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Transition
to Professional Nursing
CRISIS/CRISIS
INTERVENTION
To e-mail the instructor phillips@fiu.edu
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ASSIGNMENT
(FOR WEB-BASED STUDENTS ONLY): 1. Briefly describe a crisis that occurred in your own life. Who or what was most helpful to you during that time? Why? 2.
Briefly describe a clinical situation in which you successfully
used a stress management E-MAIL YOUR ANSWERS TO THE INSTRUCTOR (AT LEAST 200 WORDS). |
CLASS HANDOUT
DEFINITION
OF CRISIS
Internal
disturbances that result from a stressful event or a perceived threat
to self.
Greek--word
"crisis" is derived from the word "krinen"--to
decide.
Chinese--2
characters used to denote crisis; one is character for danger, the
other character for opportunity.
Crises
are an inevitable part of human existence.
Any
stressful event can trigger a crisis, depending on the individual's
perception of the event, coping skills and support system.
A
crisis is a period of increased vulnerability that may lead to growth
of an individual.
HISTORICAL
PERSPECTIVE
Freud's
(1920) developed psychoanalytic theory:
Was
basis for crisis theory development.
All
human behavior has its source in the history and experience of infancy
and childhood.
Erikson
(1963) developed psychosocial theory:
Basis
for maturational and situational crises.
Progression
through stages represented a crisis for the individual.
World
War II:
Psychiatrists
noted that battle weary soldiers who were given immediate
treatment
responded well; those soldiers who had delayed treatment did poorly.
Linderman
(1944) studied bereavement:
Differentiated between behaviors of a normal and morbid grief reaction.
Described
the mental health worker as assisting individuals through the crisis.
Used as the basis for development of current approaches to crisis intervention.
Tyhurst
(1958)
Studied
reactions of individuals to natural disasters, migration and
industrial retirement.
Described
stages of crisis--shock, recoil, and post-trauma.
Caplan
(1964)
Developed
overall theory of crisis/crisis intervention (definition/concepts).
Emphasized goal of individual is returning to a state of equilibrium after a crisis.
Outcome
dependent on the kind of interaction between the individual and
his/her support system.
Joint
Commision of Mental Illness and Health (1961) report:
CHARACTERISTICS OF CRISES
All
crises are experienced as “sudden” to the individual or family.
They were unaware of warning signals and unprepared for the
event.
The crises is often experienced as ultimately life-threatening, whether that perception is realistic or not.
Communication
with significant others is often decreased or cut off.
There
may be perceived or real displacement from familiar surroundings or
significant loved ones.
All
crises have an aspect of loss, whether actual or perceived.
TYPES
OF CRISIS
Transitional
(maturational and anticipated) crisis
Precipitated
by the normal stress created during social, psychological, and
behavioral changes associated with transitions.
These crises are anticipated and can be prepared for.
Universal
transition states:
Normal
transitions of human development.
Predictable
and occurs gradually.
Each
stage is characterized by unique stressors and tasks to accomplish.
Failure
at one stage compromises the next stage of development.
Non-universal
transition states:
Includes
changes such as marriage, retirement, student to worker.
Crises
occur when the individual cannot adapt to functioning at the new
level.
Crisis may occur if the individual:
Is
not able to visualize a new role.
Experiences
two or more life changes or events suddenly.
Lacks
interpersonal resources to make necessary changes.
Has
significant persons refusing to acknowledge the individual's new role.
Situational
crisis
Can
originate from material or environmental sources (disaster), personal
or physical sources (illness), and interpersonal or social sources
(divorce, death).
Occurs
in response to a traumatic event that is usually sudden and
unavoidable.
Can
produce threat of loss or loss of a role necessary to maintain one's
self image.
May
challenge every coping mechanism, especially if it is an uncommon or
unexpected event involving multiple losses or gross environmental
changes.
Phases
of human disaster responses:
Impact
phase
Includes
the event itself.
Characterized
by shock, panic, or extreme fear.
Judgment
and assessment of reality are poor.
Heroic phase
Cooperative
spirit between friends, neighbors and emergency teams.
Constructive
activity can help overcome feelings of anxiety and depression.
Over-activity
can lead to burn-out.
Honeymoon
phase
Appears
one to several months after disaster.
Money,
resources and support received cause daily life to begin again.
Psychological
and behavioral problems may be overlooked.
Disillusionment
phase
Lasts
two months to one year.
A
time of disappointment, resentment, frustration and anger.
Victims
compare others to their own plights; may experience resentment and show hostility toward others.
Reconstruction
and reorganization phase
May
last for years.
Individuals
begin to come to grip with their own problems.
They
begin to re-build their lives, homes, businesses.
