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Lesson Plan on Crisis Intervention

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Sr . no Specific Objectives Dura tion Contents TEACHING LEARNING ACTIVITY A V AIDS BLACKBOARD ACTIVITY EVALUATION INTRODUCTION Black Tuesday that ripped apart soul wet only in Mumbai but the whole nation could be best way of describing the concept of crisis what followed later was helplessness, anxiety, shock, and disbelief, which further produced a state of crisis for all people staying in MUMBAI as well as in INDIA . DEFINITION OF CRISIS:- A sudden event in one’s life that disturb homeostasis during which usual coping mechanism cannot resolve the problem - LANGERQUIST Crisis is a state of disequilibrium resulting from the interaction of an event with the individual’s or family’s coping mechanisms , which are inadequate to meet the demands of the situation combined with the individual’s or family’s perception of the meaning of the event. -TAYLOR 1982
Transcript
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A V AIDS BLACKBOARD

ACTIVITYEVALUATION

INTRODUCTION

Black Tuesday that ripped apart soul wet only in Mumbai but the whole nation could be best way of describing the concept of crisis what followed later was helplessness, anxiety, shock, and disbelief, which further produced a state of crisis for all people staying in MUMBAI as well as in INDIA .

DEFINITION OF CRISIS:-A sudden event in one’s life that disturb homeostasis during which usual coping mechanism cannot resolve the problem

- LANGERQUISTCrisis is a state of disequilibrium resulting from the interaction of an event with the individual’s or family’s coping mechanisms , which are inadequate to meet the demands of the situation combined with the individual’s or family’s perception of the meaning of the event. -TAYLOR 1982

DEFINITION OF CRISIS INTERVENTION:-It is a specific type of brief psychotherapy with prescribed steps. -AQUILERA 1998Crisis intervention is a short term therapy focused on solving the immediate problem, usually limited to 6 weeks.

GENERALLY:-

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Crisis intervention is an intervention designed to help an individual or client to cope up, with a sudden problem and encourage at a level of functioning equal to or higher than pre-crisis state.

Crisis intervention is more directive than traditional psychotherapy or counseling and can be used by any member of the health member of the health care team who has been trained in its techniques. The basic approach is problem solving and focuses only on the problem presented by the crisis.

CRISIS PRONENESS:

HENDRICKS (1985) suggests that certain individuals are more prone to crisis than others .the following are characteristics often found in individuals who are regarded as being more susceptible to crisis:-

Dissatisfaction with employment or lack of employment. History of unresolved crisis. Poor self-esteem, unworthiness. Superficial relationship with others. Difficulty in coping with everyday situations. Under utilization of resources and support systems. Aloofness and lack of caring.

It is important to note that individual personality crisis must also be considered in conjunction with these characteristics .crisis is defined by the individuals what is a crisis for one is merely an occurrence for another .this factors is a critical component that must be evaluated in relation to crisis prone characteristics as well as personality traits.

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TYPES OF CRISIS SITUATION:-

DEVELOPMENTAL/MATURATIONAL CRISISSITUATIONAL CRISIS ADVENTITIOUS/SOCIAL CRISIS

1. DEVELOPMENTAL/MATURATIONAL CRISIS:-Predictable events in the normal course of life and formerly used coping mechanisms no longer work.Examples:

o Passing from school-age to adolescence.

o Passing from adolescent to adult.

o Leaving home

o Getting married

o Having a baby

o Beginning a career

Maturational Crisis New coping mechanisms yet to be developed. While individual is without effective coping methods

they have anxiety which may affect behavior. The way these crisis are resolved affects the ability to

pass through subsequent stages. Alcohol and drug addiction can interrupt passage thru

these stages.

