Crisis Theory – This book covers the entire syllabus of “Psychiatric Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.
At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.
Crisis Theory
Crisis:
“When an individual is failing to respond adequately by utilizing efficient coping mechanisms to the stressor or exposed stressful events and unable to meet the demands and the needs, a state of internal imbalance will results, known as a crisis”.
Or
“Any temporary situation that threatens the person’s self-concept, necessitates reorganization of the psychological structure and behaviour, causes a sudden alteration in the person’s expectation of self and cannot be handled with the person’s usual coping mechanism”
Or
“A sudden event that occurs in one’s life, which disturbs the individual homeostasis and usual coping mechanisms will not resolve the problem”.
Or
“A crisis situation is the result of a person’s perception and emotional response to a loss or threat of loss of self-esteem from events”.
Classification of crisis:
1. Situational Crisis/External Crisis/Coincidental Crisis
2. Maturational Crisis/Developmental Crisis/Internal Crisis
3. Socio-cultural Crisis
4. Crisis Resulting from Traumatic Stress
5. Crisis Resulting from Psychopathology
6. Adventitious Crisis/Community Crisis
7. Psychiatric Emergencies
Characteristics of crisis:
1. Individual is totally involved, get hurt in all heightened feeling of stress
2. Unable to interpret and perceive the circumstances of crisis event.
3. Precipitating by specific identifiable event of actual or perceived losses, threats of losses or challenges.
4. It occurs in all the individuals at one time or other.
5. Crisis are personal by nature.
6. Crisis are acute, will be solved by one or another within a brief period.
7. It is self-limiting, lasts for 4-6 weeks
8. Crisis situation may be potential for psychological growth or retardation or dangerous to person (may harm to self or other); unable to function effectively.
9. Universal experience.
10. Almost all crises will develop in a predictable fashion
The causes of crisis
1. Social isolation or loneliness.
2. Experiencing discrimination and stigma
3. Social disadvantage, poverty or debt.
4. Bereavement (losing someone close to you).
5. Severe or long-term stress
6. Having a long-term physical health condition.
7. Unemployment or losing your job.
8. Homelessness or poor housing.
9. Being a long-term carer for someone.
10. Drug and alcohol misuse,
11. Domestic violence, bullying or other abuse as an adult.
12. Significant trauma as an adult.
Signs and symptoms of crisis situation:
1. Heavy burden of free-floating anxiety, e.g., heightened emotional tensions, the drive to act
2. Depression or agitated
3. Anger, guilt, tension, fear
4. Neglects in performing self-care activities and fulfilling responsibilities
5. Utilizing unhealthy coping mechanisms
6. Irrational and blaming others
7. Helplessness, hopelessness, uselessness
8. Chaos, overwhelmed
9. Detached, despair
10. Depersonalized
11. Panic
12. Low self-esteem
13. Uncontrollable crying
14. Frustration, confused, depressed, immobilized, unable to make decisions
15. Lack of confidence discouragement
16. Imperfection, unfamiliarity with self
17. Lack of self-control
18. Altered sensorium
19. Disorganized thinking
20. Unable to plan, reasoning, logical analysis
21. Impaired judgement
22. Hallucinations
23. Preoccupation with certain ideas
24. Somatic, distress
25. Physical illnesses
26. Withdrawal behaviour, aloofness
27. Avoids reality with over activity
28. Unwilling to initiate new behaviour
29. Unable to maintain daily routine, work performance or social roles
30. Irritable
31. Low self-esteem
32. Painful feelings, blames others
33. Change in life style
Crisis theory
1. Historical Crisis Theory: Four stages of crisis
a. Disturbed equilibrium
b. Brief therapy or grief work
c. Working through the problem or grief
d. Restroation of equilibrium
2. Modern Applied Crisis Theory: Domains of Modern Applied Crisis Theory are-
a. Developmental Crisis
b. Situational Crisis
c. Existential Crisis
3. Other Theories of Crisis and Crisis Intervention: They are
a. Psychoanalytic Theory
b. Systems Theory
c. Ecosystems Theory
d. Adaptational Theory
e. Interpersonal Theory
f. Chaos Theory
g. Developmental Theory
4. Other Models of Crisis Intervention
a. Equilibrium Model
b. Cognitive Model
c. Psychosocial Transition Model
d. Developmental Ecological Model
e. Contextual-Ecqlogical Model
Crisis intervention:
This involves offering immediate help or counseling to disaster survivors to help them to resolve their problem as much as possible and to cope with the present problems or emotional disturbances
Principles of crisis therapy:
Use comfort strategies –
1. By acceptance of the person
2. Establishing rapport and positive concern social relationship to lessen anxiety and to create a sense of hope wrathfulness
3. Let the family and the client understand that coming for help is a good indication and a sign of strength and judgement.
