Crisis InterventionNURS 20172

What is a Crisis?

Emotional and physical response to a precipitating event or series of events

Disrupts our normal day to day functioning

A normal part of life Examples?

Stress that crisis is normal and everyone does experience crises as part of normal life

There are many definitions of what a crisis is…the reality is that everyone at some time experiences a crisis. Usually with normal coping mechanisms they can overcome the crisis and move on.

examples of crises that happen (ie death of a pet, car accident, failed test)

Crisis management consists of skills and techniques required to assess, understand, and cope with any serious situation, especially from the moment it first occurs to the point that recovery procedures start.

When is a Crisis a Problem?

3 Core Components

1. A precipitating event occurs2. Perception of the event leads to

subjective distress3. The person’s usual coping

mechanisms fail

RNAO Best Practice GuidelineCrisis intervention

crisis can become problematic for some people depending on several factors .

The RNAO BPG identifies 3 core components that identify how crisis can become a problem

1.Precipitating event – stressful event in itself is not a crisis – the event may or may not develop into a crisis as it depends on personal and social circumstances

2.Subjective distress – can take on the form of many feelings or emotions that often feel overwhelming or confusing for the person in crisis. If subjective distress does not impair coping or functioning one is experiencing manageable stress but is not in crisis

3.If the person is able to function emotionally, occupationally and interpersonally he/she is not in crisis

Crisis as a Problem

Verbal Escalation Intimidation/Threatening Behaviour Physical Violence

If someone’s usual coping mechanisms fail they are more susceptible to manifesting some of the mentioned behaviours.

It is important to be aware of signs and ways to provide early interventions in order to help prevent further escalation of the situation.

The person may lose judgment and perspective on the situation.

Where Can a Crisis Occur?

Home School Workplace Public place Health care facility Anywhere!

The client may also be experiencing significant loss of independence or feel stress related to the diagnosis, frustrations due to limitations

Family members may also feel stressed related to the illness of their loved one, uncertainty of the future, impatience regarding care

Highlight that crisis is not unique to healthcare setting s and it can happen almost anywhere!

Why do we need to know about Crisis Intervention?

We may have client’s in crisis

We may have family members in crisis

We may have to assist another person in crisis

We can’t always predict when we will use crisis intervention however the communication knowledge and awareness will aid in stressful and potentially crisis producing situations.

Signs of Escalating Crisis Louder tone of voice Faster pace of speech Agitation Pacing Facial expression Clenched fists, clenched teeth Tense body position Other signs???

Ask the class to identify how someone would be able to identify that a person may be exhibiting signs of crisis and their behaviour may be ‘escalating’ as they are unable to cope with the stressor.

When it comes to agitation and facial expression ask the class to describe what they would observe

The Integrative Model of Crisis Intervention

Develop Rapport Maintain Contact

Identify the Problem Explore Coping

Assess risk to life

Negotiate an action plan Implement the plan

Follow up on the plan

Introduce that this is a model from the RNOA BPG on Crisis intervention and it describes the steps that should be taken when dealing with a person who is in crisis

Also highlight that it is a model and may not be suitable 100% of the time, we need to be adaptable depending on the situation and the client’s needs.

We will be discussing each step separately

Develop Rapport and Make Contact

How do you develop rapport?

Maintain contact with the client Ensure the client feels understood,

accepted and supported Avoid asking ‘why’ questions

Developing rapport – Ask class – they should be familiar with this stage

• Using therapeutic communication techniques• Being empathetic, non-judgmental,

respectful and genuine

• Avoid asking ‘why’ questions – they have the connotations of blaming or accusatory….counterproductive to the therapeutic relationship

Develop Rapport and Make Contact

Verbal communication and empathetic understanding always implemented first!

Identify the Problem

Collect information that is relevant and aids in the nature of the crisis

Focus on client functioning including a history of prior coping

Collect information – could be a theme like loss of control, loss of nurturance

Understanding the nature of the crisis could be key in determining the best way to help the client through the crisis.

Remember that it is important to establish rapport before getting into the specific problem. Without rapport with the client the questioning of what is causing the problem could be interpreted as invasive and cause further escalation.

You must have the client’s trust first.

Explore Client Coping & Negotiate an Action Plan

Encourage client to consider alternative coping strategies

Encourage active participation in creating solutions

Focus on immediate problems that directly contributed to the crisis

Allow time for expression of feelings Mobilize support networks

Explore what the client used to cope in the past and whether or not it is appropriate in this situation

Work with the client to see if there are ways of adapting or adjusting coping to help with this current situation and crisis

Avoid exploring in depth personality or psychiatric issues, keep focused on the immediate crisis and resolving it.

If the client is highly emotional be sure to provide time for expression of feelings. At this point provide simple and specific directions to the client until the immediate crisis is over

Mobilize community and other resources to assist the client as needed.

Follow-Up

Did the client carry out the crisis plan? Does the client have a plan to work towards

meeting his/her goals? Does the client require additional linkages to

community resources and support?

Follow up will help to assess whether or not the client’s coping strategies are effective

The follow up is best planned and carried out by professionals who help the client work through the crisis event

Therapeutic Communication Review

Verbal and Non-Verbal Communication

VERBAL COMMUNICATION

Vocabulary Denotative &

Connotative meaning Pacing Intonation Clarity and Brevity Timing and Relevance

NON-VERBAL COMMUNICATION

Personal Appearance Posture and Gait Facial Expression Eye Contact Gestures Sounds Territoriality and

Personal Space

What are Therapeutic Communication Techniques?

“Specific responses that encourage the expression of feelings and ideas and convey the nurse’s acceptance and respect”

p. 271 Perry & Potter

Examples of Therapeutic Communication

Active listening Sharing

observations Sharing empathy Sharing hope Sharing humour Summarizing Self-disclosure

Sharing feelings Using touch Using silence Clarifying Focusing Paraphrasing Asking relevant

questions

Examples of Non-Therapeutic Communication

Asking personal questions

Giving personal opinions

Changing the subject Automatic responses Arguing Passive or

aggressive responses

False reassurance Sympathy Asking for

explanations Approval or

disapproval Defense responses

Role-Play

Time!