This appears when the client enters a new stage of life development and is unable to make changes which are necessary

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to function .eg inability to change with marriage, birth of the child or death of a parent.A maturational crisis is a stage in a person’s life where adjustment and adaptation to new responsibilities and life patterns are necessary.The transition points where individuals more into successive stage often generate disequilibrium .individuals are required to make cognitive and behavioural changes and to integrate those physical changes that accompany development.The extent to which individual’s experience success in the mastery of these tasks depends on previous successes availability of support systems ,influence of role models and acceptability of new role by others.The transitional periods or events that are commonly identified as having increased crisis potential are adolescence, marriage, parenthood, midlife and retirement.This relates to the process of matuaration and passing various stages of the life cycle.coping skills used earlier may no danger be helpful and appropriate .this leads to anxiety or crisis –adolescence ,marriage, to be parent, and retirement are some examples of maturational crisis.

Erickson's theory of personality development, which our personality continues to develop through life. Sudden change is a kind of function of how a certain individual deal each stage of development.

Stages of Social-Emotional Development In Children and Teenagers.

Erikson’s Psychosocial Development

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The following stages are called as crucial points in the cycle of human being:

a. PRENATAL PERIOD :-Pregnancy can causes stress to the women .they need helps not only for their physical as well as emotional wellbeing which ultimately has an effect on the physical and emotional wellbeing of the fetus.

b. FIRST FIVE YEARS OF LIFE:-The roots of mental health get set in early childhood .the infant and young child should experience, a warm intimate and continuous relationship with his mother and father .it is this relationship that underlines the development of mental health.E.g. Broken homes, lack of affection, battered children all these lead to behaviour disorder in children.

c. SCHOOL AGE:-Everything which happen in the school affects the mental health of the child .The program and practices of the school may satisfy or frustrate the needs of the child .from this stand point , child mental health as shown in effectiveness in learning .proper teacher pupil relationship and climate of the class rooms are very important to the mental health

d. ADOLESCNCE:-This is the transitional stage from adolescence to adulthood .this is otherwise called as stormy phase .when dangers exist in the form of mental ill health .e.g. Juvenile delinquency Following needs should be met

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The need to be needed by others The need for increasing independence The need for achieve adequate adjustment with

opposite sex

e. OLD AGE:-Mental health problems of elderly individual need more attention in the developing countries .the course of mental illness are organic condition of the brain, economic insecurity, lack of home and poor status.

2. SITUATIONAL CRISIS:-A situational crisis is one that is precipitated by an unanticipated stressful event that creates disequilibrium by threatening one’s sense of biological, social or psychological integrity.Unanticipated or sudden events arising from an external source that threaten the individual’s integrityExamples: Job Loss, Death Of Loved One, Abortion, Job Change, Financial Change, Divorce, Pregnancy, Severe Illness.Other examples of events that can precipitate situational crisis are premature birth status and role changes, death of a loved ones, physical or mental illness, divorce ,change in geographic location and poor performance in school.

3. SOCIAL CRISIS/ADVENTITIOUS CRISIS:- An unplanned, accidental event that is not part of everyday life. May be a natural disaster flood, fire or earthquake National disaster, war, riot

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Crime of violence rape, murder, spousal or child abuse.

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. These are unexpected occurrences that necessitate changes in a person because they involve a severe threat of self esteem or physical safety.Examples are rape, disturbance like cyclones, earthquakes, flood etc. Here not only an individual alone is involved, a community or locality or a population, its adjacent environment are also involved .so here change not only takes place in individual, but also in his environment also. Social crisis is accidental ,uncommon and unanticipated and results in multiple losses and radical environmental changes ,social crisis include natural disasters like floods, earthquakes, violence, nuclear accidents, mass killings, contamination of large areas by toxic wastes ,wars etc.This type of crisis is unlike maturational and situational crisis because it does not occur in the lives of all people. Because of the severity of the effects of social crisis coping strategies may not be effective. individual confronted with social crisis usually do not have previous experience from which to draw expertise .support systems may be unavailable because they may also be involved in similar situations .mental health professionals are called upon to act quickly and provide services to large number of people and in some cases ,the whole community. There are certain psychiatric illnesses, which need immediate attention in order to make changes in the

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PHASES OF CRISIS:-CAPLAN (1964) has described four phases of crisis :-

1. PHASE I:-o Threatens self-concepto Increased feelings of anxietyo Problem-solving techniques and defense mechanisms

are stimulated to lower anxiety. o Persons experiencing a crisis are usually distressed &

likely to seek help.o They are ready to learn new coping skills to relieve

distress.Perceived threat acts as a precipitatant that generates increased anxiety .normal coping strategies are activated and if unsuccessful, the individual moves into PHASE II.When faced with a problem that seems to be unresolvable, ‘TENSION’ starts and anxiety mounts. The person’s attempts more and more to solve the situation.

