LECTURE NO.

Crisis Intervention
 Learning Objectives
Define crisis
Name the types of crisis
Describe the various phases of crisis
Describe various steps in the nursing
process in relation to crisis
 Definitions
Crisis is an acute, short-lived and
overwhelming emotional reaction to
a situation or an event.
A sudden event in one's life that
disturbs homeostasis, during which
usual coping mechanisms cannot
resolve the problem.
 Types of Crisis
Maturational
Situational
Adventitious
 Maturational Crisis
This relates to the process of maturation
and passing through various stages of the
life cycle.
Coping skills used earlier may no longer be
helpful and appropriate. This leads to
anxiety or crisis.
Adolescence, marriage, becoming a parent
and retirement are some of the examples
of maturational crises.
 Situational Crisis
Is precipitated by various life events
and is not anticipated
Change of job, loss of job, divorce,
financial loss, death of a loved one
and major physical illnesses are some
of the life events that can lead to
situational crisis.
 Adventitious Crisis
Also known as crisis of disaster,
adventitious crisis is a situation that is
not a part of everyday life
It is unplanned and accidental.
Various examples of adventitious crisis
include earthquake, flood, airplane
crashes, rape, murder, war, riots and
terrorism.
 Phases of Crisis

Caplan (1964) described four phases

of crisis:
i. When faced with a problem that
seems to be unsolvable, tension
starts and anxiety mounts. The
person attempts more and more to
solve the situation.
 Phases of Crisis (cont.)
ii. Anxiety increases further with impairment of
function and results in disorganization and
distress. If anxiety and arousal are in
excess, it hinders coping behaviour.
iii. Emergency measures are taken and new
coping skills are tried.
iv. Failure to resolve the crisis leads to further
deterioration, disorganization and
decompensation.
 Application of the
Nursing Process
1. Nursing Assessment
Determine the severity of the crisis
Assess the risk for suicide/homicide
Assess patients perception of the
precipitating events
Assess the patients coping skills
Assess the available support system
 Application of the
Nursing Process (cont.)
2. Nursing Diagnosis
Various nursing diagnosis in a patient
with crisis include:
Anxiety
Ineffective coping
Inability to meet role expectations
Inability to carry out routine activities
 Application of the
Nursing Process (cont.)
Decreased socialization
Low self-esteem
Risk to self
 Application of the
Nursing Process (cont.)
3. Nursing Outcome
Set short-term and long-term goals
with patient and the family
Goals should be realistic, culturally
relevant and meet the patients level of
functioning
Nursing Outcome Classification (NOC)
can be used to help set the outcome
goals.
Possible Outcome Criteria in
Crisis Intervention
Short Term Long Term
Refrains from harming Feels safe even when
self or attempting suicide alone
Level of anxiety goes
down Sleep and appetite patterns
are back to pre-crisis level
Sleeps better
Learns new coping skills
Becomes more coherent
and organized Able to carry out roles at
Interacts better with home and at the workplace
others Has confidence in self to
Able to see some hope in handle life and problems
life effectively
 Application of the Nursing
Process (cont.)
4. Nursing Intervention
Crisis intervention is a brief psychiatric
treatment to forestall the process of mental
decompensation in severe emotional stress.
Two basic aims of crisis intervention are
safety and anxiety reduction.
Nursing interventions in a crisis can be
carried out at three levels.
Levels of Crisis Intervention
Primary level: promotes mental well-
being and reduces the incidence of crisis
Secondary level: works towards
preventing prolonged anxiety,
diminished efficacy and personality
disorganization.
Tertiary level: aims at providing support
to patients recovering from a crisis
 Application of the Nursing
Process (cont.)
5. Evaluation
To judge the effectiveness of the crisis
intervention strategies used
Usually carried out 48 weeks after the
initial assessment
Nurse may decide to follow up with
patient or refer to other agencies
 Crisis Stabilization

People with mental illness are more prone

to crisis.
The nurse can adapt the crisis model by
taking the following steps:
Clarify the reality of the situation
Make the patients aware of own
capabilities and social support
available
Crisis Stabilization (cont.)
Set realistic goals according to
level of functioning
Take up responsibility and help the
patient for the initial period