Crisis and its intervention

Introduction

Crisis can be viewed as an integral componentof everyday life situations. A crisis mayinfluence peoples lives in different ways .as aconsequence of a crisis experience the peoplemay go down to the lower or less healthy levelof functioning than what was before the crisis

Definition of crisis “An internal disturbance results

from stressful event or a perceivedthreat to self precipitatory events“(BT BASAVANTHAPPA,2007)

“A sudden event that occurs in one’slife, which disturbs the individualhomeostasis and usual copingmechanisms will not resolve theproblem” (largerquist , 2001)

Characteristics of crisis Individual is totally involved ,get hurt in all

heightened feeling of stress i.e.disorganization of biological, cognitive,emotional, and behavioral

Unable to interpret & perceive thecircumstances of crisis event

Precipitating by specific identifiable event ofactual or perceived losses, threats of lossesor challenges

It occur in all individual one time or other Crisis are personally by nature Crisis are acute Crisis will be resolved by one or another time

within brief period

It is self limiting lasts for 4-6 weeks

Crisis situation may be potential orpsychological growth or retardation ordangerous to person, unable to functionproperly.

Universal experience

Almost all crises will develop inpredictable manner

Developmental phases Crisis result from certain distinct

biopsychosocial phases. Cpalan 1964described 4 specific phases

Phase 1:-

The individual is exposed to precipitatingstressor, it result in to anxiety. If theindividual uses effective problem solvingtechniques and situational support isprovided , then the problem will beresolved and no crisis occurs

PHSES 2:-

When Coping mechanism are ineffective,anxiety discomfort, helplessness furtherincreases ,person’s ability to overcomestressor will decrease ; confusion ,personaldisorganization prevails

Phase 3:-

The individual feels more pressure ,unable torespond ,anxiety still increases .the allexternal and internal resources will be triedto relieve discomfort

Phase 4:-

If the problem was not solved ,tensionreaches to its peak, as the time passesburden increases over time, panic state willresult, psychotic thinking, depression,distorted thinking, unproductive behavior,short attention span, impaired relationshipwill result. Extensive treatment isnecessary if negative outcomes areapparent

Human being

Balance state

Imbalance state

To restore equilibrium

Stressful eventsstressors

Felt need was not

fulfilled

Absence of one or

more balancing

factors

Unable to resolve

problems

Continuation in

imbalance in life,

failed to overcome

stressor

crisis

Balancing factors available e.g

•Situational support utilization

•Utilizing appropriate ,adequate coping strategy or

more constrictive coping skills

•Perceiving realistically the event

Efforts to resolve the problems

Re-attains equilibrium

No crisis

Types of crisisSituational crisis /external crisis / coincidental

crisis:-(E.g, death of loved one, an accident, a sexual

assault, loss of employment, loss of valued object)

Maturational crisis/developmental crisis/internal crisis(adolescence, marriage, antenatal period, retirement )

Socio-cultural crisis(race, religion):- it arises from the cultural values that are embedded in the social structure

Crisis resulting from traumatic stress(robbery, rape,):- its results when unexpected external stress over which the individual has little or no control

Adventitious crisis :- it is uncommon,unanticipated results in multiple losses maybe because of environmental changes e.g,natural disaster like floods, earthquakes

Psychiatric emergency:-crisis occurs whengeneral functioning is impaired and theindividual is incompetence to assumepersonal responsibility

Crisis resulting from psychopathology:-preexisting psychopathology has beeninstrumental in precipitating the crisis or in whichpsychopathology significantly impairs orcomplicates (borderline personality disorder,severe neurosis, schizophrenia )

Signs and symptoms Anger , guilt, tension, fear

Helplessness, hopelessness, uselessness

Neglects in performing self care activities and fulfilling responsibilities

Utilizing unhealthy coping mechanisms

irrational and blaming others

Panic

Low self esteem, uncontrollable crying

Frustration , confused, depressed ,immobilized

Unable to make decisions

Lack of confidence

Hallucinations and impaired judgment

Physical illness

Shortness of breathing, anorexia

Change in lifestyles

Irritable

Unable to maintain daily routine, work performance , social role

Crisis intervention techniques

“Crisis intervention aimed at helpingthe person resolve the situationquickly through supportivetechniques, suggestion, reassurance,environmental modifications, andhospitalization, if necessary.”

Crisis Techniques Abreaction (Release the feelings for tension

reduction) Clarification(– Identify the relationship between the

event and client.) Suggestion(To feel confident, calm and hopeful to

face the crisis) Manipulation(Manipulate clients emotional aspect) Reinforcement of behavior(Reinforce for healthy

behavior changes) Support defense (Support for healthy defense

mechanism than unhealthy one). Raise the self-esteem – (Help to regain his self- worth) Exploration of solutions(Help to form many

alternative ways of solving the problem.)

Indications for crisis People who attempted suicide

Psychosomatic patients

Violent behavior

Accident victims

Family crisis

Severe depression and anxiety

Marital conflicts

Suicidal thought

Illicit drug abuse: alcohol abuse

Client management issues

Settings for crisis intervention Hospitals-outpatient unit ,emergency room

settings

Mental health care centers

Community setting

Telephonic counseling

Nurse’s Role:-1).Assessment

Identifying the precipitating events

Clients perception of the event

Clients strength and available supportsystem

Previous coping style and strength

2). Plan

To develop strength of his own, to facethe crisis.

3).Intervention

Environmental Manipulation: - To change clients physical or interpersonal situations to remove stress.

General Support: - Making the client feel warm, acceptance, empathy, caring by providing reassurance.

Generic Approach: - Reaching high risk individual and large groups as quickly as possible.

Individual Approach: - By understanding individual psychodynamic, many techniques and used.

4).Evaluation

Assess the client, whether he has returned to his pre-crisis level.

Whether patient experiences pre-crisis level after the interventions

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