CRISIS MANAGEMENT

Before you proceed …

1. Compare and contrast the differences among primary, secondary, and tertiary
intervention including appropriate intervention strategies;
Primary intervention
-promotes mental health and reduces mental illness to decrease the incidence of crisis. The
nurse can work with the patient to recognize potential problems by evaluating the patients
experience of stressful life events; teach specific coping mechanisms such as decision
making, problem solving, assertiveness skills, and mediation and relaxation skills.

Secondary intervention
-establishes intervention during acute crisis to prevent prolonged anxiety from diminishing
personal effectiveness and personality organization. After safety issues are dealt with the
nurse works with the patient to assess the patient's problems, support systems, and coping
styles. Desired goals are explored and interventions planned. Secondary care lessens the time
a patient is mentally in hospital units, ER, clinics, and mental health centers, usually during
day time hours.

Tertiary intervention
-provides support for those who have experienced a severe crisis and are now recovering from
a disabling mental state. Social and community facilitation centers, sheltered workshops, and
outpatient centers. Primary goals are to facilitate optimal levels of functioning and prevent
further emotional disruptions. People with severe and persistent mental problems are often
extremely susceptible to crisis, and community facilities provide the structured environment
that can help prevent

2. Explain the potential crisis situations that patients may experience in hospital settings
a)Person is confronted by a conflict or problem that threatens the self concept responds with increased
feelings of anxiety. The increase in anxiety stimulates the use of problem solving techniques and defense
mechanisms in an effort to solve the problem and lower anxiety.
b)If the usual defensive response fails and the threat persist, anxiety continues to rise and produce feelings of
extreme discomfort. Individual functioning becomes disorganized. Trial and error attempts at solving the
problem and restoring a normal balance begin.
c)If the trial and error attempts fail, anxiety can escalate to severe and panic levels, and the person mobilizes
automatic relief behaviors, such as withdrawal and flight. Some form of resolution may be made in this
stage. (Ex: compromising needs or redefining the situation to reach an acceptable solution.)
d)If the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person and
lead to serious personality disorganization, depression, confusion, violence against others, or suicidal
behavior.
3. Provide concrete examples of interventions to minimize crisis situations; and,
• Provide an atmosphere of support
• Avoid giving false reassurances
• Determine whether the patient presents a safety risk to self or others
• Initiate necessary precautions to safeguard the patient or others at risk for physical harm
• Encourage expression of feelings in a nondestructive manner
• Assist in identification of the precipitants and dynamics of the crisis

4. List at least five resources in the community that could be used as referrals for a patient in
crisis.
• Support groups
• Rehabilitation centers
• Sheltered workshops
• Day hospitals
• Outpatient clinics

Activities:
1. Critical Thinking exercises
2. Crisis Intervention Simulation

Let’s Begin v:◆◆:v◆:v

Activity:
1. What do you see or perceive in this image?

I see trees, houses, a bridge, and a lady standing behind. But I can also see a face of a man when you look at
it as a whole.

2. How many faces do you see?

I can see 8 faces

 3. What happened to the feet of the elephant?

The actual legs are put in between to create an illusion.

Terms to Remember
adventitious crisis
crisis intervention
equilibrium
homeostasis
maturational
crisis mitigation
primary care
recovery
response
secondary care
situational crisis
tertiary care

What is CRISIS?
It is a major disturbance caused by a stressful event or threat, disrupts this homeostasis
Normal coping mechanisms fail resulting in an inability to function as usual
Equilibrium is replaced by disequilibrium
Factors:
 Perception
 Support
 Coping Mechanism

Perception of the Event:

Most important aspect associated with CRISIS – either realistic or distorted
Threat is based on a person’s unique perspective and coping abilities
People vary in absorption, processing, and usage of information from the environment

Situational Support
Includes all the people who are available that can be depended upon to help during the time of
a crisis

Coping Mechanisms
 Skills and mechanisms learned from variety of sources (e.g. cultural responses, modeling
behaviors from others, life opportunities) that may be used when faced with stressful events
and/or trauma

Types of CRISES

1. Maturational Crisis
Life changes that occur throughout the different lifespans
Changes may either be physical, cognitive, instinctual, and sexual
ACTIVITY: In each of the different changes that happen throughout the lifespan, give at least 2
situations that you think might affect equilibrium.
a) Physical
i. Puberty
ii. Circumcisions and menarche
b) Cognitive
i. maturity
ii. understanding
c) Instinctual
i. bullying
ii. humiliation
d) Sexual
i. Role confusion
ii. Gender identity

2. Situational Crisis
Arises from events that are extraordinary, external, and often unanticipated
ACTIVITY: Enumerate at least 2 events that may lead to situational crisis.
i. loss of job
ii. coming out to homosexual orientation

3. Adventitious Crisis
Caused by events that are unplanned and may be accidental, caused by nature, or
human-made
It may be natural disaster, national disaster or crime of violence
ACTIVITY: Provide at least 2 situations of each kind of adventitious crisis
a) Natural Disaster
i. flood
ii. earthquake
b) National Disaster
i. war
ii. terrorist attack
c) Crime of Violence
i. Sexual assault
 ii. murder in the workplace

STOP AND REFLECT!!!

