LESSON PLAN

ON
CRISIS
INTERVENTION
 LESSON PLAN ON CRISIS INTERVENTION

NAME OF THE STUDENT TEACHER : MRS. R. SUGANTHI

PROGRAMME : MSC NURSING

SUBJECT : MEDICAL SURGICAL NURSING-II

YEAR : II YEAR

UNIT : MANAGEMENT OF EMERGENCY CONDITIONS

TOPIC : CRISIS INTERVENTION

VENUE : LECTURER HALL

DATE :

TIME : 9 AM- 10 AM

DURATION : 1 HOUR

NUMBER OF STUDENTS : 60

METHOD OF TEACHING : LECTURER CUM DISSCUSSION

A.V.AIDS : BLACK BOARD,OHP, CHART, POWER POINT

PREVIOUS KNOWLEDGE OF THE STUDENTS : NIL

GENERAL OBJECTIVES:

Enable the students to acquire knowledge about crisis intervention and develop desirable attitude and practice this
knowledge in clinical and community settings

SPECIFIC OBJECTIVES:

By the end of the class, the student will be able to,

 Define crisis intervention

 Enlist the purpose and principles of crisis intervention
 Enumerate the characteristics and types of crisis
 Describe the approaches to crisis intervention
 Mention the crisis intervention model
 Illustrate the nursing management of crisis intervention
Time Specific Contents Teachers Students Av Evaluation
Objectives Activity Activity aids
2mts To introduce INTRODUCTION: Listening PPT
the topic Crisis intervention is an immediate and short-term psychological
care aimed at assisting individuals in a crisis situation in order to
restore equilibrium to their bio-psycho-social functioning and to
minimize the potential of long-term psychological trauma.
Crises happens to everyone, and intervention can take many
forms, from family helping and support strategies to professional
counselling strategies aimed at helping the individual cope with
crisis in ways that reduce the negative psychological,
physiological and behavioural effects of trauma on that person
and his or her environment.

5mts To define the DEFINITIONS: Lecturing & Listening OHP Define crisis
condition of  Meaning Discussion intervention
crisis The word crisis means both the danger and opportunity.
intervention 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.
 Definition
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)

 Definition of crisis intervention

“Crisis intervention: temporary, but active and supportive entry

into the life of individuals or groups during a period of extreme
distress. “emotional first aid.”Different interventions tools are
used for individuals vs. Groups.”
 (jeffrey h. Mitchell, phd)

Crisis intervention refers to the methods used to offer short

term immediate help to individuals who have experienced an
event that produces mental, physical, emotional and behavioural
distress.

Stages of Crises:

A crisis situation involves a sequence of events that leads

individuals from "equilibrium to disequilibrium and back again"
(Golan, 1978). This sequence generally involves five components:

1 The Hazardous Event: The hazardous event is a stressful

circumstance that disrupts an individual's equilibrium and initiates
a series of actions and reactions. The hazardous event may be
anticipated (e.g., divorce, retirement) or unanticipated (e.g., the
sudden loss of a family member).

2. The Vulnerable State: An individual's reaction to the

hazardous event is ordinarily linked to his/her subjective
interpretation of the event. Most commonly, a hazardous event is
perceived either as a threat, a loss, or a challenge. The vulnerable
state is characterized by an increase in tension which the
individual attempts to alleviate by using one or more of his/her
usual coping strategies. If these strategies are unsuccessful, the
individual's tension continues to increase and, as a result, he/she
eventually becomes unable to function effectively.

3. The Precipitating Factor: The precipitating factor is the event

that converts a vulnerable state into a crisis state. In some
situations, the hazardous event and precipitating factor are
identical; in other situations, the precipitating factor follows the
hazardous event (i.e., the precipitating factor acts as the "last
straw"). The precipitating factor may produce a variety of
 responses including, for example, a suicide attempt or, more
constructively, a desire to seek help.

4. Active Crisis State: The active crisis state is characterized by

disequilibrium and normally involves the following: physical and
psychological agitation (e.g., disturbed appetite and/or sleep,
impaired concentration and problem-solving ability, anxiety, or
depression), preoccupation with the events that led to the crisis,
and, finally, a gradual return to a state of equilibrium. The
individual ordinarily recognizes during the active crisis stage that
his/her usual coping mechanisms are inadequate and, thus, is
usually highly motivated to seek and accept outside help.

