CRISIS AND ITS INTERVENTION

INTRODUCTION= Stressful situations are part of everyday life. Any stressful situation can
precipitate crisis. crisis results in disequilibrium from which many individual require
assistance to recover. Crisis intervention diminished by the level of anxiety. Therefore
assistance is required to solve the problem and pressure the self esteem. In recent years
people in India have faced a number of catastrophic event eg.earthqualke in Sikkim, floods in
Orissa, this year,etc the priority of crisis intervention counseling is to increase stabilization.
Crisis are temporary , no longer than a month although the the effect may become long
lasting.

People in crisis generally have distorted perception of the event do not have
adequate situational symptoms.

Meaning of crisis= crisis meaning a turning point whether in disease or another condition. in
the Chinese language two symbols communicate crisis “danger” and opportunity crisis is a
crucial point or situation in the course of anything, Turing point, crisis refers to the emotional
reaction to an event and not necessarily to the threatening situation or event itself.

Terminology=

Stress= pressure or tension

Crisis = a time of danger or great difficulty.

Coping = deal effectively or contend manage.

Ventilation = cause air to circulate fuel to let out the fueling.

DEFINITION= crisis is a sudden event in ones life that disturbs homeostasis during which
the individual usual coping mechanism can not resolve the problem.

ACCORDING TO LAGERQUIST,2001

A state of disequilibrium resulting from the intraction of can event with the individual or
family’s coping mechanism, which are inadequate to meet the demands of the situation,
combined with the individuals or family perception of the meaning of the event.

A crisis is self limited and can last from a few hours to weeks. its is charactererized by an
initial phase in which anxiety and tension rise, followed by a phase in which problem solving
mechanism are set in motion.

KALPAN AND SADDOCK 1998

Crisis is the turning point in disease, the decisive stage in the progress of anything a state of
affairs in which change for the better or worse imminent. The original usage of the tern was
the turning point in an illness.

OXFORD ENGLISH DICTIONARY 1989.

CHARACTERISTICS OF CRISIS=

Crisis isoccurs in all indiviual at one time or anthor and

is not necessarily equated with psychopatholog.

Crisis are precipited by specific indentify event.

Crisis are personal by nature what any be concidered a

crisis sitution by one indiviual may not be for anthoers

Crisis are acute,not chronic,and will be resotored in one

way or anthoer within a brief period.

A crisis situation contains the potential for psychological

growth or deterioration.

TYPE OF CRISIS =

1. DISPOSITIONAL CRISIS = An acute response to an external situational stressor.

2. CRISIS OF ANTICIPATED LIFE TRANSITION =Normal life cycle transititions
that may be anticipated but over which the individual may feel a lack of control.
3. TRAUMATIC STRESS= Crisis precipitated by unexpected external stresses over
which the individual has little or no control and from which he or she feels
emotionally over whelmed and defeated.
4. MATURATIONAL/ DEVELOPMENT CRISIS –Maturational crisis are
development event requiring role changes.
5. CRISIS REFLECTING PSYCHOPATHOLOGY =Emotional crisis in which
preexisting psychopathology has been instrumental in precipitating the crisis or in
which psychopathology significantly impairs or complicates adaptive resolution.
6. PSYCHIATRIC EMERGENCIES = Crisis situation in which general functioning
has been severely impaired and the individual rended incompetent or unable to
assume personal responsibility.
 PHASES OF CRISIS= The development of a crisis situation follows a relatively
predictable course caplan[1964].individual progress in response to precipitating
stressor and that culminate in the state of acute crisis

FIRST ARISE
STAGE OF IN Use habitual problem solving
TENSON response (if ineffective )

SECOND STAGE
Habitual problem solving response (if
INCREASE TENSION still ineffective in resolving crisis)

Emergency problem solving mechanism

activated (if still ineffective)
THIRD STAGE
Redefining resolution of problem
discontinuances of efforts to achieve
LEVEL OF TENSION goal
CONTINOUES Or
Avoidance of problem by distorting
INCREASE
reality (if all are ineffective.)

FOURTH STAGE
Disorganization of personality
TENSION CONTINUES
TO INCREASE

CAPLANS DEVELOPMENT STAGES OF CRISIS

 PHASE –I = The individual is exposed to a precipitating stressor.

Anxiety increase and the previous problem solving techniques are used.
 PHASE – II = When the previous problem solving. Techniques do not relieve the
stressor anxiety increase further. the individual begins to feel great deal of discomfort
at this point. coping that have worked in the past are attempted. when they are not
successful, that will create feeling of helplessness. Feeling of confusion and
disorganization prevails.