As it was mentioned earlier, crisis is associated to an unanticipated

event. Which do you think might be one of your crisis two years
from now?

I would say that one of my crisis in two years is that the thought of being unemployed. In the way where I
cannot provide enough for my family and for myself. It drives me crazy thinking about it.
CRITICAL Thinking

Give what is being asked. Explain each item comprehensively. If answers were taken from articles or
journals, please cite according and don’t forget to include your bibliographic entries using the APA
format. Please be reminded to include proper punctuation and the use of subject- verb agreement.

Situation: Currently a third-year nursing student of MCNP, Jomar voices concerns to his class adviser
regarding his father’s (43 years old) termination from work. For years long, his father has been drinking
heavily, and Jomar seems to cope with the situation difficultly. Because of his father’s heavy drinking and
the increasing stress in his family, Jomar expressed that he wanted to leave the school for good. His
mother is currently experiencing neuromuscular disorder and thinks Jomar should stop studying and
should be taking care of her.

1. Enumerate and discuss the different crises present in the situation based from the different
viewpoints of each family member.
a) father- situational crisis. The father loss his job, and because of that situation, he took it hard and
started to drink a lot in order to forget the termination not knowing that he is also causing another crisis
to others, especially to his son, Jomar.
b) Jomar- situational crisis. Jomar is having a hard time in class because of the situation of both his
father who is alcoholic and mother who has an illness. Jomar couldn’t handle the situation anymore
because of the crises he has been facing,
c) mother- situational crisis. The mother would probably be in so much pain because she has an illness
and couldn't’t help her family because of the situation they are facing.
 
2. Identify the areas of assessment and what questions to be included to evaluatethe individual’s needs and
the needs of the family as a unit?
 
For Jomar’s situation
✓ How do you feel about the situation of your family?
✓ How does this situation affect your academic standing?
✓ Have you talk about this stuff at home?
 
Regarding the father's alcohol intake:
✓ How do you feel when you're terminated from your job?
✓ How many alcoholic beverages do you consume?
✓ What events causes you to drink heavily? 
 
For his mother's health:
✓ Do you have any past medical history or any hospitalization?
✓ How do you feel right now?
✓ Have you had regular check-ups or consultation with your doctor? 
 
 
3. Provide tentative goals that is fitted for this family.
 
✓ After 2 weeks of home visit, the family will be able to identify the problem as well as any ways to solve the
problem with the ways recommended by the health care provider through health education.
✓ After all the home visits, the family will be able to manage family problems effectively and efficiently.
 
4. Identify appropriate agencies in your local areas that you think will be helpful for each client and for
the family as a whole
 
✓ RHU, Support Groups, Alcoholic Rehabilitation Center. LGU, Department of Social welfare and development,
Department of Health.
 
5. Device an effective discharge plan for this family. Include the set-up of follow-up visits,  cooperation of
family members, and type of service to be provided.
 
 
Medications ✓ Educate the mother to take medications as prescribed
✓ Encourage the family to exercise on a regular basis to reduce stress and improve physical health.
✓ Encourage significant others to create a peaceful environment in order to reduce stress.
✓ In order to promote a good connection within the home, instruct significant others to maintain the
Exercise/Environment
environment clean, peaceful, and stress-free.
✓ Instruct significant others to limit environmental damage as much as possible, such as drinking
alcohol within the house's boundaries.
✓ Encourage the family to get medical help and take medications as prescribed.
✓ Encourage the father to avoid drinking alcohol and smoking, and to think rationally about how to
handle family difficulties.
✓ Encourage the family to seek counseling from social workers to assist them in resolving family
difficulties.
Treatment ✓ Encouraged the mother to continue seeing her doctor about her underlying illness.
✓ Encourage Jomar to talk to her friends as a source of support.
✓ Encourage enough relaxation times or family time to aid in the development of a strong
relationship with each member of the family.
✓ Encourage Jomar to participate in extracurricular activities at school to distract his focus.
✓ Provide family health education about stress management techniques,
diversional activities.
✓ Encourage the father to avoid alcohol intake to fit his lifestyle. That alcohol is not a
Health Teaching
healthy way of relieving stress.
✓ Teach the family how to set a realistic goal and develop a personal action plan in order to cope
with difficulties in a more open and welcoming manner.
OPD ✓ Remind the family to attend follow-up sessions and check-ups as planned.
✓ Advise the family to have a well balance diet and provide meal plan as necessary. 
Diet ✓ Encourage to drink water frequently
Spirituality ✓ Encourage the family to attend church regularly and to meditate at all times.