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Crisis: Is a turning point in an individuals life that produces an overwhelming emotional response.

Individuals experience a crisis when they confront some life circumstance or stressor that they cannot effectively manage through use of their customary coping skills. Caplan (1964) Identified Stages of crises: The person is exposed to stressor, experience anxiety and times to cope in customary fashion. Anxiety increases when customary coping skills are ineffective The person makes all possible efforts to deal with the stressor, including attempts at new methods of coping. When coping attempts fail, the person experiences disequilibrium and significant distress Crises occurs in response to variety of life situations and events and fall into 3 categories: Crisis intervention Is an effective, short-term therapy that focuses only on immediate problems to be resolved. The primary goal of intervention is to return the individual to a higher level of function because of new skills that were learned in the process of resolving the crisis. Includes a variety of technique based on the assessment of the individual. In assessing a patient the nurse should identify: The patient's behaviors Precipitating event Perception of the event Support systems and coping resource Previous strengths and coping mechanisms. The nurse and patient should consider the following factors in evaluating nursing care: The patient's level of functioning Symptoms coping resources Coping mechanisms Evidence of adaptive coping responses Need for referral for further treatment.

Crisis Counselor Is an active participant rather than a passive listener during the crisis intervention process. Working through a step-by-step methodology, the client is assisted out of the seeming maze. Therapist Role Therapist must remember that crisis has a dual nature. It is according to ancient chinese teachings: - Time of danger and threat - Time of opportunity.

Although crisis will resolve without intervention, the result of an unsuccessful resolution can be diminished levels of function and possible disorder in the form of: Mental Emotional Physical Spiritual The client usually benefits from caring and educated guide Directive interventions Are designed to assess the persons health status and promote problem solving such as: Offering the person new information, knowledge or meaning Raising the persons self awareness by providing a feedback about behavior directing the persons behavior by offering suggestion or courses of action.

Supportive Intervention Aim at dealing the persons need for empathetic understanding such as: Encouraging the person to identify and discuss feelings Serving as a sounding board for the person Affirming the persons self worth/ Active Intervention Process 1. Stay focused in the present. Do not allow digressions or unrelated material to interfere. Ex. Redirect the client who discusses past problems that are not directly related. 2. Discuss the clients positive actions and strengths during the crisis. Ex. Reinforce all positive attempts the client make to resolve the problem. One strength to always reinforce is that the client sought help. 3. Direct client when necessary. Ex. Disorganized clients who take alcohol to alter mood before therapy session and is preparing to drive home. The nurse tells the client to call a family member or a taxi for a ride home to avoid an accident arresst. 4. Allow and encourage client to express feelings for the purpose of relief (catharsis) 5. Encourage client to express thoughts. While verbalizing the client will begin to formalized thoughts. Guide the client in the problem solving process. (Use nursing process). 6.Help client name techniques that were tried and discuss new option and alternative approximately for solving problems. What else could you have done instead Did you try.? Some people have done.. in similar situations. Is that something you could do? What has worked in the past for some people is (Do not give absolute advice). 7. Assist the client to identify and connect with support people and agencies.

Crisis Intervention: Crisis intervention is emergency first aid for mental health & domestic violence. It requires that the person experiencing the crisis receive timely and skillful support to help cope with his/her situation before physical or emotional deterioration occurs. Crisis intervention therefore involves three major components: The actual crisis victims perception of an unmanageable situation, The individual in crisis, and The helper who provides aid. Crisis intervention can be implemented in any setting, including hospitals, clinics, community health centers, and the home. It should be a competency skill of all nurses. Modalities of crisis intervention include mobile crisis programs, group work, telephone contacts ,disaster response, victim outreach programs, and health education. Characteristics of a Crisis Time limited: Generally lasting no more than six weeks. Typical phases: Traditional attempt to problem solve Attempts to try alternative methods Disorganization People are more open to change Opportunity to resolve previously unresolved issues Successful experience Crisis Intervention Goal is to stabilize the family situation and restore to their pre-crisis level of functioning. Opportunity to develop new ways of perceiving, coping, and problem-solving. The intervention is time limited and fast paced. Worker must take an active and directive approach. Process Assessment Intervention Termination Assessment includes: the stressor event; the person experiencing the crisis; and the meaning of the event to the person in crisis. Important to assess risk factors.

Risk Factors Suicide or homicide Risk of physical or emotional harm to the children Risk of break from reality (psychosis) Risk of client fleeing the situation. Performing the Assessment Conducting the interview History: personal and familial of risk behavior Any means and plans the client may have about carrying out the risk behavior Controls: internal and external that are stopping the client from undertaking the risk behavior. Observations during the interview Level of anxiety; desperation; despair; sense of hopelessness; contact with reality. The skill and technique most essential at this stage is that of focusing while allowing the client to ventilate and express the overwhelming flood of emotions. Focusing technique can elicit more coherent information for assessment as well as help the client pull themselves together cognitively and emotionally. A focused interview can serve as an instrument of both assessment and intervention. Intervention Planning occurs simultaneously as assessment is made about how much time has elapsed between the occurrence of the stressor event and this initial interview. How much the crisis has interrupted the persons life; The effect of this disruption on others in the family; Level of functioning prior to crisis and what resources can be mobilized. The goal of intervention is to restore the person to pre-crisis level of equilibrium, not of personality changes. Worker attempts to mobilize the clients internal and external resources. Exact nature of the intervention will depend on the clients pre -existing strengths and supports and the workers level o f creativity and flexibility. Three Approaches Affective: Expression and management of feelings involving techniques of ventilation; psychological support; emotional catharsis. Cognitive: Helping the client understand the connections between the stressor event and their response. Techniques include clarifying the problem; identifying and isolating the factors involved; helping the client gain an intellectual understanding of the crisis Also involves giving information; discussing alternative coping strategies and changing perceptions. Environmental modification: Pulling together needed external, environmental resources (either familial or formal helping agencies) Any and all three approaches may be used at any time depending where the client is, emotionally and cognitively. The goal is to help the client restore pre-crisis levels of functioning. Warnings Danger of misunderstanding the clients nonverbal behavior as well as spoken words due to cultural differences or the client s state of disorganization. Imperative for the worker not to assume that they understand what the client means by his spoken word or non-verbal behavior and vice versa. It is best to clarify and make sure. The nurse and patient should consider the following factors in evaluating nursing care: the patient's level of functioning, symptoms, coping resources, coping mechanisms, evidence of adaptive coping responses, and need for referral for further treatment. Crisis intervention can be implemented in any setting, including hospitals, clinics, community health centers, and the home. It should be a competency skill of all nurses. Modalities of crisis intervention include mobile crisis programs, group work, telephone contacts ,disaster response, victim outreach programs, and health education.