CS-Crisis Intervention PDF

Unit II. Psychiatric/ Mental Health Nursing Interventions CS-Intervening in Crisis Presented by Mrs. Kanchanamalini OCHS- North Sharqiya Branch 9/10/2024 Learning Objectives 1. Define related terms (crisis/crisis intervention) 2....

Unit II. Psychiatric/ Mental Health Nursing Interventions CS-Intervening in Crisis Presented by Mrs. Kanchanamalini OCHS- North Sharqiya Branch 9/10/2024 Learning Objectives 1. Define related terms (crisis/crisis intervention) 2. Describe the phases in the development of a crisis (phases/types of crises) (crisis intervention/phases) 3. Identify the role of the nurse in crisis intervention Study: Table 10.3 Care Plan for the Client who experiences a traumatic event 10/10/2024 Crisis Intervention 2 Definition of Crisis A crisis is “a sudden event in one’s life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem” (Lagerquist, 2012) All individuals experience crises at one time or another. This does not necessarily indicate psychopathology 10/10/2024 Crisis Intervention 3 Crisis Crises are precipitated by specific, identifiable events and are determined by an individual’s personal perception of the situation. They are acute, not chronic, and generally last no more than 4 to 6 weeks. Crises occur when an individual is exposed to a stressor and previous problem-solving techniques are ineffective. This causes the level of anxiety to rise. Panic may follow when new techniques are employed and resolution fails to occur. 10/10/2024 Crisis Intervention 4  Characteristics of a crisis 1. Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology 2. Crises are precipitated by specific identifiable events 3. Crisis are personal by nature: What may be considered a crisis situation by one individual may not be so for another 4. Crisis are acute, not chronic, and will be resolved in one way or another within a brief period 5. Crisis situation contains the potential for psychological growth or deterioration. 10/10/2024 Crisis Intervention 5  Crisis intervention Crisis intervention is designed to provide rapid assistance for individuals who have an urgent need. Aguilera (1998) suggests that the “focus is on the supportive, with the restoration of the individual to his pre-crisis level of functioning or possibly to a higher level of functioning.” (p. 24) Requires problem skills that are often diminished by the level of anxiety accompanying disequilibrium. 10/10/2024 Crisis Intervention 6 Crisis Intervention The goal of crisis intervention is the resolution of an immediate crisis. Its focus is on the supportive , with the restoration of the individual to his pre-crisis level of functioning or possibly to a higher level of functioning. The therapist role is direct, supportive , and that of an active participant. 10/10/2024 Crisis Intervention 7 Crisis Intervention In crisis intervention the therapist becomes a part of the individual life situation Because of the individual emotional state she is unable to problem solve, so requires guidance and support from another to mobilize the resources needed to resolve the conflict 10/10/2024 Crisis Intervention 8 Phases in the Development of a crisis 10/10/2024 Crisis Intervention 9  Phases in the Development of a crisis Phase 1 The individual is exposed to a precipitating stressor. Anxiety increases Previous problem-solving techniques are employed. 10/10/2024 Crisis Intervention 10 Phases in the Development of a crisis Phase 2 When previous problem-solving techniques do not relieve the stressor, anxiety increases further. The individual begins to feel a great deal of discomfort at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not successful. Feelings of confusion and disorganization prevail. 10/10/2024 Crisis Intervention 11 Phases in the Development of a crisis Phase 3 All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. The individual may try to view the problem from a different perspective, or even to overlook certain aspects of it. New problem-solving techniques may be used, and, if effectual, resolution may occur at this phase, with the individual returning to a higher, a lower, or the previous level of premorbid functioning. 10/10/2024 Crisis Intervention 12 Phases in the Development of a crisis Phase 4 If resolution does not occur in previous phases, Caplan states that “the tension mounts beyond a further threshold or its burden increases over time to a breaking point. Major disorganization of the individual with drastic results often occurs” (p. 41). Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking. 10/10/2024 Crisis Intervention 13 Phases in the Development of a crisis 10/10/2024 Crisis Intervention 14 Concept of balancing factors by Aguilera (1998) Factors that influence individual response to stressful situation 1. The individual’s perception of the event 2. The availability of situational supports Situational supports – are those persons who are available in the environment and who can be depended on to help solve the problem. 3. The availability of adequate coping mechanisms 10/10/2024 Crisis Intervention 15 Types of Crises Six types of crises have been identified. 1. Dispositional crises 2. Crises of anticipated life transitions 3. Crises resulting from traumatic stress 4. Maturational or developmental crises 5. Crises reflecting psychopathology 6. Psychiatric emergencies 10/10/2024 Crisis Intervention 16 Types of Crises Class 1: Dispositional crises An acute response to an external situational stressor. Example: Ted have difficulty with his boss and work. He became angry and hit his wife last night. This morning when he went for work. His wife Nancy , went to emergency department of the hospital. 