 PHASE –III= All possible resources-both internal and external are called onto solve
the problem and relieve that discomfort. The individual may try to look at the problem
from different perspectives. New problem solving techniques may be used. If
effective, the individual will come out of the stressful situations.
 PHASE-VI= If solution does not occur, the tension mouth beyond the threshold and
individual reaches to a breaking point. Anxiety will reach to a panic level. Cognitive
functions get disordered. Behavior may reflect presence of psychotic thinking.
FACTORS RESPONSE FOR AN INDIVIDUAL EXPERIENCE OF A CRISIS=

1. Individual perception of the event

2. The availability of situational support.
3. The availability of adequate coping mechanism.

continuum of crisis response

adaptive response maladaptive response

growth pre crisis disorganization

functioning

PARADIGM OF THE EFFECT OF BALANCING FACTORS IN STRESSFUL

EVENT:-
Crisis continuum

Potential crisis state

Pre-crisis state

Immediate crisis state

Intermediate crisis state

Advanced crisis state

Full crisis state

Potential crisis state :- Whenever any acute problem or serious threat occurs individuals will
become tense and employs emergency problem solving methods to resolve crisis ,but it is
ineffective.

Pre-crisis state :- When person has high probability of exposure to stressful events, in an
adequate support , lack of coping abilities , poor history of handing stress will be more upset
and enter into a state of disequilibrium.

Immediate crisis state:- As tensions continue to bulied , they mobilize all internal and
external resources to restore the equilibrium.

Intermediate crisis state :- The problem may be re-evaluated and attacked from a new angle
or the problem. may be distorted and viewed as unsolvable.

Advanced crisis state :- Person who have continued to draw all inner resources have
continued failing attempts to resolve the problem ,emotional pressure continue to bulied and
people become completely disorganized or immobilized owing to serve anxiety or
depression state.

Full crisis state :- Person ,who has failed in all attempts to solve the problem ,belives that all
resources have been used feel more stress
Sign & symptom:-

heavy burden
of free
rigid in nature
floatinganger ,guilt
denial anxiety tension,fear
irritable lack
panic
of control
neglecting
lack of performing
confidency self care
activity
withdrwal irrational and
behavioral blaming
oofness others
uncontrollable helplessness,u
low self estem
crying& imapairedseless
jugdement
Crisis intervention :- Crisis intervention is a short term therapy focused on solving the
immediate problem. It is usually limited to6 hours .who experience an event that produce
emotional ,mental physical , and behavioral distress or problem.

Purpose:-

1. To reduce the intensity of an individual, emotional ,mental ,physical and behavioral

reaction to a crisis.
2. To help individual return to their level of functioning before the crisis.
3. To assist the individual in encourage from the crisis and to prevent serious long term
problem from developing .

Goal :-

1. Reduction in disequilibrium or relief of symptoms of crisis.

2. Restoration to pre crisis level of functioning .
3. Some understanding of the relevant precipitating event.
4. Identification of remedial measure.
5. Connecting the current situation with past life experience and conflicts.
6. Initiating new modes of thinking , perceiving feeling and development of new
adaptive an coping response .

Requisites of effective crisis intervention:-

1. Ability to create trusting confidentiality and honestly .

2. Ability to listen in an attentive manner.
3. Provide the individual with the opportunity to communicate by taking less.
4. Being attentive to verbal and nonverbal cues.
5. Pleasant interested intonation of voice.
6. Maintaining good eye contract , posture , and appropriate social distance if in a face to
face to face situation.
7. Remaining undistracted open, honest service.
8. Asking open ended questions
9. Giving feedback and receive feedback whenever possible if the person is prepared to
hear.
10. Asking permission never acting on assumptions.
11. Checking out sensitive cross cultural factors.

Phases of crisis intervention :-

Assessment Planning &implementation

PHASES

Evaluation
Assessment :- The first step of crisis intervention is assessment .at this time data about the
nature of crisis and its effects on the patient must be collected from these data an
intervention plan will be developed .

During the phase the nurse begins to establish a positive

working relationship with the patient a number of balancing factors are important in the
development and resolution of a crisis and should be assessed.

1. Precipitating events:- To help identify the precipitating event the nurse should
explore the patient need. the event that threaten those needs and the time at which the
symptoms appear four kinds needs.
 Self esteem:- Is achieved when the person attains work , successful social rate
experience .
 Role mastery :- Is achieved when the person attains work , sexual and family
role successes.
 Dependency :- Is achieved when a satisfying interdependent relationship with
others is attained.
 Biological function:- Is achieved when a person is safe and life is not
threatened.
Nurses determine which needs are not being met by asking the patient

to reflect on issues of self image and self esteem. the area of life that are considered a
success, ones relationship with or these , and the degree of safety and security of life the
nurse look for obstacles that might interfere with meeting patient needs coping patterns
become ineffective and symptoms appear usually after the stressful incident.

