CRISIS AND CRISIS INTERVENTION

Crisis:
An acute emotional reaction to a powerful stimulus or demand, it is a state of emotional turmoil. Three
characteristics of crisis:
The usual balance between thinking and emotions is disturbed; a serious interruption and disturbance
of one's equilibrium or homeostasis
The usual coping mechanisms fail; a situation that occurs when an individual's habitual coping ability
becomes ineffective to meet the demands of a situation.
There is evidence of impairment in the individual or group involved in the crisis. Leads to potentially
dangerous, self-destructive or socially unacceptable behavior.

In 1961, psychiatrist Gerald Caplan defined a crisis as occurring:

When a person faces a problem that cannot be solved by customary problem-solving methods.
When the usual problem- life balance or
equilibrium is upset.
During the period of disequilibrium, there is a rise in inner tension and anxiety, followed by
emotional upset and an inability to function (Caplan, 1961).
Caplan argued that during a crisis, a person is open to learning new ways of coping to survive the current
crisis. The outcome of a crisis is governed by the kind of interaction that occurs between the person and his
or her key social contacts.
. Events like marriage, retirement and
childbirth are often desirable for the individual but may still present overwhelming challenges.

Characteristics
Highly individualized
Self-limiting: 4-6 weeks
Person affected becomes passive and submissive
Affects

Phases
Denial
Increased Tension
Disorganization
Attempts to reorganize
Stage for full reorganization

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 First, an event occurs that is perceived by the person as a threat and for which the usual coping methods do
not work. Tension builds, and the person attempts to adapt to the situation by using new coping techniques
that emerge naturally or are supported by helpers. If adaptation occurs, the person is able to cope with future
threatening events. If the person cannot cope, overall functioning decreases, and the person does not return to
the previous level of functioning

Phases of Crisis

A problem arises that contributes to increase in anxiety levels. The anxiety stimulates the implementation of
usual problem-solving techniques of the person.

The usual problem-solving techniques are ineffective. Anxiety levels continue to rise. Trial-and-error
attempts are made to restore balance.

The trial-and-error attempts fail. The anxiety escalates to severe or panic levels.
The person adopts automatic relief behaviors.

When these measures do not reduce anxiety, anxiety can overwhelm the person and lead to serious
personality disorganization, which signals the person is in crisis

A person in crisis should not be viewed as having a mental disorder. However, if the person is significantly
distressed or his or her social functioning is impaired, a diagnosis of acute stress disorder should be
considered. The person with an acute stress disorder has dissociative symptoms and persistently re-
experiences the event.

Type Description Example

Maturational/developmental expected, predictable and Puberty, adolescence, young adulthood, marriage,
crisis internally motivated or the aging process.
Situational/accidental Unexpected, unpredictable Economic difficulty, illness, accident, rape, divorce
and externally motivated or death

Adventious crisis Due to acts of nature Natural calamities

Many life events can evoke a crisis. Obvious crisis evoking events include natural and manmade disasters
(floods, fires, tornadoes, earthquakes, wars, bombings, and airplane crashes), trauma (rape, sexual abuse,
assault), and interpersonal crises (divorce, marriage, birth of a child). The crisis response is similar in all
these different situations.

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TYPES OF CRISES

Developmental Crisis

While Lindemann and Caplan were creating their crisis model, Erik Erikson was formulating his ideas about
crisis and development. He proposed that maturational crises are a normal part of growth and development,
and that successfully resolving a crisis at one stage allows the child to move to the next. According to this
model, the child develops positive characteristics after experiencing a crisis. If he or she develops less
desirable traits, the crisis is not resolved. The concept of developmental crisis assumes that psychosocial
development progresses by an easily identifiable, orderly process. The concept of developmental crisis
continues to be used today to describe unfavorable person environment relationships that relate to
maturational events, such as leaving home for the first time, completing school, or accepting the
responsibility of adulthood.

Situational Crisis
ity and
results in some degree of disequilibrium. The event can be an integral one, such as a disease process, or any
number of external threats. A move to another city, a job promotion, or graduation from high school can
initiate a crisis, even though they are positive events. For example, graduation from high school marks the
end of an established routine of going to school, participating in school activities, and doing homework
assignments. On starting a new job after graduation, the former student must learn an entirely different
routine and acquire new knowledge and skills. If a person enters a new situation without adequate coping
skills, a crisis can develop.

Another category of situational crisis is victim crisis. In certain situations, people face overwhelmingly
hazardous events that may entail injury, trauma, destruction, or sacrifice. Such an event involves a physically
aggressive and forced act by a person, a group, or an environment. National disasters (e.g., racial
persecutions, riots, war) and violent crimes (e.g., rape, murder, and assault and battery) are examples of
events that precipitate this type of crisis (Hazelwood & Burgess, 2001).