10/10/2024 Crisis Intervention 17 Intervention Nancy’s physical wounds were cared for in the emergency department. The mental health counselor provided support and guidance in terms of presenting alternatives to her. Needs and issues were clarified and referral for agency assistance made. 10/10/2024 Crisis Intervention 18 Class 2: Crises of anticipated life transitions Normal life cycle transitions that may be anticipated but over which the individual may feel lack of control. Example: Jay got low grades this semester. His wife had a baby and had to quit her job. He increased his working hours to his part time work to full time to compensate and therefore had little time to studies. He presents himself to the student health nurse practitioner complaining of numerous vague physical complaints. 10/10/2024 Crisis Intervention 19 Intervention 1. Physical examination should be performed (physical symptoms could be caused by depression) 2. Ventilation of feelings encouraged. 3. Reassurance and support should be provided as needed. 4. Referral services that can provide financial and other types of needed assistance. 5. Problematic areas should be identified and approaches to change discussed. 10/10/2024 Crisis Intervention 20 Class 3: Crises Resulting from traumatic stress Crises precipitated by unexpected external stresses over which the individual has little or no control He or she feels emotional overwhelmed and defeated. 10/10/2024 Crisis Intervention 21 Class 3: Crises Resulting from traumatic stress Example: Ms.S working at night shift, was walking going to work when two men with guns took her money and beaten her. Since that time, her physical wounds have nearly healed , however, Ms. S cannot be alone, is fearful, relieves the experience in flashbacks and dreams and is unable to eat or sleep, or work at her job. Her friend offers to accompany her to mental health clinic. 10/10/2024 Crisis Intervention 22 Intervention 1. Encourage ms.S to talk about the experience and to express her feelings associated with it. 2. Offer reassurance and support. 3. Discuss stages of grief. 4. Identify support systems that can help ms.S to resume her normal activities 5. Explore new methods of coping with emotions arising from a situation with which she has had no previous experience. 10/10/2024 Crisis Intervention 23 Class 4: Maturational/ Developmental crises Class 4: Maturational/ Developmental crises Crises that occur in response to situations that trigger emotions related to unresolved conflicts in one’s life. These crises are of internal origin and reflect underlying developmental issues that involve dependency, value conflicts, sexual identity, control and capacity for emotional intimacy. 10/10/2024 Crisis Intervention 24 Class 4: Maturational/ Developmental crises Example: B is 40 years old. He has just been rejected for a job promotion for the third time. He has moved many times within the large company for which he works, usually after angering and isolating himself from the supervisor. His father was dominating and became abusive when B did not comply with his every command. Over the years, B became one of passive aggressiveness-first with his father, then with his supervisors. This third rejection has created feelings of depression and intense anxiety. At his wife ‘s firmness, he has sought help at the mental health clinic. 10/10/2024 Crisis Intervention 25 Intervention The primary intervention is to help B identify the unresolved developmental issue that is creating the conflict. Support and guidance are offered during the initial crisis period assistance is given to help B work through the underlying conflict in an effort to change response patterns that are creating problems in his current life situation. 10/10/2024 Crisis Intervention 26 Class 5: Crises reflecting psychopathology Emotional crises in which pre existing psychopathology has been instrumental in precipitating the crisis or which psychopathology significantly impairs or complicates adaptive resolution. Example of psychopathology that may precipitate crises: Borderline personality disorder, severe neuroses, other personality disorders and schizophrenia. 10/10/2024 Crisis Intervention 27  Class 5: Crises reflecting psychopathology Example: S, age 29, was diagnosed with borderline personality disorder at age 18. She has been in therapy on a weekly basis for 10 years, with several hospitalizations for suicide attempts during that time. She has had the same therapist for the past 6 years. This therapist told S today that she is to be married in 1 month and will be moving across the country with her new husband. S is upset and experiencing intense feelings of abandonment. She is found wandering, in and out of traffic on a busy road Police bring her to the emergency department of the hospital. 10/10/2024 Crisis Intervention 28 Intervention 1. The initial intervention is to help bring down the level of anxiety in S that has been created feelings of unreality in her. 2. Someone stay with her and reassure her safety and security. 3. After the feelings of panic anxiety have subsided , she should be encouraged to verbalized her feelings of abandonment. 