2. PHASE II:-o The usual defense mechanisms tend to fail and anxiety

continues to rise. o The individual becomes disorganized.o Trial and error problem solving begin.

The effectiveness of the PHASE I coping mechanisms leads to further disorganization .the individual experiences a sense of

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vulnerability .the individual may attempt to cope with the situation in a random fashion. If the anxiety continues and there is no reduction, the individual enters PHASE III.Anxiety increases further improvement of function and results in disorganization and distress .if anxiety and arousal are in excess, it hinders coping behaviour.

3. PHASE III:-o If trial-and-error attempts fail, anxiety escalates to severe

panic levels.o Uses relief behaviors such as withdrawal & flight.o Some resolution may occur (compromising needs, redefine

situation to make more acceptable).Redefinition of crisis is attempted and the individual is most amenable to assistance in this phase. New problem solving measures may also affect a solution .return to precrisis level of functioning may occur .if problem solving is unsuccessful, further disorganization occurs and the individual is said to have entered PHASE IV. Emergency measures are taken and new coping skills are tried.

4. PHASE IV:-If problem unsolved, anxiety continues at severe or panic level, serious personality disorganization occurs (confusion, immobilization, and violence against others, suicide attempts, aimless running and shouting.Severe to panic levels of anxiety with profound cognitive, emotional and physiological changes may occur .referred to further treatment resources is necessary. Failure to resolve the crisis leads to further disorientation, disorganization &

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SIGN AND SYMPTOMS OF CRISIS:- The major feeling in a crisis situation is anxiety .the individual

experiences a heavy burden of free floating anxiety. The anxiety may be manifested through depression ,anger and

guilt .the victim will attempt to get rid of the anxiety using various coping mechanism ,healthy or unhealthy .

The individual may become incapable of even taking care of his daily needs and may neglect his responsibilities.

The individual may become irrational and blame others for what has happened to him.

RESOLUTION OF CRISIS :-Healthy resolution of crisis depends upon the following three factors

1. Realistic appraisal of the precipitating event , i.e. recognition of the relationship between event and feelings of anxiety is necessary for effective problem solving to occur.2. Availability of support systems3. Availability of coping measures over a life-time. A person develops successful coping strategies that enables him to identify and resolve stressful situations.

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The individual may resolve the crisis by three ways:-

PSEUDO-RESOLUTION:-In this , the individual uses repression and pushes out of consciousness the incident and the intense emotions associated with it .so there will not be any change in the level of functioning of the individual.ut in future ,if and when a crisis occurs ,the repressed feelings may surface and influence the feelings aroused by the new crisis. In such a situation ,the particular crisis may be ,more difficult to resolve because the feelings associated with the earlier crisis are neither expressed nor handled that time.

UNSUCCESSFUL RESOLUTION:- In this , the victim uses pathological adaptation at any phase of crisis, resulting in a lower level of functioning .the victim rather than accepting the loss and reorganizing his life ,keeps ruminating over the loss. An example prolonged grief reaction, which results in depression.

SUCCESSFUL RESOLUTION:-I n this the victim may go through the various phases of crisis ,but reaches PHASE III where various coping measures are utilized to resolve the crisis situation. The individuals develops better skills and problem solving ability which can be and will be used in various crisis situations in future.

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CRISIS INTERVENTION:-

CRISIS INTERVENTION IS AN INTERVENTION DESIGNED TO KEEP AN INDIVIDUAL OR CLIENT TO COPE UP WITH A SUDDEN PROBLEM AND ENCOURAGE AT A LEVEL OF FUNCTIONING EQUAL TO OR HIGHER THAN PRE-CRISIS STATE.

