Post on 02-Jan-2016
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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!