5. Reintegration: Successful reintegration (restoration of

equilibrium) is dependent on a number of factors including the
individual's ability to objectively evaluate the crisis situation and
to develop and utilize effective coping strategies

The Goals of Crisis intervention are to

 Mitigate the impact of an event

 Facilitate a normal recovery process, where normal
people are having normal reactions to abnormal events.
 Restore adaptive functioning

2mts To enumerate The purpose of crisis intervention: Lecturing & Listening & ppt What are all
the purpose of Discussion taking notes black the purpose
crisis  To deal with the person’s current status by dealing with a board of crisis
intervention crisis. Chronic exposure to stress or trauma can lead to intervention
mental illness. Therefore, it is important that counsellors
have the skills and knowledge

 To help clients cope with their current stressors and

trauma.
  Crisis counselling is not intended to provide
psychotherapy or similar, but offers a short-term
intervention

 To helps clients receive assistance, resources,

stabilisation and support.

10 mts To explain the Types of crisis:

types & Lecturing & Listening & PPT Write the
characteristics  According to pathogenisis Discussion taking notes types of
of crisis crisis
 Mental health crisis intervention
 Psychiatric crisis

 According to priority

 urgent crisis
 emergent crisis

 According to nature

 maturational crisis
 situational crisis
 adventitious crisis

Mental health crisis:

A mental health crisis is a non life threatening situation in

which an individual is exhibiting extreme emotional disturbances
or behavioural distress, considering harm toself with reality, poor
compromised ability to function, or is otherwise agitatand unable
to be calmed.
Psychiatric crisis:

It is a situation in which a person is mentally volatile, suicidal,

psychotic or suffering from acute mental decompression.

Urgent crisis:

It is an situation or exigency is urgent and demands immediate

action.

Emergency crisis:

It can be anticipated and minimized at early stages.

Maturational crisis:(developmental crisis)

Developmental crises occur as part of the process of growing and

developing through various periods of life. Sometimes a crisis is a
predictable part of the life cycle, such as the crises described in
Erikson’s stages of psychosocial development.

situational crisis:

Situational crises are sudden and unexpected, such as accidents

and natural disasters. Getting in a car accident, experiencing a
flood or earthquake, or being the victim of a crime are just a few
types of situational crises

adventitious crisis:(social crisis)

It is a rare accidental and unexpected tragedy that may affect an

entire community or population such as airplane crash, terrorist
attack
Existential crisis:
These are inner conflicts related to things such as life purpose,
direction, and spirituality. A midlife crisis is one example of a
crisis that is often rooted in existential anxiety.

Other types:

Financial Crisis:
Financial Crisis occurs when the business is hit with the crisis
financially. An example of a financial crisis is a business not
having funds to pay its dues such as paying dividends, interests,
making repayments of loans etc

Technological Crisis:
Technological crisis occurs as a result of break downs in the
common scientific and technological tools and appliances that we
use in a business.

Crisis of Malevolence:
All businesses compete with each other. But some competitors
take such extreme steps that they in fact try to go below the belt
and ruin the other business for their own success. Crisis that
happens as a result of the extreme tactics employed by a
competitor or a miscreant to ruin the business is known as a crisis
of malevolenc

Natural Crisis:
Natural Crisis refers to those that are created as a direct result
of a natural event such as volcano or earthquake etc. These crisis
are completely out of a management’s hands and cannot be
prevented unlike the other crisis.
 Characteristics of crisis intervention:

 Crisis occurs in all individuals at one time or another and

is not necessarily equated with psychopathology.
 Crisis are precipitated by specific identifiable events
 Crisis are personal by nature. What may be considered a
crisis situation by one individual may not be so for
another.
 Crises are acute, not chronic, and will be resolved in one
way or another within a brief period.
 A crisis situation contains the potential for psychological
growth or deterioration.
 Time limited- Generally lasting no more than six weeks.

