Lesson plan on crisis

and its interventions

objectives
GENERAL OBJECTIVE: By the end of the lesson plan the group will be able to understand and gain
knowledge on crisis and its interventions.
SPECIFIC OBJECTIVES:
 Explain about crisis and interventions.
  Discuss the incidence of crisis.
 List out the types of crisis.
 Enlist the phases of crisis.
 Explain the signs and symptoms of crisis.
 Enumerate the characteristics of crisis.
 Elaborate the factors responsible for crisis.
 Explain the crisis intervention.
 Discuss the purposes , principles and goals of crisis intervention.
 List out the techniques used in crisis intervention.
 Explain the phases of crisis intervention.
 Discuss crisis therapy.
 Explain the nurses role in crisis and its interventions.

GENERAL INFORMATION
NAME OF THE TEACHER: MRS.A.NIRMALA MSc(N)
SUBJECT: MENTAL HEALTH NURSING
NAME OF THE TOPIC: CRISIS INTERVENTION
CLASS: M.SC NURSING 1ST YEAR
UNIT: 2
VENUE: MSC(N)CLASSROOM
DATE:
TIME:
AV AIDS: PPT,CHART,BLACK BOARD
METHOD OF TEACHING: LETURE CUM DISCUSSION METHOD
 TEACHING
TIME OBJECTIVES CONTENT AND AV EVALUATION
LEARNING AIDS
OBJECTIVES

2min Success starts from crisis. Crisis starts from needs. Needs start
from will power. Will power starts from wisdom.
Manob Das

Modern world is full of hassles, deadlines, frustration, demands.

For many people stress is a common place that it has become a
way of life. Stress is not always bad, in small doses, it can help
you to perform under pressure and motivate you to do your best.

The word stress is defined by the oxford dictionary as “A State

of affair involving demand on physical or mental energy”. A
condition or circumstance which can disturb the normal
physiological and psychological functioning of an individual.

A crisis in the mindset requires the ability to think of the worst

case scenario while simultaneously suggesting numerous
solutions. Crisis intervention is not sufficient for individuals with
 long standing problems.
Sessions length may range from 20 minutes to two or more hours.
This crisis intervention is appropriate for children, adolescents
and adults. Local and national telephone hotlines are available to
address crisis related to suicide, domestic violence, sexual assault
and other concerns. They are usually available 24 hours a day,
seven days a week
Incidence of Black
crisis. Teacher board Students
INCIDENCE explained understood the
Before 1991, all major posts independence economic crisis in incidence incidence.
India were caused by exogenous forces – the contribution of
policy errors towards their exacerbation not withstanding whether
by war or drought or global commodity shocks. In a seminal
study by Joshi and Little during 1991, A policy induced crisis par
excellence was identified. It was not developed over night. It was
caused by more than a decade of imprudence.

Taking the recent crisis COVID-19 pandemic may increase the

number of people battling acute hunger, the United Nations says
❖ Climate change policies are coming second as officials focus
on fighting the virus. Income loses for informal economy workers
could be massive, according to the International Labour
Organization.
❖ The pandemic could result in 7 million unintended
pregnancies, the UN warns. Many mass vaccination campaigns
are being temporarily suspended. Hunger crisis, unemployment,
unintended pregnancies are some of the crisis the people are
suffering from.

DEFINITIONS
 1. A state of disequilibrium resulting from the interaction of
families coping mechanisms, which are inadequate to meet the
demand of the situation, combined with the individuals or
families perception of the meaning of the event.
- Sheeber P Basheer

2. Crisis is a sudden event in one’s life that disturbs homeostasis,

during which usual coping mechanisms cannot resolve the
problem.
- Lagerquist: 2001
3. An essential property of crisis is the potential for promoting
growth.
- Rapport (1965)
4. A crisis is a difficult or dangerous time in which a solution is
needed – and quickly. For e.g.: The crisis caused by a Natural
disaster might inspire you and your friends to make a donation.
- Webster.com
Types of crisis. 5. A crisis is any event or period that will lead or may lead to an Teacher listed Flash Students gained
unstable and dangerous situation affecting an individual, group or out the types of cards knowledge on
all of society. crisis types of crisis
- Wikipedia