Adventitious Crisis- is not part of everyday life. They are unplanned and accidental resulting in traumatic
experiences. Such as:
Natural disaster:
National disasters:
Crime of violence:

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 CRISIS INTERVENTION
Crisis intervention is a TEMPORARY but ACTIVE and SUPPORTIVE entry into the life of individuals
or groups, Emotional First Aid
Goals of Crisis Intervention:
Mitigate impact of event (lower tension)
Facilitate normal recovery processes, in normal people who are having normal reactions to abnormal
events
Restoration to adaptive function

Restore the maximum level of functioning (pre-crisis state)

A way of entering into the situation to help them mobilize their resources and to decrease the effect
of stress.

NURSING MANAGEMENT: HUMAN RESPONSE TO CRISIS DISORDER

Aguilera (1998) identified three factors that influence whether or not an individual experiences crisis.

The availability of emotional support

Availability of appropriate coping mechanisms

These three factors represent a guide for effective intervention.

The person can be assisted to view the event or issue from a different perspective, for example, as an
opportunity for growth or change, rather than a threat.
Assisting the person to use exiting supports or helping the individual find new sources of support can
decrease the feelings of being alone or over whelmed.
Assisting the person to learn new methods of coping will help to resolve the current crisis and give
him or her new coping skills to use in the future.
Persons experiencing a crisis usually are distressed and likely to seek help for their distress.

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CRISIS INTERVENTION:
Principles of Crisis Intervention:
Simplicity People respond to simple not complex in a crisis
Brevity Minutes up to 1 hour in most cases (3-5 contacts typical)
Innovation Providers must be creative to manage new situations
Pragmatism Suggestions must be practical if they are to work
Proximity Most effective contacts are closer to operational zones
Immediacy A state of crisis demands rapid intervention
Expectancy The crisis intervener works to set up expectations of a reasonable positive outcome

Critical Incidents:

Powerful traumatic events that initiate the crisis response. These events are usually outside of the usual range

of normal human experiences. On

severe threats to life personal safety are also classified

Critical Incident Stress:

A state of cognitive, physical, emotional and behavioral arousal that accompanies the crisis reaction. The

elevated state of arousal is caused by a critical incident. If not managed and resolved appropriately, either by

oneself or with assistance, it may lead to several psychological disorders including Acute Stress Disorder,

Post Traumatic Stress Disorder, Panic Attacks, Depression, Abuse of Alcohol and Other Drugs, etc.

Critical Incident Stress Management:

A comprehensive, systematic and integrated multi-tactic crisis intervention approach to manage critical

incident stress after traumatic events. CISM is a coordinated program of tactics that are linked and blended

together to alleviate the reactions to traumatic experiences.

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NURSING PROCESS
The goal for people experiencing a crisis is to return to the pre-
to support the patient through the crisis and to facilitate the use of positive coping skills. For people who are
experiencing a crisis, nursing management can easily serve as a framework for care. If a person is in crisis,
he or she may be at high risk for suicide or homicide. To determine the level of effectiveness of the coping
mechanisms of the client, the nurse should assess unusual behaviors and determine the level of involvement

mechanisms (emotional and financial), and his/her coping capabilities.

ASSESSMENT, PLANNING AND NURSING ACTIONS FOR CRISIS

Primary concerns:
o Physical injuries
o Alleviation of psychological trauma
Nurse should display:
o Sensitivity

o Attitude (Nonjudgmental)

o Confidentiality
o Respect
o Empathy
o Dignity
Evidences are important: (especially in cases of abuse)
o stained clothing
o fingernail scrapings
o mouth or anal smears containing semen
Intervention focuses family as a unit.
If the victim is a child: Play and art therapy

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Biologic Domain
Biologic Assessment
Biologic functioning is important because a crisis can be physically exhausting.
Disturbances in sleep
Disturbances in eating patterns
The reappearance of physical or psychiatric symptoms are common.
s inadequate, he or she will not have the
physical resources to deal with the crisis. Pharmacologic interventions may be needed to help
maintain a high level of physical functioning

Nursing Diagnoses for the Biologic Domain

Biologic responses can be very severe during crises.
All the body systems can be affected.
Risk for Body Temperature Imbalance,
Diarrhea, Impaired Urinary Elimination,
Stress Urinary Incontinence.
During crisis, thoughts are often disturbed; there may be a high risk for injury.
Medications may be needed.
Interventions for the Biologic Domain
Unless the crisis involves physical injury, interventions focusing on the biologic domain will be those
performed for similar nursing diagnoses. If the crisis involves physical injury, the injur ies should be treated.
Medication cannot resolve a crisis, but the judicious use of psychopharmacologic agents can help reduce its
emotional intensity.

Psychological Domain
Psychological Assessment

s and coping strengths.

In the beginning of the crisis, the person may report feeling numb and in shock.
Later, as the reality of the crisis sinks in, he or she will be able to recognize the felt emotions. The
nurse should expect those emotions to be intense, and will need to provide some support during their
expression.
At the beginning of a crisis, coping by problem solving may be disrupted.

cognitively cope with the stressful situation and determine the amount of support needed.

Nursing Diagnosis for the Psychological Domain

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Many nursing diagnoses generated from assessment of the psychological are appropriate for the person
experiencing crisis.