5mts To discuss the Principles of Crisis Intervention:

principles of Lecturing & Listening & ppt What are all
crisis  Simplicity – People respond to simple not complex in a discussion taking notes black the
intervention crisis board principles of
 Brevity – Minutes up to 1 hour in most cases (3-5 crisis
contacts typical) intervention?
 Innovation – Providers must be creative to manage new
situations
 Pragmatism – Suggestions must be practical if they are to
work
 Proximity – Most effective contacts are closer to
operational zones
 Immediacy – A state of crisis demands rapid intervention
 Expectancy – The crisis intervener works to set up
expectations of reasonable positive outcome”
others:

 Be specific, use concise statements, and avoid over

whelming the patient with irrelevant questions or
excessive detail.
 Encourage the expression of feelings.
  A calm, controlled presence reassures the person that the
nurse can help.
 Listen for facts and feelings, seeking clarification,
paraphrasing and reflection are effective strategies.
 Allow sufficient time for the individuals involved to
process information and ask questions.
 Help patients legitimize feelings by letting them know
that others in similar situations have experienced
comparable emotions.
 Clarify distortions by getting persons to look at the
situation realistically, focus on what can be changed
versus what cannot.
 Empower person by allowing them to make informed
choices.
 Assist the person in confronting reality.
 Encourage the person to focus on one implication at a
time.

Factors responding to crisis:

To describe the When responding to a crisis, the emergency services will deal
factors with a wide range of psychological and social problems. Problems Lecturing & Listening & ppt What are all
responding and can occur slowly over time or suddenly. When people face a Discussion taking notes black the factors of
balancing crisis, they can experience a range of psychological and physical board crisis
factor for crisis symptoms, as well as changes in their relationship and routines. intervention
intervention Some problems are emergencies and require urgent intervention
and stabilization, whilst others are not emergencies. Many may be
urgent and require attention within three days. A qualified
emergency and crisis intervention specialist can evaluate a crisis
and give advice on the necessary steps to take.

 Religion
 Warfare
 health
 Disasters
 Law enforcement
  Psychiatry and psychology
 Emergency medical services

Balancing factor:

 Perception of an event refers to the importance of a

problem to the individual in crisis and includes such
things as health, career, financial status, and reputation.
 Support system refers to the resources possessed by the
person in crisis, such as other people the individual trusts
who can provide support and assistance during a time of
need.
 Coping mechanisms are skills or methods people use to
reduce anxiety and solve problems, such as reasoning,
meditation, physical exercise, sleep, and denial.

Responders of crisis intervention:

In the initial stages, a range of professionals may be involved.

They may include:

 psychiatrists psychologists
 counsellors
 fire fighters
 emergency medical staff
 search and rescue staff
 police officers
 doctors
 nurses
 soldiers
 clergy
 communications personnel
 community members
 hospital workers and so on
 Techniques of crisis management:
5 mts To explain the Lecturing & Listening & ppt Write the
techniques of  Catharsis: the release of feelings that takes place as the discussion taking notes black techniques of
crisis patient talks emotionally charged areas board crisis
intervention  Clarification: encouraging the patient to express more management
clearly the relationship between certain events.
 Manipulation: using the patient’s emotions, wishes or
values to benefit the patient in the therapeutic process.
 Reinforcement of behavior: giving the patient positive
reinforcement to adaptive behavior.
 Support of defenses: encouraging the use of healthy,
adaptive defenses and discouraging those that are
unhealthy or maladaptive.
 Increasing self- esteem: helping the patient to regain
feelings of self worth.
 Exploration of solution: examining alternative ways of
solving the immediate problem.

10mts To explain the Approaches to crisis intervention:

approaches & Lecturing & Listening & ppt How will you
modalities of Discussion taking notes approach the
crisis crisis
intervention situation?
 Modalities of crisis intervention:

 Mobile crisis programs

 Telephone contacts
 Group work
 Disaster response
 Victim outreach programme
 Crisis intervention centers
 Health Education

10mts To brief out Crisis intervention model: Lecturing & Listening & ppt Explain the
the crisis Discussion taking notes management
intervention In conceptualizing the process of crisis intervention, Roberts of crisis
model (1991, 2000, 2005) has identified seven critical stages through intervention
which clients typically pass on the road to crisis stabilization,
resolution, and master. These stages, listed below, are essential,
sequential, and sometimes overlapping in the process of crisis
intervention:
 plan and conduct a thorough biopsychosocial and
lethality/imminent danger assessment;
 make psychological contact and rapidly establish the collaborative
relationship;
 identify the major problems, including crisis precipitants;
 encourage an exploration of feelings and emotions;
 generate and explore alternatives and new coping strategies;
 restore functioning through implementation of an action plan;
 plan follow-up and booster sessions

Stage I: Psychosocial and Lethality Assessment

The crisis worker must conduct a swift but thorough
biopsychosocial assessment. At a minimum, this assessment
 should cover the client's environmental supports and stressors,
medical needs and medications, current use of drugs and alcohol,
and internal and external coping methods and resources. One
useful (and rapid) method for assessing the emotional, cognitive,
and behavioral aspects of a crisis reaction is the triage assessment
model