TYPES OF CRISIS
There are three types of crisis
• Maturational or Developmental Crisis
• Situational Crisis
• Adventitious Crisis
1. Maturational or Developmental Crisis:
➢ May occur at any transitional period in normal growth
 and development. The transitional periods where
individuals move to successive stage after generate
disequilibrium.
➢ Individuals are required to make cognitive and
behavioural changes that accompany development,
precipitate factors are normal stress of development (e.g.:
Adolescence, Retirement, Marriage and Parenthood)
➢ Because of all changes in a person’s life result in loss
and loss requires grief work to process, an individual with
need to take the time to process their life changes.
Example of Maturational Crisis: Leaving home during late
adolescence Marriage Birth of a Child Retirement Death
of a parent
2. Situational Crisis:
➢ A situational crisis sometimes called (accidental or
external crisis) is a response to a sudden and unavoidable
traumatic event that largely affects a people identify and
roles.
➢ It usually follows the loss of an established support or
role. Examples of Situational Crisis: Unexpected Job Loss
Serious Car Accidents Loss of Spouse Failure Birth of a
Child with a disability Diagnoses with a chronic or
terminal illness, affects how people perceive themselves.
3. Adventitious Crisis (Social Crisis):
➢ Social crisis is a accidental, uncommon and
unanticipated and result in multiple losses and radical
environment changes. ➢ An adventitious crisis occurs
outside the person precipitate by unexpected events.
➢ Social crisis is one arising from the cultural values that
are embedded in the social structure.
➢ An unexpected event that is usually beyond the
 individual central.
Phases of crisis Teacher Students gained
➢ This type of crisis is unlike maturational and situational described the LCD knowledge on
crisis because it doesn’t occur in the lives of all people. phases of crisis phases of crisis
Examples of Social Crisis: The loss of job streaming from
discriminatory practices based on age, race, sex, sexual
preference or class is a primary example of a social cultural crisis.
Natural Disaster Fire Floods and War are some of the other types
of social crisis.

PHASES OF CRISIS
CAPLAN (1964) has described four phases of crisis as described
below Phase 1 (Potential Crisis State)
Phase 2 (Pre-Crisis) Phases
Phase 3 (Intermediate Crisis)
Phase 4 (Full Crisis)

1. Phase 1 ( Potential Crisis State):

➢ Perceived threat act as a precipitant that generates
increased anxiety.
➢ Normally coping strategies are activated and if
unsuccessful the individuals moves into phase 2.
2. Phase 2 (Pre – Crisis):
➢ The ineffectiveness of phase 1 coping mechanisms leads
to further Disorganization.
➢ The individual experiences a sense of vulnerability.
➢ The individual may attempt to cope with the situation in a
random fashion.
➢ If the anxiety continues and there is no reduction, the
individual enters phase 3.
Signs and 3. Phase 3 (Intermediate Crisis):
symptoms of ➢ Re-definition of the crisis is attempted and the individual Teacher enlisted Chart Students learned
crisis. is most amenable to assistance in this phase. the signs and about signs and
➢ New problem solving measures may also affect a solution. symptoms of symptoms of
crisis crisis.
➢ If problem solving is unsuccessful, further disorganization
occurs and the individual is said to have entered phase 4.

4.Phase 4 (Full Crisis State):

➢ Secure to panic levels of anxiety with profound cognitive,
emotional and physiological change may occur.
➢ Referral to further treatment resources is necessary.

SIGNS AND SYMPTOMS OF CRISIS

Veterans who are considering suicide after show signs of
depression, anxiety, low-self-esteem and/or helplessness such
as.... ➢ Appearing sad or depressed most of the time.
➢ Clinical depression: Deep sadness, loss of interest, trouble
sleeping and eating that doesn’t go away or continuous to get
worse.
➢ Feeling anxious, agitated or unable to sleep.
➢ Neglecting personal welfare, deteriorating physical
appearance. ➢ With drawing from friends, family and
society or sleeping all the time.
➢ Losing interest in hobbies, work, school or other things
are used to care about.
➢ Frequent and dramatic mood changes.
➢ Expressing feelings of excessive guilt or shame.
Teacher Black Students
Symptoms:
Process of crisis described the board understood
➢ It is important to note than an identity crisis is not an actual
diagnosis. Rather a person, going through an identity crisis may process of crisis about process of
find themselves preoccupied with certain questions.. crisis
• What am I passionate about
• What are my spiritual beliefs
• What are my values
• What is my role in society or purpose in life 11 Who am I?
This question may be in general, or in regards to your
relationships, age and I career. Majorly depression symptoms are
observed during the period of crisis like.. Low Mood, Loss of
Interest, Fatigue and Irritability.

PROCESS OF CRISIS
(RESOLUTION OF CRISIS)
Healthy resolution of a crisis depends upon the following three
factors.
1. Realistic appraisal of the precipitating event, i.e. recognition of
the relationship between the event and feelings of anxiety is
necessary for effective problem solving to occur.
2. Availability of support system.
3. Availability of coping measures over a life time. A person
develops a repertoire of successful coping strategies that enable
him to identify and resolve stressful situations.

