTERVENTION INTRODUCTION

  • Goals of Crisis Intervention:

    1. Promote a realistic perception of the event.

    2. Ensure adequate situational supports.

    3. Develop adequate coping skills.

CRISIS INTERVENTION - ACUTE CRISIS ASSESSMENT

  • Assessment Objectives:

    1. Determine if the patient can identify the precipitating event.

    2. Assess the patient’s understanding of situational supports.

    3. Identify the patient’s usual coping styles and determine effective coping mechanisms for the situation.

    4. Consider any religious or cultural beliefs pertinent to the crisis assessment and intervention.

    5. Assess the need for:

    • Primary Prevention: Education, environmental manipulation, or new coping skills.

    • Secondary Prevention: Crisis intervention.

    • Tertiary Prevention: Rehabilitation.

ASSESSING PERCEPTION OF THE PRECATIPATING EVENT

  • Importance of Problem Perception:

    • The clearer the person can define the problem, the more likely they can identify effective solutions.

  • Sample Questions for Assessment:

    • What leads you to seek help now?

    • Has anything upsetting happened to you within the past few days or weeks?

    • Describe how you are feeling right now.

    • How does this situation affect your life?

    • How do you see this event affecting your future?

    • What do you hope to gain from this treatment?

ASSESSING SITUATIONAL SUPPORTS

  • Determining Support Systems:

    • Family and friends should be involved when possible, offering emotional or material support.

    • If such resources are unavailable, the nurse may serve as a temporary support person and assist in establishing community relationships.

  • Sample Questions for Assessment:

    • Is there anyone—family or friends—you would like to involve in your care?

    • Have you used a community agency for support before?

    • Do you have any religious affiliations?

    • Are you active in a religious group?

ASSESSING COPING SKILLS

  • Assessment of Coping Mechanisms:

    • Positive coping mechanisms may include seeking someone to talk to, journaling, or engaging in physical activity.

    • Ineffective coping can include overeating, drinking, smoking, withdrawing, yelling, and fighting.

  • Sample Questions for Assessment:

    • What have you been doing to relieve anxiety?

    • What has helped in the past to relieve stress?

    • Did you try it this time? If so, what was different?

    • What helped you through difficult times previously?

CRISIS INTERVENTION - ACUTE CRISIS INTERVENTION

  • Nursing Function in Crisis Intervention:

    • Crisis intervention is a primary function of the psychiatric-mental health registered nurse.

    • The focus is strictly on the present problem with the following initial goals:

    1. Patient Safety:

      • Implement external controls to protect the patient if suicidal or homicidal.

    2. Anxiety Reduction:

      • Utilize anxiety-reduction techniques to enable the patient to mobilize inner resources.

BAD CRISIS OUTCOMES

  • Critical Outcomes Discussion:

    • Just a mention of severe psychological crises such as suicide, homicide, and episodes of violence, which must be prevented.

    • Prevention relies on the nurse's awareness of the person's history, risk factors, warning signs related to acts of violence, and applying this knowledge during care and monitoring.

  • Example Case:

    • Identify and treat individuals with severe depression to mitigate the risk of suicide and violent acts, ensuring both self and others are protected from harm.

CRISIS INTERVENTION IN THE UNIT

  • Review Resources:

    • Review “De-Escalation Tips” on Moodle.

  • CRISIS DEVELOPMENT Behavioral Levels:

    1. Anxiety:

    • Noticeable increase or changes in behavior (e.g., pacing, drumming fingers, wringing hands, staring).

    • Approach: Supportive—Empathetic, nonjudgmental attempts to alleviate anxiety.

    1. Defensive:

    • Beginning stage of loss of rationality; individual may become belligerent and challenge authority.

    • Approach: Directive—Staff takes control of the escalating situation.

    1. Acting-Out Person:

    • Total loss of control leading to physical acting-out episodes.

    • Approach: Physical Intervention—Safe, nonharmful control and restraint until behavior is regained.

    1. Tension Reduction:

    • Decrease in physical and emotional energy post-acting out, where the person regains rationality.

    • Approach: Therapeutic Rapport—Re-establishing communication with the individual experiencing tension reduction.