OR

CRISIS INTERVENTION IS A TECHNIQUE USED TO HELP AN INDIVIDUAL OR FAMILY TO UNDERSTAND AND COPE WITH THE INTENSE FEELINGS THAT ARE TYPICAL OF A CRISIS.

AIMS OF CRISIS INTERVENTION TECHNIQUES:-

To provide a correct cognitive perception of the situation. To assist the individual in manageging the intense or

overwhelming feelings associated with the crisis.

MODEL OF CRISIS INTERVENTION:-

Kubler-Ross described five stages of grief in her 1969 book "On Death And Dying" that are just as relevant to the normal range of feelings people have when they are dealing with change on an individual level or in the workplace.

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ELIZABETH KUBLER ROSS MODEL (FIVE STAGES OF GRIEF IN 1969) It describes the five discrete stages, a process by which people deal with grief and tragedy especially when diagnosed with a terminal illness or catastrophic loss.

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptanceo DENIAL :-

Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely. "I can't believe it", "This can't be happening", "Not to me!", "Not again!" Denial is usually a temporary defense that gives us time to absorb news of change before moving on to other stages. It is the initial stage of numbness and shock. We don't want to believe that the change is happening. If we can pretend that the change is not happening, if we keep it at a distance, then maybe it will all go away. A bit like an ostrich sticking its head in the sand.

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o ANGER :-

Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgmental when experiencing the anger of someone who is very upset.

"Why me? It's not fair!" "NO!I can't accept this!" When we realise that the change is real and will affect us our denial usually turns to anger. Now we get angry and look to blame someone or something else for making this happen to us. What's interesting is that our anger can be directed in many different directions. I've seen people angry with the boss, themselves, or even God. In these tough economic times it's often the economy that is blamed. It's the government, or top management's fault for not planning properly. You might find you are more irritable towards colleagues or family. You'll notice others finding fault with the smallest things.

o BARGAINING :-

Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. "Just let me live to see my children graduate."; "I'll do anything,

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can't you stretch it out? A few more years." This is a natural reaction of those who are dying. It's an attempt to postpone what is inevitable. We often see the same sort of behaviour happening when people are facing change. We start bargaining in order to put off the change or find a way out of the situation. Most of these bargains are secret deals with God, others, or life, where we say "If I promise to do this, then you make the change not happen to me". In a work situation someone might work harder and put in lots of overtime to prove themselves invaluable, in order to avoid retrenchment.

o DEPRESSION:-

Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality. "I'm so sad, why bother with anything?"; "What's the point of trying?" When we realise that bargaining is not going to work the reality of the change sets in. At this point we become aware of the losses asssociated with the change, and what we have to leave behind. This has the potential to move people towards a sad state, feeling down and depressed with low energy. The depression stage is often noticeable in other ways in the workplace. People dealing with change at work may reach a point of

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feeling demotivated and uncertain about their future. I recently experienced a group of bank employees asking why they should continue to give of their best at work when they were unsure that their jobs were safe; and the bank was obviously not committed to them. My experience is that there is an increase in absenteeism at this time as people use sick leave and take 'mental health' days.

o ACCEPTANCE:-

Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief."It's going to be OK."; "I can't fight it, I may as well prepare for it." As people realize that fighting the change is not going to make it go away they move into a stage of acceptance. It is not a happy space, but rather a resigned attitude towards the change, and a sense that they must get on with it. For the first time people might start considering their options. I think it's a bit like a train heading into a tunnel. "I don't know what's in there, I have to keep going on this track, I'm scared but have no option, I hope there's light at the end..." This can be a creative space as it forces people to explore and look for new possibilities. People tell me that they learn lots about themselves, and it's always good to acknowledge the bravery that acceptance takes.

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GOALS OF CRISIS INTERVENTION:-

The goal of crisis intervention change according to the degree of treatment you will be involved in crisis intervention for the health care provider is obviously provided at different level that it would be from a law of enforcement or emergency dispatch viewpoint . We will look at the goals of crisis intervention from a health care prospective.

