Crisis 2025

Understanding Crisis

  • What is a Crisis?

    • Disturbance of homeostasis

    • Normal coping mechanisms are not effective

Characteristics of Crisis

  • Can occur without psychopathy

  • Identifiable event

  • Personal in nature

  • Acute response

  • Potential for growth or deterioration

  • Feelings of helplessness, anxiety, and being overwhelmed

  • Often leads to maladaptive responses

Phases of Crisis Development

  1. Phase 1: Exposure to a stressor

  2. Phase 2: Previous problem-solving methods are ineffective

  3. Phase 3: Utilization of all available resources

  4. Phase 4: No resolution, panic ensues

Levels of Anxiety

Mild Anxiety

  • Normal level of anxiety

  • Increased perception of reality

  • Identifiable cause and mild symptoms

Moderate Anxiety

  • Mild escalation in anxiety

  • Slight decrease in reality perception

  • Problem-solving abilities become hampered

  • Symptoms may include headaches and concentration issues

  • Benefits from direction and support

Severe Anxiety

  • Distorted perception of reality

  • No learning or problem-solving capabilities

  • Signs of confusion and rapid speech, tachycardia, and fast breathing

Panic Levels

  • Disturbed behavior

  • Possible loss of touch with reality

  • Extreme fright and hyperactivity

  • Physical symptoms such as shakiness, delusions, and dilated pupils

Types of Crises

  • Class 1: Dispositional crisis – Acute response to external stressors

  • Class 2: Crises of anticipated life transitions – Lack of control during normal life cycle transitions

  • Class 3: Crises resulting in traumatic stress – Unexpected events leading to overwhelming responses

  • Class 4: Maturational or developmental crisis – Failure to master developmental tasks during life transitions

  • Class 5: Crisis reflecting psychopathology – Triggered by preexisting mental health disorders

  • Class 6: Psychiatric emergencies – Impaired functioning and incompetency

Crisis in Inpatient Unit

  • Crises can occur once a patient is admitted

  • Anger:

    • Secondary emotion often tied to grief, depression, anxiety, or trauma

  • Aggression:

    • Ranges from mild to severe; can be reactive or proactive

Signs of Anger and Aggression

Anger Signs

  • Clenched fists and teeth

  • Low-pitched verbalization; shouting

  • Intense or absent eye contact

  • Feelings of defensiveness and tension

Aggression Signs

  • Pacing and threatening body language

  • Loud speech, overreaction, panic

  • Disturbing behaviors and destruction

Assessment of Risk Factors

  • Importance of prevention

  • Consider history of violence, diagnosis, and behavior

  • Signs to monitor: anxiety, tension, verbal abuse, hyperactivity

De-escalation Techniques

  • Use a calm voice and helpful attitude

  • Identify consequences of behaviors

  • Maintain a non-threatening posture

  • Allow for phone calls and offer food/drink

  • Decrease waiting time and encourage positive activity

Additional Techniques

  • Walk with the individual to calm them

  • Reduce demands and group participation

  • Employ relaxation techniques and express concerns

  • Set limits and offer time-out options

Medications for Crisis Intervention

Antianxiety Agents

  • Lorazepam (Ativan): Enhances GABA effects, CNS depressant

    • Contraindications: Pregnancy, sleep apnea, respiratory depression

Antipsychotics

  • Haloperidol (Haldol): Alters dopamine effects, anticholinergic effects

  • Ziprasidone (Geodon), Olanzapine (Zyprexa): Other options for acute intervention

Antihistamines

  • Diphenhydramine (Benadryl): CNS depression and anticholinergic effects

Post-De-escalation

  • Options for time-out, unlocked and locked seclusion, observation, and debriefing staff

Client Problems

  • Ineffective coping: Negative role modeling, dysfunctional family systems

  • Risk for violence: Inadequate anger management

Outcomes for Clients

  • Ability to recognize and voice feelings of anger

  • Responsibility for emotions

  • Demonstration of self-control and constructive tension use

Nursing Interventions/Implementation

  • Rapid assessment: Prioritize safety

  • Utilize anxiety management techniques

  • Support services and follow-up care

Crisis Intervention: Phases

Phase 1: Assessment

  • Identify triggers and prior coping methods

  • Assess mental and physical status, support systems

Phase 2: Planning Therapeutic Intervention

  • Determine nursing actions, resources, and goals for crisis resolution

Phase 3: Intervention

  • Focus on the here and now, active listening, and problem clarification

  • Promote verbalization of feelings and alternative coping strategies

Phase 4: Evaluation of Crisis Resolution

  • Evaluate positive behavioral changes and the effectiveness of coping mechanisms

Understanding Disaster

  • A disaster overwhelms local resources and threatens safety

  • Range from violent events to natural disasters inducing emotional trauma

Responses to Disaster

Adults/Adolescents

  • Emotions: Anger, disbelief, anxiety

Children

  • Signs: Separation anxiety, regressive behavior, nightmares

Client Problems in Disasters

  • Risks for physical injury, infection, anxiety, and spiritual distress

Client Outcomes in Disasters

  • Safety and protection from further harm

  • Emotional processing and expression of beliefs

Interventions Post-Disaster

  • Maintaining manageable anxiety levels

  • Encouraging the expression of spiritual beliefs

References

  • ATI (2023). Content Mastery Series Review Module: RN Pharmacology for Nursing (9th ed.)

  • Townsend, M. C. (2023). Essentials of Psychiatric Mental Health Nursing, Concepts of Care in Evidence-Based Practice (9th ed.), F.A. Davis.