Grieving
Post-Trauma Syndrome
Confusion
Ineffective Coping are common.
Interventions for the Psychological Domain
Safety interventions to protect the person in crisis from harm should be used, such as preventing the
person from committing suicide or homicide,
Arranging for food and shelter (if needed),
Mobilizing social support.

Counseling reinforces healthy coping behaviors and interaction patterns.

Counseling
corresponding nursing diagnosis, helps the person integrate the effects of the crisis into his or her life.
At times, telephone counseling may provide the person with enough help that face to- face counseling
is not necessary.
If counseling strategies do not work, other stress reduction and coping enhancement interventions can
be used.
The nurse should refer anyone who cannot cope with a crisis to a mental health specialist for short-
term therapy.

Social Domain
Social Assessment
social functioning is essential because a crisis usually
severely disrupts social aspects. Shelter, money, and food may not be available. Basic human needs such as a
place to live or immediate transportation can quickly become a priority.
Nursing Diagnosis for the Social Domain

Nursing diagnoses appropriate for the social domain, the following are diagnoses that could be generated
during a crisis.

Impaired Adjustment, Impaired Social Interaction

Interrupted Family Processes.
Ineffective Role Performance and
Relocation Stress Syndrome
Interventions for the Social Domain

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 o changes in available social support.
Sometimes, the development of a new social support system can help the person more effectively
cope with the crisis.

Supporting the development of more contacts within the social network can be done by referring the
person to support groups or religious groups.

Telephone Hot Lines. Public and private funding and the efforts of trained volunteers permit most
communities to provide crisis services to the public. For example, telephone hot lines for problems ranging
fro
immediate access to the mental health system for people who are experiencing an emergency (such as
threatened suicide) or for those who need help with stress or a crisis.

Residential Crisis Services.

Residential crisis services for people who need short-term housing. The specific residential crisis services
available within a community reflect those problems that it judges as particularly important. Fo r example,
some communities provide shelter for teenage runaways; others offer shelter for abused spouses. Still others
provide shelter for people who would otherwise require acute psychiatric hospitalization. These settings
provide residents with a place to stay in a supportive, homelike atmosphere. The people who use these
services are linked to other community services, such as financial aid.

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Domestic Violence Requiring Crisis Intervention:

RAPE
Nonconsensual sexual penetration of an individual, obtained by force or threat, or in cases in which the
victim is not capable of consent.

Kinds of Rape
Power to prove masculinity
Anger means of retaliation
Sadistic to express erotic feelings

Silent Rape Syndrome

Is a maladaptive reaction to rape
The victim:
fails to disclose information about the rape
is unable to resolve feelings about the sexual assault
Results to increase anxiety and may develop a sudden phobic reaction.

Rape Trauma Syndrome (RTS)

Refers to a group of signs and symptoms experienced by a victim in reaction to rape

Phases:
Acute Phase shock, numbness, disbelief
Denial refusal to discuss the event
Heightened Anxiety fear, tension, nightmares
Stage of Reorganization

Battered Wife Syndrome (BWS)

A form of cyclic domestic violence
Men: low self-esteem
Women: Dependent personality disorder

Child Abuse
Is an act of omission of responsibility or commission in which intentional harm is inflicted on a child.

Components of Omission:
Child abandonment leaving the child physically
Child neglect - lack of provision of those things which are necessary for the child's growth and
development

Types of Commission:
Physical Abuse
Is an intentional physical harm inflicted on a child by a parent or other person.

Emotional abuse - insult and undermining one's confidence

Sexual abuse - abuse in the form of sexual contact

Characteristics of Abusive Parents:
They come from violent families
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 They were also abused by their parents
They have inadequate parenting skills
They are socially isolated because they don't trust anyone
They are emotionally immature
They have negative attitude towards the management of the abused

Warning signs of Child Abuse / Neglect:

Hair growth in various lengths

Inconsistent stories from the child and parent/s
Low self-esteem
Depression
Apathy
Bruised or swollen genitalia; tears or bruising of rectum or vagina

Serious injuries (fractures, burns, lacerations)

Evidence of old injuries not reported

(Anti Child Abuse Law)

Required reporting of suspected cases
Report cases to the nearest authorities within 48 hours

SUMMARY OF KEY POINTS

Stress occurs when a person environment relationship is appraised as being unfavorable. Stress
responses are simultaneously emotional and physiologic, leading to an innate tendency to act.
Many personal factors, such as personality patterns, beliefs, values, and commitment to an outcome,
interact with environmental demands and constraints that produce a person environment relationship.

Within the social network, social support can help a person cope with stress.

Effective coping can be either problem focused or emotion focused. The outcome of successful coping is
enhanced health, psychological well-being, and social functioning.
A crisis is a severely stressful situation that causes exaggerated stress responses. The nursing process is
similar for the person experiencing a stress response, except that increased attention is paid to safety
issues.

Disaster is a sudden, overwhelming catastrophic event that causes great damage, destruction, mass
casualties, and human suffering that require assistance from all available resources.

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