Crisis Intervention

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CRISIS INTERVENTION

Crisis is defined as occuring when a person faces an obstacle to important life goals that is, for a time, insurmountable through the utilization of customary methods of problem solving. A period of disorganisation ensues ,a period of upset during which many abortive attempts at solution are made. (Caplan)

Donna Auguilera and Janice Mesnick

Types of crisis
Maturational crisis (developmental crisis) situational crisis Adventitious crisis

Crisis responses
Psychiatric responses Organic mental disorders secondary to head injury, toxic exposure,illness and dehydration Acute stress disorder Adjustment disorder Substance abuse Major depression PTSD generalized anxiety disorder

Psychological or behavioral responses


grief reactions family violence self directed violence

PHASES OF CRISIS INTERVENTION


Assessment Planning of therapeutic intervention Intervention crisis resolution and anticipatory planning

ROLE OF THE NURSE


Assessment Precipitating event or stressor Patients perception of event or stressor Nature and strength of the patients support systems and coping resources Patients previous strength and coping mechanism

NURING DIAGNOSIS
risk for self directed violence risk for other directed violence related to anger anxiety related to sense of unknown fear related to sense of precipitating event hopelessness related to sense of inability to recover from crisis powerlessness related to sense of being overwhelmed ineffective coping related to inability to handle the situation

sleep pattern disturbance related to sense of inability to overcome the crisis chronic low self esteem related to lack of self confidence social isolation related to lack of interest impaired social interaction related to fear or threat caregiver role strain related to inadequate coping mechanisms spiritual distress dysfunctional grieving related to actual or perceived object loss

Planning and Implementation.

INDIVIDUAL APPROACH

GENERAL APPROACH

GENERIC SUPPORT

ENVIRONMENTAL MANIPULATION

techniques of crisis intervention


Catharsis Clarification Suggestion Reinforcement of behaviour Support of defenses Raising self esteem Exploration of solutions

NURSING INTERVENTIONS
assess for any suicidal, homicidal thoughts or plans initiate necessary precautions to safeguard the patient or others at risk of physical harm encourage expression of feelings in a non destructive manner take initial steps to make client feel safe and to lower anxiety Provide an atmosphere of support. assist in identification of precipitants and dynamics of crisis

listen carefully(make eye contact,give frequent feedback to make sure you understand, summarise what client said at the end.) identify needed social support and mobilize the most needed first

provide guidance about how to develop and maintain support systems identify needed coping skills(problem solving, relaxation ,assertiveness,job training, newborn care, selfesteem raising) assist in identification of personal strength and abilities that can be used in resolving crisis introduce the patient to persons who have successfully undergone the same experience plan with client interventions acceptable to both client and counsellor. Assist in identification of alternative courses of action in resolving the crisis Assist in formulating a time frame for implementation of the chosen course of action Assist in evaluation of the possible consequences of various courses of action

Plan regular follow up to assess clients progress Evaluate whether the crisis has been resolved by the chosen course of action Plan with the patient how adaptive coping skills can be used to deal with crisis in future

SETTINGS FOR CRISIS INTERVENTION MODALITIES OF CRISIS INTERVENTION Mobile crisis programs Telephone contacts Disaster response Victim outreach programs

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