Indications of crisis interventions:
1. Abstinence
2. People who attempted suicide
3. Psychosomatic patients
4. Violent behaviour. e.g., crime
5. Accident victims
6. Family crisis
7. High risk families, e.g., ill members recent deaths H/O difficulty coping chronic illness bereavement
8. Severe depression
9. Severe anxiety
10. Marital conflicts
11. Suicidal thought
12. Illicit drug abuse; alcohol abuse
13. Traumatic events or traumatic experiences
14. Intra group staff issues
15. Client management issues
Goals of crisis intervention:
1. To return to a pre-crisis level of functioning
2. To provide real perception of the situation by the client
3. To assist the individual in managing the intense and overwhelming feelings associated with crisis
4. To resolve the crisis situation.
Settings of crisis intervention:
1. Hospitals- outpatient unit, inwards, emergency room settings
2. Mental Health Care centres.
3. Community setting
➤ Stress
➤ Home visits
➤ Outreach centres.
4. Telephonic counselling and hotline
➤ Crisis calls
➤ Ventilation calls
➤ Information calls
5. Suicide prevention and crisis intervention centres.
6. Schools, offices, private practice
Techniques of crisis intervention:
The techniques which are used to help the affected individual and his family to understand and cope up with the intense feelings that are typical of a crisis. They are –
1. Abreaction
2. Clarification
3. Suggestion
4. Manipulation
5. Reinforcement of behaviour
6. Support of Defenses
7. Raising Self-Esteem
8. Exploration of Solutions
Role of a nurse in crisis intervention:
Phase 1 Assessment:
1. Assess the following
2. Ability to perceive the problematic situation.
3. Identification of precipitating event or stressor and when it occurred
4. Balancing factors.
5. Nature and strength or adequacy of clients. Supporting systems and coping resources, strategies that can be used.
6. Client’s abilities and limitations in dealing with the problem
7. Needs of the client, e.g. self-esteem, role mastery, dependency and biological function.
8. Nature of crisis and its effects on the individual and family.
Phase 2 Nursing Diagnoses:
After analyzing the information gathered through assessment, appropriate nursing diagnosis can be formulated to solve the immediacy of the crisis situation.
Nursing diagnosis may be related to any aspect of the client’s life, which can reflect the variety of nursing problems. For example, in effective individual or family coping.
- Disturbed thought processes
- Risk for emergency situation like suicide or violence, post-traumatic stress or experiences
- Altered family processes
- Maladaptive crisis responses
Phase 3 Planning:
Based on the assessment, diagnosis the short term and long term goals will be formulated with a specific and appropriate plan of activities. In formulating interventions client’s abilities or strengths, available resources for support alternative solutions to the problem and steps for achieving the solutions has to be identified.
Phase 4 implementation of intervention:
1. Nurses has to use reality-oriented approach
2. Remain with the individual who is experiencing panic anxiety
3. Establish a rapid, positive working relationship by –
➤ Showing unconditional acceptance
➤ Active listening
➤ Attending to immediate needs
➤ Appropriate communication techniques to make the client to feel more comfortable.
4. Discourage lengthy explanation by rationalizing the situation
5. Provide adequate situational support and guidance
6. Promote conducive atmosphere for ventilation of truc or real overwhelming. intense emotional feelings.
7. Set firm limits (to avoid aggressive or destructive behaviour) what is acceptable and not acceptable
8. Handle the feelings gently, don’t give false reassurance
9. Maintain consistency.
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