Cultural/Social
crisis
Can
originate from cultural and social sources (loss of a job due to
discrimination, being a victim of deviant acts of others or behaviors
that violate social norms).
Often
are less amenable to control by individuals.
Community
or government action may be a component of identification and
resolution of the crisis.
CRISIS
SEQUENCE
Precrisis
Stage--individual
maintains equilibrium through use of coping skills during minor
stressors.
Crisis
Stage
Individual
perceives an event as threatening to life goals and unmanageable based
on current coping mechanisms.
Leads
to increased anxiety, tension, and disorganization.
Lasts
no longer than six weeks since much energy is expended.
Postcrisis
Stage—may
result in positive or negative state.
Positive
state--develops
new equilibrium and functioning (a better social network, problem
solving abilities, improved self-image).
Negative
state—loses
skills, regresses or develops socially unacceptable behaviors.
SYMPTOMS
EXPERIENCED IN CRISIS
Anxiety
Depression
Confusion
Anger
Helplessness
Withdrawal
Somatic
symptoms
Inefficiency
Hopelessness
FACTORS DETERMINING OUTCOME OF CRISES
People
in crisis are usually ready to accept help from others; support aids
in a positive resolution.
Factors that determine the outcome:
Precipitating
event.
Perception
of event.
Age
and developmental level.
Previous
strengths/coping mechanisms.
Past
experience with crises.
Nature/strength
of support systems.
POST-TRAUMATIC
STRESS DISORDER
Caused by a psychologically distressing event or series
of events resulting in fear, terror,
or feelings of helplessness.
Event(s) may be:
A threat to one’s integrity or life.
Sudden destruction of home or community.
Seeing
a person(s) who have been seriously injured or killed as a result of
accident or violence.
Natural
disasters.
Deliberate
disasters.
Repeated
exposure to trauma.
Child
abuse.
Sudden
loss of loved ones.
Symptoms
Repeated
memories with painful emotions.
Flashbacks—strong
re-experiencing of the events.
Sleep
disturbances and distressing dreams of the events.
Distress
at events that resemble the trauma.
Avoidance
of stimuli associated with the trauma (feelings, thoughts, activities, situations).
Inability
to recall the trauma.
Diminished
interest in activities.
Increased
reliance on crutches (alcohol, drugs).
Inability
to have loving feelings.
Sense
of no hope for tomorrow.
Irritability
and angry outbursts.
Difficulty
concentrating.
Physiological
reactions (sweating, tremors) with exposure to memories.
Survival
guilt.
Treatment
Individual
psychotherapy.
Family
therapy.
Peer
counseling.
Physical
care and nurturing.
Use
of stress management strategies.
Re-socialization
support.
Medication
when appropriate.
Inpatient,
intensive treatment, as appropriate.
CRISIS
INTERVENTION
Treatment
strategy that can offer immediate help to a person in crisis to
restore equilibrium.
Inexpensive,
short-term and focuses on solving the immediate problem.
Guidelines:
Use
environmental manipulation—calming atmosphere.
Listen
actively and with concern.
Encourage
the open expression of feelings.
Link the client to a social network.
Help
the client gain an understanding of the crisis.
Help
the client gradually accept reality—visit site.
Help
the client explore new ways of coping with problems.
Engage
in decision counseling or problem solving with the client.
Reinforce
newly learned coping strategies.
Make
appropriate referrals.
Follow
up the case after resolution of the crisis.
MODALITIES
OF CRISIS INTERVENTION
Individual
intervention
Generic
approach--provides a specific intervention effective for all clients
experiencing a
particular type of crisis.
Individual
approach--treats a specific problem in a specific client.
Family
intervention
Provides
immediate emergency response to stabilize family anxiety; mobilizes
extended family
members.
Restructures
the kinship system to provide long-term solutions.
Group
intervention
Collection
of individuals who meet with therapist.
The
group works toward a resolution of the members' crises.
Telephone
hotlines and counseling
Provide
a link (listening) for individuals unwilling to come to centers for
help.
Used
for a variety of crises—suicide threats, AIDS, child abuse, etc.
Guidelines:
Always
remain calm.
Use
active listening skills, but also offer direction and solutions.
Help the individual form an action plan.
Keep
the caller talking and inform him/her that you are available to talk.
If
there are threats of immediate harm to self or others:
Assess the safety of the caller.
Attempt to get basic identifying information on the caller, but do not press.
Assess the involvement of vulnerable people or children.
Listen to background noises for cues.
Acknowledge
the caller’s distress, but inflicting harm is not a solution.
Notify
the police, mental health workers, and family members who can
intervene.
Trace
the call.
Home
visits
Used
when telephone counseling does not suffice or not possible.
Can
initiate contacts when an individual is too disorganized or distraught
to seek help.
Visit
teams often consist of a male and female—less threatening to
individual.