ENSURES SAFETY:- Assess the situation .if you or the patient is in physical danger, signal for help .do not leave the patient carelessly in danger to yourself in imminent. It may sound harsh, but you will be no good to anyone, if you are hurt or worse .take care of your own safety first, then later care of patient safely.

DOFFUSE THE SITUATION:-Do this verbally, when at all possible .A person in crisis is most likely not in control of his or her thoughts, feelings or actions. Physical attempts at restraining or calming are best left until all verbal attempts have been made and only when there is enough help to do it safely for the patient and staff.

DETERMINE THE PROBLEM:-Attempt to find out from the patient’s viewpoint the cause of the crisis. It is very important that you not push the patient to give you reason and that you remain calm during the intervention.

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DECREASE THE ANXIETY LEVEL:-Your adrenaline level will be probably at all time high, but it won’t be even close to that of person in crisis. Make every attempt to reassure the patient that he or she in a safe place. Let the person know you are concerned and want to help. Gently but firmly tell him or her that you will do whatever you can make the situation more comfortable but that you do need his or her help and co-operation.

CAUTION:-Be very careful with physical contact at this point. Touch as a nonverbal communication skill may be interpreted inaccurately as aggression sexual intimacy by a person whose thoughts are in turmoil.

RETURN PATIENT TO PRECRISIS (OR BETTER) LEVEL OF FUNCTIONING:- You may be able to calm the person to the point that he or she is able to understand what just happened; you may not .it might take a longer term session of treatment to help the person gain that kind of insight. No matter what level of intervention the patient requires, the ultimate goal is for him or her to learn the skills necessary to cope up with stress in a more positive way than was used before the crisis.

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STEPS IN CRISIS INTERVENTION:-A. STEPS TO PROVIDE A CORRECT COGNITIVE

PERCEPTION:-

ASSESSMENT OF THE SITUATION:-This may be achieved by direct questioning with the purpose of identification of the problem and the people involved.It is necessary to identify the support systems available and to know the depth in which the individuals feelings are affected Assessment should also be done to identify the strengths and limitations of the victims.

DEFINING THE EVENT:The victim at times may not be able to identify the precipitating event because of possible denial or due to reluctance to talk about it.It may be necessary for the therapist to review the details of the incidents in the past 2 to 4 weeks in order to identify the event that precipitated the crisis such as a review will help the victim becoming aware of the precipitating event .

DEVELOP A PLAN OF ACTION :-The victim and the people closely associated with him should have active involvement in developing the plan of action.The therapist must be aware that the victim may not be aware

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that the victim may not be in condition to mentally comprehend.Complicated information due to the overwhelming anxiety experienced by him . The instructions given by the therapist must be simple and clear and too much information should not be given ata a time .the instructions may have to be written down ,as the victim may not be able to retain all the information.

B. STEPS TO ASSIST THE VICTIM IN MANAGING THE INTENSE FEELINGS:-

Helping the individual to be aware of the feelings The victim needs help in identifying his own feelings ,which is first step in handling them .The therapist should use appropriate communication technique so that the victim will feel comfortable to express his feelings without the fear of being judged or criticized .The therapist should also be efficient in observing verbal and nonverbal behaviour of the victim ,so that he will be able to make a careful assessment of his feelings .

HELP THE INDIVIDUAL TO ATTAIN MASTERY OVER THE FEELINGS:-The individual should be given adequate support and guidance through the therapeutic process in order to handle feelings associated with crisis but special care should be taken not to give any false reassurance. He should not in any way be encouraged to blame others , as this will be encouraged to blame others ,a s this will only let

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him escape from taking any responsibility.Care must be taken to ensure that the individual does not develop too much dependency on the therapist ,which is unhealthy .After the victim and support groups prepare the plan of action under the guidance of the therapist ,it should be discussed with the victim and the concerned others ,so that they will have a clear understanding of the methods of implementation of the plan.To improve the coping with the situation necessary environmental manipulation must be done in physical or interpersonal areas.it is advisable to have another appointment for the victim to visit the therapist within a week ,in order to assess how the plan is working out, if needed ,to revise and modify the plan

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ROLE OF THE NURSE IN CRISIS INTERVENTION:-

Nurses responds to crisis situations on a daily basis .crisis can occur in any unit for example in general hospitals, home settings ,community health centers ,schools ,offices and in private practice .indeed nurses may be called upon to function as crisis helpers in any situation.Knowledge of crisis intervention techniques is thus an important clinical skill of all regardless of the setting or practice specialty.

