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INTRODUCTION
Stressful events or crisis are a common part of life. Any stressful situation can precipitate a crisis. Crisis results in a disequilibrium from which many individuals require assistance to recover. Crisis intervention requires problem solving skills that are often diminished by the level of anxiety accompanying disequilibrium. Knowledge of Crisis Intervention techniques is an important skill of all nurses, regardless of clinical settling or practice specialty. Here we will examine the phases in the development of a crisis and the types of crisis that occurs in people s lives. The methodology of crisis intervention, including the role of the nurses is exploded here.
DEFINITIONS
According to Largerquist, 2001
Crisis is a sudden event in ones life that disturbs Homeostasis, during which usual coping mechanisms cannot resolve the problem.
OR
Crisis is a struggle for equilibrium when problems seen insolvable. A crisis can be a turning point in ones life.
Crisis is a state of disequilibrium resulting from the interaction of an event with the individuals or familys coping mechanisms, which are inadequate to meet the demands of the situation, combined with the individuals or familys perception of the meaning of the event.
OR
A crisis is an acute, time-limited reaction to an overwhelming emotional experience, which can result in a state of state of disequilibrium or imbalance.
CHARACTERISTICS
Crisis occurs in all the individuals at one time or other. Crises are precipitated by specific identifiable events. Crises are personal by nature. What may be considered a crisis situation by one individual may not be so for another. Crises are acute, not chronic and will be resolved in one way or another within a brief period. A crisis situation contains the potential for psychological growth or deterioration. It is self limiting, lasts for 4-6 weeks Universal experience Almost all crises will develop in a predictable fashion.
PHASE 1:
Whenever the individual is exposed to a precipitating stressor, it results into anxiety to overcome it. If individuals uses effective problem solving techniques and situational support is provided then the problem will be resolved and no crisis occurs.
PHASE 2:
When previous problem-solving techniques do not relieve the stressor or when coping mechanisms are ineffective, anxiety, discomfort, helplessness further increases hence person s ability to overcome the stressor will decrease. Feeling of confusion, personal disorganization prevails.
PHASE 3:
Individual feels more pressure, unable to respond, anxiety still increases; In this phase all external and internal resources will be tried to resolve the crisis and to relieve discomfort. Individuals use every means like cognitive emotional and physiological means, counseling etc. as a last resort. If it fails the premorbid functioning will results.
PHASE 4:
If resolution does not occur in previous phases, Caplan states that The tension reaches to its peak. As time passes, burden increases to a breaking point. Major disorganization of the individual with drastic results often occurs . Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile and behavior may reflect the presence of psychotic thinking.
TYPES:
1. Situational Crisis/ External Crisis/ Coincidental Crisis
Develops from an external event such as an accident, loss of job, death of very close person, illness, financial troubles etc. It is sudden, unexpected, onset. An acute response occurs due to an external situational stressor i.e. dispositional crisis. The life events can become situational crisis, depending on a persons emotional status, ability to cope and the support received.
3. Socio-Cultural Crisis
It arises from the cultural values that are embedded in the social structure. For eg:- Discrimination between race and robbery.
7. Psychiatric Emergencies
Crisis situation in which general functioning is impaired and the individual is incompetent to assume personal responsibility. For eg:- Suicide, addictions, drug over doses, uncontrollable anger and alcohol intoxication
CRISIS INTERVENTION
In crisis intervention, the therapist becomes a part of the individual s life situation. Because of the individual s emotional state, he or she is unable to solve the problem, so requires guidance and support from another to help mobilizes the resources needed to resolve the crisis.
Definition:
Crisis intervention is a short term therapy focused on solving the immediate problem. The goal of crisis intervention is for the individual to return to a pre-crisis level of functioning. It usually limited to 6 weeks.
2) Clarification Encourage the client to express more clearly the relationship between certain events, behaviors and feelings. It helps the client to understand his feelings and the pattern of developing these feelings into crisis.
For eg:- After having an argument, discussion about future with spouse, the client became sick. 3) Suggestion It influences a person to accept an idea or belief. In crisis intervention the patient is influenced to see the nurse as a confident, calm, hopeful, empathic person who can help. By believing the nurse can help, the patient may feel more optimistic and less anxious. Suggestion is a way of influencing the patient by pointing out alternatives or new ways of looking at things. 4) Reinforcement of Behavior It occurs when healthy, adaptive behaviors of the patient give positive response and appreciate the patient. For eg:- I observed you have done it, you can do it 5) Support of Defenses Encourage the client to use healthy and adaptive behavior to cope up stressful situation to maintain ego and integrity, at the same time discourage the maladaptive, unhealthy behavior. For eg:- Ask the client, when he is angry, over the other, divert it by drinking half glass of cool water and doing other works. 6) Raising Self-Esteem It is a particularly important technique. The patient in crisis feels helpless and may be overwhelmed with feelings of inadequacy. Help the client to regain the feelings of selfworth, active participation, communicates effectively, good listening skills, accepts his feelings with respect. For eg:- you have done so many tasks in your life up to now. I feel you can be able to do this task also. 7) Exploration of Solutions It is essential because crisis intervention is geared towards solving the immediate crisis. The nurse and patient actively explore solutions to the crisis. For eg:- A client who has lost her job, is aware of the fact that there are people who can help her out for getting a new job.