This assessment requires


 Asking about suicidal thoughts and feelings (e.g., "When
you say you can't take it anymore, is that an indication
you are thinking of hurting yourself?");
 Estimating the strength of the client's psychological intent
to inflict deadly harm (e.g., a hotline caller who suffers
from a fatal disease or painful condition may have strong
intent);
 Gauging the lethality of suicide plan (e.g., does the person
in crisis have a plan? how feasible is the plan? does the
person in crisis have a method in mind to carry out the
plan? how lethal is the method? does the person have
access to a means of self-harm, such as drugs or a
firearm?);
 Inquiring about suicide history;
 Taking into consideration certain risk factors (e.g., is the
client socially isolated or depressed, experiencing a
significant loss such as divorce or layoff?).

Stage II: Rapidly Establish Rapport

Rapport is facilitated by the presence of counselor-offered

conditions such as genuineness, respect, and acceptance of the
client (Roberts, 2005). This is also the stage in which the traits,
behaviors, or fundamental character strengths of the crisis worker
come to fore in order to instill trust and confidence in the client.
Although a host of such strengths have been identified, some of
the most prominent include good eye contact, nonjudgmental
attitude, creativity, flexibility, positive mental attitude, reinforcing
small gains, and resiliency.

Stage III: Identify the Major Problems or Crisis Precipitants

Crisis intervention focuses on the client's current problems, which

are often the ones that precipitated the crisis. As Ewing (1978)
pointed out, the crisis worker is interested in elucidating just what
in the client's life has led her or him to require help at the present
time.

Roberts (2005) suggested not only inquiring about the

precipitating event (the proverbial "last straw") but also
prioritizing problems in terms of which to work on first, a concept
referred to as "looking for leverage" (Egan, 2002). In the course of
understanding how the event escalated into a crisis, the clinician
gains an evolving conceptualization of the client's "modal coping
style"—one that will likely require modification if the present
crisis is to be resolved and future crises prevented.

Stage IV:Deal With Feelings and Emotions

There are two aspects to Stage IV. The crisis worker strives to
allow the client to express feelings, to vent and heal, and to
explain her or his story about the current crisis situation. To do
this, the crisis worker relies on the familiar "active listening" skills
like paraphrasing, reflecting feelings, and probing (Egan, 2002).
Very cautiously, the crisis worker must eventually work
challenging responses into the crisis-counseling dialogue.
Challenging responses can include giving information, reframing,
interpretations, and playing "devil's advocate." Challenging
responses, if appropriately applied, help to loosen clients'
maladaptive beliefs and to consider other behavioral options

Stage V: Generate and Explore Alternatives

This stage can often be the most difficult to accomplish in crisis

intervention. Clients in crisis, by definition, lack the equanimity to
study the big picture and tend to doggedly cling to familiar ways
of coping even when they are backfiring. However, if Stage IV
has been achieved, the client in crisis has probably worked
through enough feelings to re-establish some emotional balance.
Now, clinician and client can begin to put options on the table,
like a no-suicide contract or brief hospitalization, for ensuring the
client's safety; or discuss alternatives for finding temporary
housing; or consider the pros and cons of various programs for
treating chemical dependency. It is important to keep in mind that
these alternatives are better when they are generated
collaboratively and when the alternatives selected are "owned" by
the client.

Stage VI: Implement an Action Plan

Here is where strategies become integrated into an empowering

treatment plan or co-ordinated intervention.
Example for the suicidal youth, an action plan can involve
several elements:
 Removing the means—involving parents or significant others
in the removal of all lethal means and safeguarding the
environment;
 Negotiating safety—time-limited agreements during which the
client will agree to maintain his or her safety;
 Future linkage—scheduling phone calls, subsequent clinical
contacts, events to look forward to;
  Decreasing anxiety and sleep loss—if acutely anxious,
medication may be indicated but carefully monitored;
 Decreasing isolation—friends, family, neighbors need to be
mobilized to keep ongoing contact with the youth in crisis;
 Hospitalization—a necessary intervention if risk remains
unabated and the patient is unable to contract for his or her
own safety