NURSING ASSESSMENT:-The first step of crisis intervention is assessment .during this phase the nurse collects data regarding following factors :- Precipitating event or stressors Patients perception of the event or stressor Nature and strength of the patients support systems. Coping

resources Level of psychological stress patient is suffering from and

degree of impairment he is experiencing. Patients previous strengths and coping mechanisms

During this phase, the nurse begins to establish positive working relationship with the patient.

In a disaster or mass casualty situation, different systems for triage have been developed. One system is known as START (Simple Triage and Rapid Treatment). In START, victims are grouped into four categories, depending on the urgency of their need for evacuation. If necessary, START can be implemented by persons

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without a high level of training. The categories in START are:

the deceased, who are beyond help the injured who could be helped by immediate transportation the injured with less severe injuries whose transport can be

delayed those with minor injuries not requiring urgent care.

Another system that has been used in mass casualty situations is an example of advanced triage implemented by nurses or other skilled personnel. This advanced triage system involves a color-coding scheme using red, yellow, green, white, and black tags:

Red tags - (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

Yellow tags - (observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

Green tags - (wait) are reserved for the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

White tags - (dismiss) are given to those with minor injuries for whom a doctor's care is not required.

Black tags - (expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

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PLANNING :-In planning the previously collected data is analysed and specific interventions are proposed .during this phase the nurse will undertake the following activities

Dynamics underlying the present crisis are formulated Alternative solutions to the problem are explored . Steps for achieving the soluations are identified . Environment support needed to help the patient is

decided upon ,coping mechanisms that need to be developed and those which need to be strengthened are identified.

IMPLEMENTATION:-The following interventions are carried out to resolve the crisis:

ENVIRONMENTAL MANIPULATION:-

Environmental manipulation includes interventions that directly change the patients physical or interpersonal situations. These interventions may resolve stress or provide situational support. For example, a patient having difficulty in his job may take a week of sick leave so that he can be removed temporarily from that stress.

GENERAL SUPPORT :-

The nurse uses warmth ,acceptance ,empathy and reassurance to provide general support to the patient.

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GENERIC APPROACH:-

The generic approach is deigned to reach high risk individuals and large groups as quickly as possible .it applies a specific method to all individuals faced with a similar type of crisis .(e.g. in social disasters)Debriefing is a method of generic approach .in debriefing method ,disaster victims are helped to recall eventsand clarify traumatic experiences .it attempts to place the traumatic event in persprective ,allows the individual to relive the event in a factual way,encourages group support,and provides information on normal reaction to critical events .the goals of debriefing is to present the maladaptive responses that may result if the trauma is suppressed.

INDIVIDUAL APPROACH:-

The individual approach is a type of crisis intervention similar to the diagnosis and treatment of a specific problem in a specific patient.it is particularly useful in combined situational and matuarational crisis and also benedficial when symptoms include homicidal and suicidal risk.the nurse must use the interventions that is most likely to help the patient develop an adaptive response to the crisis.

LEVELS OF CRISIS INTERVENTION:-

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1. INDIVIDUAL APPROACH:-It is similar to diagnosis and treatment of a specific problem in a specific patient.

2. GENERIC APPROACH:-It is designed to reach high-risk individual and large group as quickly as possible .It applies a specific method to all individuals faced with similar type of crisis.

3. GENERAL SUPPORT:-Includes interventions that convey the feelings that therapist is on the patients side and will be a helping person.

4. ENVIRONMENTAL MANIPULATION:-Involve interventions that directly change patient physical or interpersonal situation. These intervention provides situational

INDIVIDUAL APPROACH

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support or remove stress.