4. Regressive behaviors should be given for independent activities and accomplishments. 5. The primary therapist will need to pursue this issue of termination with S at length. Referral to a long-term care facility may be required 10/10/2024 Crisis Intervention 29 Class 6: Psychiatric Emergencies Crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility. Examples : acutely suicidal individuals , drug overdose, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger and alcohol intoxication 10/10/2024 Crisis Intervention 30 Class 6: Psychiatric Emergencies J age 16 and M are friends for so many years. One day M told J that she will be leaving soon and will be studying and be with her family in another country. J become hysterical and M was frightened by her behavior. Her friend gave J a valium and left her in her room to take a rest. After an hour, she went back to see J and found that J had take valium from the medicine cabinet and swallowed all the tablets. J was unconscious. An ambulance was called and J was transported to the hospital. 10/10/2024 Crisis Intervention 31  Intervention 1. Crisis team monitored vital signs 2. Ensured maintenance of adequate airway, initiated gastric lavage 3. Administered activated charcoal to minimize absorption. 4. J’s parent’s were notified and rushed to the hospital. 5. The situation was explained to them, and they were encouraged to stay by her side. 10/10/2024 Crisis Intervention 32 Intervention 5. When the physical crisis were resolved, J was transferred to the psychiatric unit. In therapy, she was encouraged to ventilate her feelings. 6. Family therapy sessions were conducted in an effort to clarify interpersonal issues and to identify areas for change. 7. On an individual level, J ‘s therapist worked with her to establish more adaptive methods of coping with stressful situations 10/10/2024 Crisis Intervention 33 Nursing Process application in crisis intervention Nursing process is the vehicle by which nurses assist individuals in crisis with a short-term, problem-solving approach to change. A four-phase technique is used: assessment/analysis; planning of therapeutic intervention; intervention; and evaluation of crisis resolution and anticipatory planning. Through this structured method of assistance, nurses assist individuals in crisis to develop more adaptive coping strategies for dealing with stressful situations in the future. 10/10/2024 Crisis Intervention 34 Phases of Crisis intervention: The Role of the Nurse Phase 1- Assessment The crisis helper gathers information regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help. Phase 2: Planning of therapeutic Intervention The nurse selects the appropriate nursing actions for the identified nursing diagnosis In planning the interventions, the type of crisis, as well as the individual strengths and available resources. 10/10/2024 Crisis Intervention 35 Phases of Crisis intervention : The Role of the Nurse Phase 3 Intervention: The actions that were identified in phase 2 are implemented. The focus of nursing intervention 1. Use a reality oriented approach 2. Remain with the individual who is experiencing panic anxiety 3. Establish a working relationship by showing unconditional acceptance 4. Discourage lengthy explanations or rationalizations of the situation; promote an atmosphere for verbalization of true feelings 5. Set firm limits on aggressive behavior 10/10/2024 Crisis Intervention 36 Phases of Crisis intervention: The Role of the Nurse Phase 3 Intervention 6. Clarify the problem that the individual is facing. 7. Help the individual determine what he or she believes precipitated the crisis 8. Acknowledge feelings of anger , guilt , helplessness and powerlessness while taking care not to provide positive feedback for these feelings 9. Guide the individual through a problem solving process by which he or she may move in the direction of positive life change. 10. Help the individual to discuss changes he or she would like to make 10/10/2024 Crisis Intervention 37 Phases of Crisis intervention: The Role of the Nurse Phase 3 Intervention 11. Encourage exploration of feelings about aspects that cannot be changed , and explore alternative ways of coping more adaptively in these situations. 12. Discuss alternative strategies for creating changes that are realistically possible 13. Weigh benefits and consequences of each alternative 14. Assist the individual to select alternative coping strategies that will help alleviate future crisis situations. 10/10/2024 Crisis Intervention 38 Phases of Crisis intervention: The Role of the Nurse Phase 4 Evaluation of crisis Resolution and anticipatory planning Nurse & client summarize what has occurred during the intervention. They review what the individual has learned and anticipate how he or she will respond in the future. A determination is made regarding follow up therapy; if needed, the nurse provides referral information 10/10/2024 Crisis Intervention 39  Robert’s seven stage crisis intervention model 10/10/2024 Crisis Intervention 40 Further Reading Study: Table 10.3 Care plan for the client who experiences a traumatic event Table 10.1 Robert’s seven stage crisis intervention model 10/10/2024 Crisis Intervention 41  References Townsend, M. C. (2014). Essentials of Psychiatric Mental Health Nursing. (6th ed.). Philadelphia: F.A. Davis. ISBN: 13:978-0-8036-3876-1 pp. 179- 188 10/10/2024 Crisis Intervention 42 Summarize…… Any Questions???? 10/10/2024 Crisis Intervention 43