Crisis Intervention

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Crisis Intervention

• Peggy Pannell RN, MSN

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What is a Crisis?

• Katrina
• 911
• Tsunami
• Earth Quakes
• Tornado
• How about less severe things?
• Divorce
• Death
• Marriage
• Childbirth

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Why Do We React Like We Do To Crisis?

• Stress
• Any physical or psychological force that disturbs
  equilibrium
• What are physical stresses?
• What are psychological stresses?
• Anxiety
• Physical and psychological response to stress

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Stress

• Maturational
• Start School
• Leave School
• Develop Relationships
• Become Employed
• Support Families
• Lose Loved Ones
• Prepare for Death
• All Stress causes Anxiety at some level

• Situational
• Acute Illness
• Accidents
• Divorce
• Work lay off
• Chronic Illness

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Anxiety Levels

• Mild 1
• Constructive action, slight muscle tension,
  Feeling challenged, alertness
• Moderate 2
• Protective action, moderate muscle tension,
  feeling uncomfortable, difficulty concentrating
• Severe 3
• Prepare for flight or fight, extreme muscle
  tension, extreme discomfort, distorted
  perceptions
• Panic 4 (Crisis)
• Actual Flight or Fight, Feeling overwhelmed and
  out of control, Disorganized perceptions

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Major Nursing RolesHelping patient learn/regain
effective coping strategies

• Most common
• Problem solving
• Assertiveness
• Positive self-talk
• Stress/Anger Management
• Skills needed for communication and relationships
• Conflict resolution
• Time management
• Community living

• Temporary Strategies
• Visualization
• Concentration of breathing
• Relaxation training
• Stretching exercises
• Healthy lifestyle
• Hobbies
• Calming Music
• Massage
• Decreasing self destructive behaviors
• Support systems

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Types of Coping

• Adaptive (study for test, make A)
• Solve Problem
• Palliative (go jogging, then study, make A)
• Reduce anxiety then solve problem
• Maladaptive (go to movie, cram for 1 hr, make C)
• Unsuccessful attempt to reduce anxiety
• No problem solution, anxiety remains
• Dysfunctional (go out with friends, pass out,
  make F)
• No anxiety reduction, no problem solution,
  minimal functioning becomes difficult, more
  problem arise

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Crisis

• Any stressful event can lead to a crisis.
• May be due to
• poor coping mechanism
• level of stress
• severity or multiple stressors
• The straw that broke the camels back
• Stress Vs. Crisis
• Disorganized from failure to cope
• Out of control
• Motivates pt to escape pain
• Tune out
• Drugs/alcohol

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Individual Reaction

• Anxiety to severe or panic level
• Helpless, hopeless, immobile, Give up or keep
  repeating same ineffective coping method
• During Crisis
• Being dependent upon other is natural
• Growth and Promotion Potential
• Learn new coping skills, develop new or improved
  relationships
• Extended Crisis (4-6 weeks)
• Causes exhaustion, physical illness, become
  chronic dysfunctional coping, violent, suicidal
  to escape pain (requires intense counseling at
  this point. Earlier intervention would require
  less time.

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Crisis Intervention

• Major Focus
• Decrease Cause of Anxiety
• Increase emotional security

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5 Stages of Successful Interventions

• Immediacy- Intervene as soon as possible. Goal is
  to reduce anxiety.
• Assume Control - provide for their needs,
  physical and psychological
• Assess the situation- let the person talk, watch
  for nonverbal cues, avoid judgments
• Situation Management, prevent further
  decompensation violence, suicide
• Post crisis intervention

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Suicide and Depression

• Suicide is influenced by
• Cultural belief
• Values and Norms
• Suicide occurs in
• Children
• Adolescent
• Adults
• Suicide is assess by lethality
• Suicidal ideation level

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Suicide Ideation Assessment

• Gestures
• Nonlethal self-injury
• Cutting or burning skin
• Ingestion of small amounts of drugs
• Some feel they are attention seeking
• Threats
• Verbal Statement
• Often precede actual attempt
• Attempt
• Implementation of a self injurious act with the
  express purpose of ending life

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USA

• Suicide
• 9th leading cause of death
• 11 per 100,000 general population
• 15-34yrs (may be a cry for help)
• 3rd leading cause of death
• 71 completion ratio
• Caucasian Male (highest demo)
• 70 of all suicides
• Senior Citizen (may just want to die)
• 21 completion ratio
• 28.8 per 100,000 of white males 65 and older
• 65 per 100,000 of white males 85 and older

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Assessment of Suicidal Patients

• Plan
• More developed, higher risk
• Method
• Less lethal methods include
• Wrist cutting
• Overdose ASA, Valium
• Lethal methods include
• Guns, jump from high place, hanging, drowning,
  carbon monoxide
• over dose certain drugs (barb, alcohol CNS
  depressants
• Accessibility of means
• pills on-hand or making appoint to ask for Rx
• Gun and bullets available
• running car and overdose has potential for mind
  change
• Rescue
• Deliberately deceive rescuers more lethal
• Leave note or make phone call more likely to
  rescue

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Intervention

• Face to face
• Suspect in Depression
• Ask them
• Ask when and how
• Ask about previous tries
• Eval for
• Depression
• Loss or threat of loss
• Self-destructive hallucinations
• Alcohol/drug abuse
• Suicide preventions (level 12)
• No-suicide Contract
• Observation (Q10min or constant)
• Harmful objects removed
• Restraints

• Phone
• Express Genuine Concern
• Acknowledge their pain
• Assess Lethality
• Focus on positives (you called for help)
• Ask about alcohol/drugs
• Ask about solutions
• Assess appropriateness
• Suggest alternatives
• Get name, phone , location
• Have peer call police/ambulance
• Ask permission or inform of plan
• Is anyone with them?
• Speak with them
• Call family and ask them to go
• Refer to walk in clinic/crisis center
• If they refuse help
• Give phone to crisis center or suicide hotline