TECHNIQUES OF CRISIS INTERVENTIONS:-

1. CATHARSIS:-The release of feelings that takes place as the patient talks about emotionally charged areas.2. CLARIFICATION:-Encouraging the patient to express more clearly the relationship between certain events in their life.3. MANIPULATION:-Using the patient’s emotions ,wishes or values to beliefs the patient in the therapeutic process.4. REINFORCEMENT OF BEHAVIOUR:-Giving the patient a positive re-inforcement to develop adaptive behavior.5. SUPPORT OF DEFENCES:-Encouraging the use of healthy adaptive defenses.Discourage unhealthy and maladaptive defenses.6.INCREASING SELF ESTEEM:-Raising self esteem and helping the patient to regain feeling of self worth and selecting the best available alternative way for evolving the immediate problem.7.EXPLORATION OF SOLUTIONS:-Examining alternative ways of solving the immediate problem.

EVALUATION:-The nurse and patient reviews the changes that have occurred .the nurse should give credit for successful changes to

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patients so that they realize their effectiveness and understand that what they learnt from crisis may help in coping with future crisis.if the goals have not been met ,the patient and nurse can return to the first step assessment and continue through the phases again.

GENERAL GUIDELINES:-

The nurse listens carefully to the client and the affective quality of client presentation

She uses a strait forward approach to understand the whole situation including the thoughts, feelings and event.

She listens carefully without any judgment, altitude, attitude, feeling and events.

In case the client talk is not congruent, she allows more time to enable the client to express what he or she wanted to express.

She uses language, verbal and nonverbal to demonstrate active listening.

She avoids over involvement, wherein on other hand, she avoids detachment by keeping boundaries between the nurse and client.

SPECIFIC GUIDELINES:- 1. If the client is clearly on the verge of total collapse or self

destructiveness, she initiates emergency interventions but also only for a necessary to sustain life.

2. In case the client is in distress but not in danger of deatha) She makes the client further clarity and focus on major

problemsb) She elicits from the client experience that might successfully

solves the problem

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c) She supports the ideas of the client, if they are correct ones.d) She mutually decides with the client upon a time table for

appointments and an action on the problems.e) She elicits ideas from the client about possible action.

NURSING INTERVENTIONS FOR CRISIS:-1. BASIC NEEDS

Provide license to social agencies.2. PHYSICAL DEFICIT

Attend the physical emergencyRefer to other health care provider as necessary

3. PSYCHOLOGICAL EFFECTS Shock –listens attentively to crisis impactConfusion-give nurturing support ,permits regressionDenial-permits intermittent denile,identify patient primary concernsAnxiety – provide structural anti anxiety activityLethargy- encourage sublimation and constructive activity

4. PROTECTIVE FACTORSCoping – Encourage patient’s favoured ,adaptive coping mechanismSelf-efficacy-Support patient’s previous success and belief in own abilities.Dilute irrational self deficits Emphasis practices of expectation to provide results Support –

Add social support to patient’s world Provide professional support Refer for counseling when necessary

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MODALITIES FOR CRISIS INTERVENTION:-Community based crisis intervention modalities have recently been developed .they are based on the philosophy that the health care team must be active and go out to the patients rather than wait for the patients to come to them.Nurses working in these modalities intervene in a variety of community settings ranging from patients homes to street corners.

1. MOBILE CRISIS PROGRAMS:Mobile crisis teams provide front line interdisciplinary crisis intervention to individuals, families and communities .the nurse who is a member of a mobile crisis team, should be able to provide on site assessment, crisis management, treatment, referral and educational services to patients, families and the community at large. Nurses are thus able to ensure mental health care for even the most underserved populations efficiently and cost effectively.a. Interdisciplinary crisis interventionb. Provide on-site assessment ,crisis managementc. Treatment, referral and educational services to patient,

family.

2. TELEPHONE CONTACTS:-Crisis intervention is sometimes practiced by telephone rather than through face to face contacts .the nurse should have effective listening skills to provide crisis intervention to victims.