Stage VII: Follow-Up

Crisis workers should plan for a follow-up contact with the client
after the initial intervention to ensure that the crisis is on its way
to being resolved and to evaluate the postcrisis status of the client.
This postcrisis evaluation of the client can include

 physical condition of the client (e.g., sleeping, nutrition, hygiene);
 cognitive mastery of the precipitating event (does the client have a
better understanding of what happened and why it happened?);
 an assessment of overall functioning including, social, spiritual,
employment, and academic;
 satisfaction and progress with ongoing treatment (e.g., financial
counseling);
 any current stressors and how those are being handled;
 need for possible referrals (e.g., legal, housing, medical)

10mts To describe Nurses role in crisis management: Lecturing & Listening & ppt Write the
nurses role in discussion taking notes nursing care
crisis The AONE also said there are fundamental principles for nursing of crisis
intervention leaders for crisis planning and implementation: management

Effective communication
Nurse leaders should be trained in effective communication
techniques and media relations. They should utilize their critical
thinking and collaboration proficiencies and make sure all of their
 communications are clear, concise and unambiguous. They should
be able to dispel rumors and circulate facts.

Reliable leadership
Nurse leaders should remain calm, composed and confident but
also be authoritative under challenging situations. They should be
rational and open-minded to other ideas.

Nurse leaders should also show empathy to the staff’s needs while
maintaining control over a situation. They should be able to
approach a crisis from a systems theory perspective.
Critical-thinking competencies
Nurse leaders should also use their critical-thinking abilities,
including analyzing, evaluating and synthesizing information to
determine the best approach to crises.

“Nurse leaders should coordinate with other credible sources,

build bridges and maintain partnerships with other organizations.
The nurse leader’s central mission is to maintain safety and meet
the basic needs of the patients and healthcare staff,” AONE
researchers said.
Organizational readiness
Nurse leaders should be prepared at all times to identify the nature
of the crisis, activate plans, implement actions and provide
interventions for the organization’s readiness.

5mts Summary:

A crisis is a disturbance resulting from a perceived threat that

challenges the person's usual coping mechanisms. Crises are a
time of increased vulnerability, but they can also stimulate
growth. There are two types of crises: maturational and
situational. Crisis intervention is a brief, active therapy with the
 goal of returning the individual to a pre crisis level of
functioning. In assessing a patient the nurse should identify the
patient's behaviors, precipitating event, perception of the event,
support systems and coping resource, and previous strengths and
coping mechanisms.

BIBLIOGRAPHY:

BOOK REFERENCES:

NET REFERRENCES:

 https://www.acs.edu.au/info/psychology/counselling/crisis-counselling.aspx
 https://triggered.edina.clockss.org/ServeContent?rft_id=info:doi/10.1093/brief-treatment/mhi03
 https://onlinenursing.duq.edu/blog/the-dnp-educated-nurses-role-in-crisis-management/
 https://www.bing.com/search?q=nurses+role+in+crisis+management&form=EDGEAR&qs=HS&cvid=0964ab48170a434f98391f3b1f11f328&c
c=IN&setlang=en-US
 https://online.grace.edu/news/human-services/crisis-intervention-models
JOURNAL REFERENCES:

 https://www.researchgate.net/publication/24177620_Changes_in_Media_Reporting_of_Suicide_in_Australia_Between_200001_an
d_200607

To evaluate changes in Australian news media reporting of suicide between 2000/01 and 2006/07 against recommendations in the resource
Reporting Suicide and Mental Illness. Newspaper, television, and radio items on suicide were retrieved over two 12-month periods pre- and
postintroduction of Reporting Suicide and Mental Illness. Identifying and descriptive information were extracted for each item. Quality ratings
were made for a stratified random sample of items, using criteria from the precursor to Reporting Suicide and Mental Illness. There was almost a
two-fold increase in reporting of suicide during the study period, with 4,813 and 8,363 items retrieved in 2000/01 and 2006/07, respectively. The
nature of media reporting showed some variability, with an increased emphasis on items about individuals' experiences and a reduced emphasis on
policy and program initiatives. Most strikingly, there was significant improvement on almost all individual dimensions of quality and overall
quality. These findings are positive, although there are still clearly some opportunities for improving the way in which the media report and
portray suicide. In order to improve standards, continued support should be provided for the dissemination and evaluation of Reporting Suicide
and Mental Illness.

VINAYAGA MISSION COLLEGE OF NURSING,KARAIKAL

TEST FOR BSC(N) –II YR

SHORT ESSAY: 2X5=10

1. Explain principle and approaches of crisis intervention

2. Write nurses role in crisis management