Some other Techniques are:Family Work:Identify the individual and family affected with crisis. Involving the family in client care is essential. A nurse has to have knowledge related to family dynamics.
Provide calm and conducive, comfortable environment to the client, help to establish good rapport and IPR between client and his family. Identify the stressor and suggest possible attacking of the problem, utilize the best suiting approach to resolve the crisis. Family interventions consist of educational supportive, cognitive and behavioral strategies. Group Work:Nurses and group help the patient to solve the problem and develop new coping strategies. The group and the client follow the nurse as a role model and ideal example uses similar therapeutic techniques. Group acts as a support system for the client. For eg:- Hospitalization of the client. Patient Education:The therapeutic team members will educate and counsel the client and family about problem resolving techniques, alternative adoptive coping strategies; importance of having balance mind and emotional maturity. Educate the public to identify the crisis situations and victims.
Role of Nurse
Phases and techniques of crisis intervention are similar to the steps of nursing process.
Phase I: Assessment
The first step of crisis intervention is Assessment. At this phase data about the nature of the crisis and its effect on the patient must be collected. Assess the following. Identification of precipitating event or stressor and when it occurred. Explore the needs of the client like (1) Self-Esteem- Achieved when the person attains successful social role experience. (2) Role Mastery- Achieved when the person attains work, sexual and family role successes. (3) Dependency- Achieved when a satisfying interdependent relationship with others is attained. (4) Biological function- Achieved when a person is safe and life is not threatened.
Client s abilities and limitations in dealing with the problem. Nature and strength or adequacy of clients supporting systems and coping resources. Nature of crisis and its effects on the individual and family. Associated behavioral problems. Physical and mental status of an individual History of previous exposure and adapted strategies Exploration of problematic situation
Attending to immediate needs Appropriate communication technique to make the client to feel more comfortable
4. Discourage length explanation by rationalizing the situation 5. Provide adequate situational support and guidance 6. Handle the feelings gently, don t give false reassurance 7. Maintain consistency 8. Clarify the problem that the individual is facing 9. Guide the individual in problem solving process and to alleviate future crisis 10. Identify external support system and new social network for the individual to scale assistance and advice for follow up visit.
Nursing intervention can take place on many levels using a variety of techniques. There are four levels of crisis intervention that represent a hierarchy from the most basic to the most complex (shields, 1975)
General Support
Environmental Manipulation
2. General Support
General support includes interventions that convey the feeling that the nurse is on the patient s side and will be a helping person. The nurse uses warmth, support, acceptance, empathy, caring, concern and reassurance has to be providing general support.
3. Generic Approach
The generic approach is designed to reach high-risk individuals and large groups as quickly as possible. A specific method will be used to the persons who have similar problems. The intervention is then setup to ensure that the course of the crisis results in an adaptive response. For eg:- Grief , disasters Debriefing- an acute stress is a therapeutic intervention will be used to recall the traumatic events and to clarify painful experiences and to prevent maladaptive responses.
4. Individual Approach
The individual approach is a type of crisis intervention, similar to the diagnosis and treatment of a specific problem in a specific patient. The nurse must understand the specific patient characteristics that led to the present crisis and must use the intervention that is most likely, to help the patient to develop an adaptive response to the crisis.
Phase V: Evaluation
The last phase of crisis intervention is evaluation. When the nurse and patient evaluate whether the intervention resulted in A positive resolution of the crisis or Behavioral change has been achieved or not Whether the client returned to the normative level of functioning
Does the patient have adequate support systems For eg:- additional treatment have to be planned to resolve crisis
SUMMARY:All individuals experiences crisis at one time or another. Crisis is precipitated by specific identifiable events and is determined by an individuals personal perception of the situation. Crisis occurs when an individual is exposed to a stressor and previous problem solving techniques are ineffective. Crisis intervention is designed to provide rapid assistance for individuals who have an urgent need. Nurses regularly respond to the individuals in crisis, in all types of setting. Nursing process is the vehicle by which nurses assist individuals in crisis with a short term problem solving approach to change. Nurses have many important skills that can assist individuals and communities in the wake of traumatic events.
BIBLIOGRAPHY
Gail W. Stuart ;Michele T. Laraia Principles & Practice of Psychiatric Nursing; Elsevier Publication ; 8th edition Mary C. Townsend ; Psychiatric Mental Health Nursing ; Jaypee Publication ; 5th edition KP Neeraja ; Essentials of Mental Health & Psychiatric Nursing ; vol-1 Jaypee publication ; 1st edition BT Basvanthapa Psychology for Nursing Jaypee Publication