3. GROUP WORK:-People who have common traits on stressors will form a group.

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The group provides an opportunity fro members to express common concerns and experiences, faster hope and builds mutual support. The nurses role in the group is active, focal and focused on the present .the nurse and the group help the patient solve the problem and reinforce new problem and reinforce new problem solving behavior.

a. Group work as a support systemb. Help patient to solve problem and reinforce the patient

problem solving ability

4. DISASTER RESPONSE:-As part of the community ,nurses are called on when an adventitious or social crisis strikes the community.flood earthquakes,airplane crashes ,fires,nuclear accidents etc precipate large number of crisis .the nurses has an important role in dealing with psychosocial problems of disaster victims.the nurses participates in crisis operations and acts as a case finder for persons suffering from psychosocial stress.it is important that nurses in the immediate post disaster period go to places where victims are likely to gather ,such as hospitals ,shelters,morques.during this period nurses use the generic approach of crisis intervention so that as many people as possible can receive help in a short duration of time.

4. VICTIM OUTREACH PROGRAMS:-Victim outreach programs use crisis intervention techniques to identify the needs of victims and then to connect them with appropriate referral and other resources.Nurse often works in victim outreach programs, where victims are often seen immediately after the crisis. These victims need

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through evaluation, empathetic support and information and help with large system and social networking system.

5. CRISIS INTERVENTION CENTERS:-Crisis intervention centers provide emergency psychiatric care and counseling to victims , experiencing extreme stress or conflict ,often involving suicide attempts or drugs or alcohol abuse.these centers ,which are usually self contained units within a hospital or community health center,provide services 24 hours a day.the services may be delivered directly on the premises or counselling may be provided over the telephone .the primary objective of crisis intervention centers is to help the person cope with immediate problem and to offer quidance and support for long-term therapy.

6.HEALTH EDUCATION:-Nurses are involved in identifying people who are at high risk for developing crisis and in teaching coping strategies to avoid the development of crisis.the public also needs education so that they can identify those needing crisis services ,be aware of available services ,change their attitude .so that people will feel free to seek services and obtain information about how others deal with potential crisis producing problems.

NURSING DIAGNOSIS:-

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The primary nursing diagnoses in crisis intervention are Ineffective individual coping Ineffective family coping Altered family process Post trauma response

Ineffective individual coping refers to the inability to ask for help ,problem solving or meet role expectations.

Ineffective family coping occurs when the family’s support systems are not successful and family’s economic or social wellbeing is threatened.

Altered family processes result when the family members are unable to adapt to the traumatic experiences constructively.

Posttraumatic response is a sustained response to an overwhelming traumatic event.

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SUMMARY AND CONCLUSION:-

Today we have discussed meaning of crisis, definition of crisis intervention, types of crisis and phases of crisis. We also discussed model, level and techniques of crisis intervention and role of nurse in crisis situation.

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BIBLIOGRAPHY:-

Fundamental of Mental Health Nursing, Kathy Neeb, F.A Devis Company. Ppa-Copyrigh4 1-997. Pg. NO; l5215, 158, 289:

Advanced Practice of Psychiatric Nursing, Ann Wolbert Burgers, Copyright 1998. Simon & Schuster Company. Pg. No. 456 -457.

Review and study Guide. Psychiatric Nursing ( Promoting Mental Health). Elaine R Zimbler. Copyright 1997, Simon & Schuster Company, Pg. No. 263 -268.

Gelden. Michael, Dennis Geth and Richard May on, Oxford textbook of Psychiatric, 2’ edition, 1989. Pg. No. 705—706.

Suzane, Lego, The American Handbook of Psychiatric Nursing, J.B. Lippincot Company, Philadelphia, 1998. Pg,No. 235 -240.

Park, J.E and K.Park, Textbook of Preventive and Social Medicine, Copyright 2001, lXth edition.

Shah and Henen Shah. A hand book of Psychiatric, 2m1 edition, J.B Pñnter, Bombay, 1988. Pg.No.84 -86.

The Nursing Journal of India, Vol.XCVI No.3 April 2000.

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