2. Perception of the event :- Perception or appraisal of precipitating event is very

important what may seem trival to the nurse may have great meaning to the
patient .ex- an overweight adolescent girls may have been the only girls in the class
not invited to a dance. this may have threaded her self esteem.
Theme and suffering memories of the patient gives to the
patient gives clues to the precipitating.
3. Support system and coping resources:- Living situation and supports in the
environment must be assessed. Does the patient line done with family or friend ,with
whom close to patient who offers understanding and strength ? if may be the patient
has few supports , participation in a crisis therapy group may be recommended.
4. Coping mechanism :- Assess the client strengths and previous coping mechanism now
has the patient handled other crisis. Now were anxieties relived. Beside exploring
previous coping mechanism the nurse also should note the absence of other possible
successful mechanism,

Planning & implementation :- Next step of crisis intervention is planning ,the previously
collected data are analyzed and specific interventions are proposed.

Nursing intervention can take place on many level

using a variety of teaching .there are four level of crisis intervention.
 1. Environmental manipulation :-Includes intervention that directly change the
patient physical or interpersonal situation .there intervention provide
situational support and remove stress. important elements of this support are
mobilizing the patient supporting social system and serving as a liaison
between the patient and social support agencies.ex-patient having difficulty on
his or her job may take a week of sick leave to be removed temporarily from
the stress.
2. General support:- General support includes intervention that convey the
feeling that the nurse is on the patient side and will be a helping person. The
nurse uses warmth .acceptance empathy, eating and reassurance provide this
type of support.
3. Generic approach:- Generic approach is designed to reach high risk individual
and large group as quickly as possible. it applies to specific methods to all
people faced with a similar crisis.
The expected course of a particular crisis is studied
and mapped out. the intervention is then setup to ensure that the course of the
crisis result in or adaptive response
4. Individual approach:- The individual approach is a type crisis intervention
similar to the diagnosis and treatment of a specific problem in a specific
patient. This type of crisis intervention can be effective with all type of crisis.
it is particularly useful in combined situational and maturational crisis.
Individual approach is also helpful when symptoms include homicidal and risk
of suicidal.
Intervention are aimed at facilitating cognitive and emotional
processing of the traumatic event and at improving coping. The are five care to
assessed serious of acute stress are follows:-
 Restore psychological safety
 Provide information
 Correct misattribution
 Restore and support effective coping
 Ensure social support.

Technique uses of crisis intervention :-

1. Catharsis :- the release of feeling that takes place as the patient takes about
emotionally charged area.
2. Clarification :- encouraging the patient to express more clearly the relationship
between certain events.
3. Suggestion :- influencing a person to accept an idea or belief particularly the
belief of that the nurse can help and that the person will in time feel better.
4. Reinforcement of behavior :- giving the patient the positive response to
adoptive behavior.
5. Support of defense :- encouraging the use of healthy , adoptive defense and
discouraging those that are unhealthy or maladaptive .
 6. Raising self esteem :- helping the patient feeling of self worth.
7. Exploration of solution :- examing alternation ways of solving the immediate
problem.

Evaluation :- the phase of crisis intervention is evaluation the intervention resulted in a

positive resolution of the crisis .

Barriers to effective crisis intervention;-

 Failures to learn from experience.

 Existing mental disorder.
 Therapist client boundary problem.

Summary

Stressful situations are part of everyday life. Any stressful situation can precipitate crisis.
crisis results in disequilibrium from which many individual require assistance to recover.
Crisis intervention diminished by the level of anxiety. Therefore assistance is required to
solve the problem and pressure the self esteem. In recent years people in India have faced a
number of catastrophic event eg.earthqualke in Sikkim, floods in Orissa, this year,etc the
priority of crisis intervention counseling is to increase stabilization. Crisis are temporary , no
longer than a month although the effect may become long lasting.

Conclusion:-

At the end of my seminar student gain knowledge about crisis and its intervention .there are
able to give answer regarding crisis and its intervention.
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publication :emmess; page no 631.
 Erbs & kazier . fundamental of nursing m 8 th edition dorling Kindersley publication :
dorling ; page no 1073.
 Peery & peter .fundamental of nursing . first edition.page no 647.
 Basavathappa BT psychiatric &mental health nursing first edition page no 350
 Townsend marry c.psychiatric & mental hrealth nursing 5 th edition jaypee
publication :jaypee:page no 218.
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 GOVT.COLLEGEOF
NURSING
JAGDALPUR
SUBJECT:- ADAVANCED
NURSING PRACTICE
TOPIC ON
CRISIS AND ITS
INTERVENTION

SUBMITTED TO, SUBMITTED BY,

MRS.ANJUM NOVEL PRIYANKA
M.SC DEMONSTRATOR M.SC (N)1 ST YR
GCON JAGDALPUR GCON JAGDALPUR
 INDEX
S.N CONTENT PAGE NO
1 INTRODUCTION
2 DEFINITION
3 ELEMENTS
4 IMPORTANCE
5 CHARACTERISTICS
6 NATURE
7
STEPS OF ORGANIZATIONAL
BEHAVIOR/MODIFICATION PROCESS

8 FUNDAMENTAL CONCEPT OF
ORGANIZATIONAL BEHAVIOR

9 MODELS OF ORGANIZATIONAL
BEHAVIOR

10 SCOPE OF ORGANIZATIONAL
BEHAVIOR

11 SUMMARY