The word crisis means both the danger and opportunity. Crisis is a danger because it threatens to overwhelm the individual or his family, and it may result in suicide or a psychotic break .It is also an opportunity because during times of crisis individuals are more receptive to therapeutic influence.
Crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.(James & Gilliland, 2001)
TYPES OF CRISIS
1. MATURATIONAL CRISES
Maturational crises have to do with the predictable transitions individuals experience as they move from one stage of human development to another: Infancy, Early childhood, Preschool School age, Adolescent, Young adult, Mature adult ,Late adulthood.
2. SITUATIONAL CRISES
Situational crises arise from an external source and are events or circumstances that threaten the physical, social, and psychological integrity of individuals. Such as the loss of a job or death of a child.
3. ADVENTITIOUS CRISES
Adventitious crises have been called events of disaster 1) natural disasters, such as floods, fires, and earthquakes; 2) national disasters, such as airplane crashes, riots, and wars; 3) interpersonal disasters, such as assault and rape; and 4) acts of terrorism.
PHASES OF CRISIS
The individual is exposed to a precipitating stressor: anxiety increases; previous problem – solving techniques are employed.
Anxiety increases further. The individual further feel a great deal of discomfort at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness and disorganization prevails..
All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. The individual may try to view the problem from a different perspective, or even to over look certain aspects of it.
Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking.
PRINCIPLES OF CRISIS INTERVENTION
1 Be specific, use concise statements, and avoid over whelming the patient with irrelevant questions or excessive detail.
2 Encourage the expression of feelings.
3 A calm, controlled presence reassures the person that the nurse can help.
4 Listen for facts and feelings, seeking clarification, paraphrasing and reflection are effective strategies.
5 Allow sufficient time for the individuals involved to process information and ask questions.
6 Help patients legitimize feelings by letting them know that others in similar situations have experienced comparable emotions.
7 Clarify distortions by getting persons to look at the situation realistically, focus on what can be changed versus what cannot.
8 Empower person by allowing them to make informed choices.
9 Assist the person in confronting reality.
10 Encourage the person to focus on one implication at a time.
TECHNIQUES OF CRISIS INTERVENTION
1 Catharsis: the release of feelings that takes place as the patient talks emotionally charged areas
2 Clarification: encouraging the patient to express more clearly the relationship between certain events.
3 Manipulation: using the patient’s emotions, wishes or values to benefit the patient in the therapeutic process.
4 Reinforcement of behavior: giving the patient positive reinforcement to adaptive behavior.
5 Support of defenses: encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or maladaptive.
6 Increasing self- esteem: helping the patient to regain feelings of self worth.
7 Exploration of solution: examining alternative ways of solving the immediate problem