Crisis and Crisis Management — Study Notes

Page 1: Crisis and Crisis Management — Definition

  • Crisis: a sudden event that disturbs homeostasis during which normal coping skills cannot resolve the problem.

Page 2: Learning Outcomes

  • Identify the types of crisis that occur in a person’s life
  • Describe the four phases in the development of a crisis
  • Identify the goals of crisis intervention
  • Relate the role of the nurse utilizing the nursing process in the phases of crisis intervention

Page 3: Characteristics of Crisis

  • Any stressful event can precipitate a crisis
  • An acute, time-limited event experienced as overwhelming emotional reactions
  • The event is identifiable
  • Not necessarily associated with psychopathology
  • A crisis is unique to each individual
  • A crisis is acute, not chronic
  • Usual coping mechanisms fail
  • A crisis contains the potential for psychological growth (best outcome) or deterioration (poor outcome)

Page 4: Situational / External (Unanticipated) Changes

  • Loss of a job
  • Financial hardship
  • Divorce
  • Unexpected serious injury/illness
  • Unexpected death of a family member/friend
  • Family violence
  • Workplace harassment

Page 5: Developmental Crises

  • Based on Erikson’s 8 stages of growth and development
  • Examples: Adolescence, Marriage, Children, “Empty Nest”, Changes associated with aging, Retirement
  • Also referred to as maturational crises

Page 6: Adventitious Crises (Out of the Spectrum of Everyday Events)

  • Not in the usual book; unexpected events
  • Natural disasters
  • Violent crime
  • Acts of war
  • Terrorist attacks
  • COVID-19

Page 7: Existential Crisis

  • Questioning life purpose or spirituality
  • Can be brought on by significant events such as marriage, the death of a loved one, children becoming adults
  • Can lead to newfound motivation or higher goals for self-actualization

Page 8: Phases of Crisis

  • 44 phases:
    1) exposure to a stressor
    2) usual coping mechanisms are ineffective, anxiety increases
    3) all internal and external resources used to resolve the problem (if the crisis is resolved, functioning is restored)
    4) If no resolution, a breaking point may occur resulting in severe anxiety/panic/psychosis: disorganization of thoughts, labile emotions, and behaviors

Page 9: The Balancing Factors

  • The perception of the event
  • The availability of situational supports
  • The availability of coping mechanisms

Page 10: Intervening in a Crisis

  • The goal in crisis intervention is resolution of the immediate crisis
  • The focus is on supportive care with immediate problem solving and restoration of functioning

Page 11: Factors to Consider

  • Age/development stage
  • Support system
  • Life experience
  • Current life stressors
  • Current mental health issues
  • Current physical health issues
  • Perception of the event
  • Prior coping mechanisms
  • Prior experience with outcomes in dealing with stress or crisis

Page 12: Nursing Assessment and Interventions

  • Assess the patient
  • Physical and mental status
  • Prioritizing care — think Maslow’s Hierarchy of Needs
  • Physical injuries ALWAYS treated first
  • Is the person suicidal or homicidal?
  • Assess the crisis — what happened? Assess the patient’s perception of the crisis
  • Assess coping — what has been tried to resolve the crisis & what has helped in the past?
  • Assess support system and resources — what assistance is available to the person?

Page 13: Nursing Problems and Outcomes

  • Nursing Problems:
    • Anxiety
    • Hopelessness
    • Powerlessness
    • Lack of social support
    • Ineffective coping
  • Nursing Outcomes:
    • Patient will call one person for support
    • Patient will attend counseling sessions
    • Patient will state that anxiety is decreasing

Page 14: Planning and Implementation — Priorities for Care

  • Assess for physical injury — PRIORITY
  • Assess for threat of harm to self or others
  • Assist patient toward a more realistic perception of the crisis
  • Assist patient in problem identification and prioritization
  • Care for psychological needs
  • Explore coping strategies

Page 15: Nursing Interventions for Psychological Needs

  • Develop a rapid rapport
  • Provide immediate relief of crisis state, restore functioning
  • De-escalate panic
  • De-escalate aggression
  • Reality orientation
  • Reduce fear
  • Provide direction and assistance for problem-solving

Page 16: Evaluation

  • Ongoing evaluation until crisis is resolved and person returns to normal functioning