CRISIS INTERVENTION

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CRISIS INTERVENTION
Mercedes A. Perez-Millan MSN, ARNP
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DEFINITION A crisis is an
overwhelming reaction to a threatening
situation in which a persons usual problem
solving strategies fail to resolve the situation.

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TYPES OF CRISIS

• Developmental (Maturational) Crisis- predicted
  times of stress in everyones life which occurs
  in response to a transition from one stage to
  another in the life cycle.
• Example- Eriksons stages going from Industry
  to Identity (passage from school age child to
  adolescence)

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TYPES OF CRISIS(Continuation)

• Situational Crisis- occurs in response to a
  sudden unexpected event in a persons life from
  an external source. The critical life events
  involves a loss or a change that threatens the
  persons self esteem. For example job loss,
  divorce, abortion, death of a love one, severe
  physical or mental illness, etc.

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TYPES OF CRISIS(Continuation)

• Adventitious Crisis- are not part of everyday
  life. They are unplanned and accidental
  resulting in traumatic experiences. Such as
• Natural disasters.. hurricanes, flood, fire,
  earthquake, etc
• National disasters.. war, riots, etc
• Crime of violence.. Child abuse, rape, assault,
  bombing in crowded areas, etc

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CRISIS INTERVENTION GENERAL OVERVIEW

• Crisis.
• Occurs in everyone
• Not necessarily pathological, may encourage
  growth and change
• Time limited to a brief period, 4-6 weeks except
  death
• A persons perception determines the crisis

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CRISIS INTERVENTIONBALANCING FACTORS

• Crisis- good outcome
• Perception of event realistic
• Situational support adequate
• Coping mechanism adequate
• No crisis

• Crisis- development
• Perception of event distorted
• Situational support inadequate
• Coping mechanisms inadequate
• Crisis

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PHASES OF CRISIS
4.
3.
PERSONALITY DISORGANIZATION (CRISIS)
SEVERE ANXIETY
2.
TRIAL ERROR SOLUTIONS
1.
USUAL COPING MECHANISMS INEFFECTIVE
OR
STRESS
ANXIETY
NEW PROBLEM- SOLVING SOLUTIONS AND SUPPORT
ANXIETY
PRE-CRISIS LEVEL OF FUNCTIONING
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CRISIS INTERVENTION

• ASSESSMENT
• Perception of event What happened that prompted
  you to seek help? How are you feeling now? etc.
• Coping mechanisms Suicidal? Homicidal? Plans?
  What helps you feel better? etc.
• Support systems With whom do you live with? Who
  is available to help you? Who is most helpful?
  etc
• Mental status, previous history
• Identify clients strengths
• Self-assessment Nurses feelings

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CRISIS INTERVENTION

• Nursing Diagnosis
• 1. Risk self directed violence
• 2. Chronic low self esteem
• 3. Hopelessness
• 4. Powerlessness
• 5. Severe/Panic levels of anxiety
• 6. Disturbed thought process
• 7. Sleep deprivation
• 8. See textbook for additional diagnosis

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CRISIS INTERVENTION

• Planning and outcome identification
• 1. Assist the client in setting realistic goals
  to return to the pre-crisis level of functioning
• 2. Establish desired outcome criteria for the
  client using the problem solving approach.

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CRISIS INTERVENTION

• Implementation
• Assess for any suicidal/ homicidal thoughts or
  plans.
• Take initial steps to make the client feel safe
  and lower anxiety.
• Safety- intervene to prevent violence- suicide/
  angry, aggressive client.
• Listen attentively and encourage the client to
  discuss the crisis situation. Facilitate the
  verbalization of thoughts and feelings.
• Creative and directive approach needed. Initially
  nurse may make phone calls (arrange baby-sitters,
  find shelters, contact social workers, etc.)

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CRISIS INTERVENTION Cont

• Use problem solving approach.
• Identify needed social support (with patients
  input) and mobilize the most needed first.
• Identify and work to increase needed coping
  skills (problem solving, relaxation,
  assertiveness, job training, newborn care,
  self-esteem).
• Plan with patient interventions that are
  acceptable to both.
• Evaluate plan and instruct patient with
  alternative plan if needed.