There are three ways by which the individual may resolve the
crisis. They include:
1. Pseudo – Resolution:
➢ In this, the individual uses repression and pushes out of
consciousness the incident and the intense emotions
associated with it, resulting in the individuals functioning
at the same earlier level.
 ➢ But in future, if and when a crisis occurs the repressed
feelings may surface & influence the feelings aroused by
the new crisis.
➢ In such a situation, the particular crisis may be difficult
to resolve because the feelings associated with the earlier
crisis are neither expressed nor handled at that time.
2. Unsuccessful Resolution:
Characteristics ➢ In this, the victim uses pathological adaption at any
of crisis phase of crisis, resulting in a lower level of functioning. Teacher LCD Students gained
➢ The victim, rather than accepting the loss and explained the knowledge on
reorganizing his life keep ruminating over the loss. characteristics characteristics
of crisis of crisis
➢ An example is prolonged grief reaction which results in
depression.
3. Successful Resolution:
➢ In this, the victim may go through the various phases of
crisis, but reaches phase 3 where various coping measures
are utilized to resolve the crisis situation.
➢ The individual develops better skills and problem
solving ability, which can be and will be used in various
crisis situations in future.

CHARACTERISTICS OF CRISIS

❖ Crisis occurs in all individual’s at one time or another and is

not necessarily equated with psychopathology.
❖ Crisis is precipitated by specific identifiable events.
Factors ❖ Crisis is personal by nature. What may be considered a crisis
responsible for situation by one individual may be so far for another. Teacher Black Students
crisis ❖ Crisis is acute not chronic and will be resolved in one way or enumerated the board understood
another within a brief period.
❖ A crisis situation contains the potential for psychological factors about the factors
growth or deterioration. responsible for responsible for
❖ Individuals who are in crisis feel helpless to change. crisis crisis
❖ There may be a physical danger, which should be the first
priority.
❖ It may be difficult or impossible to carry out your usual daily
activities.
❖ Crisis generally arises on a short notice.
❖ Crisis triggers a feeling of fear and threat amongst the
individuals

FACTORS RESPONSIBLE FOR CRISIS

❖ It has been said that you really don’t know what is inside a tea
bag until you put it in hot water. You may or may not like your
boss on a day to day basis, but how is he or she in a crisis?
❖ The important thing to note about crisis is that they are not
necessary bad, but they may turn bad. How we respond to them is
crisis in determining which direction they go.
❖ Five factors they are always present at every crisis
➢ Risk
➢ Uncertainty
➢ Time Sensitivity
➢ Human Factor
➢ Potential Severe Consequences
Risk:
• This is unavoidable in every crisis and occurs on many levels.
• There is a risk to personnel, civilians, equipment and property.
• Some leaders delay making decisions out of fear and some of
the other factors in crisis does not assist the timid commander
when it comes to alloying their features by employing
procrastination as a strategy.
Uncertainty:
• This element is as unavoidable as risk.
• There are always factors that will be unknown.
• In a mechanical crisis like the one involving the picric acid the
main points of uncertainty once everyone in harm’s way was
safely executed were just how unstable are these bottles and how
will moving them excaudate this instability.
Time Sensitivity:
• Time does not take sides. It’s neutral.
• There are competing factors that influence how we use time.
• In a mechanical incident such as a chemical spill resulting in the
formation of a toxic cloud. It may be all about quickly identifying
wind direction and then instructing people how best to execute or
probably better to remain sheltered in place.
Human Factor:
• The human factor is the most complicated and important one of
the five factors for an incident commander to manage.
• Our main resource is our people, but in a crisis it’s not only
them but victim’s witnesses, bystanders and possible suspects
who are part of the equation.
• All must be considered but in a crisis how your people react
and how you take care of them may mean the difference between
success and failure.
Potential Severe Consequences:
• Potentially severe consequences are inherent in crisis.
• It’s impossible to have a desire change without the threat of a
catastrophic consequence.
.• In many crisis the severe consequences may occur before we
take one step to deal with them, but the fact that none occur does
not disqualify an incident from being a crisis.
Purposes of Flash
crisis Teacher cards
intervention explained the Students
CRISIS INTERVENTION purposes of understood
crisis about the
intervention purposes
DEFINITIONS
❖ Crisis is a sudden event in one’s life that disturbs homeostasis,
during which the individual’s usual coping mechanisms can
resolve the problem. ❖ Lagerquist, 2001

❖ A crisis is self-limited and can last from a few hours to weeks.

Principles of It is characterized by an initial phase in which anxiety and tension
crisis rise, followed by a phase in which problem solving mechanism Chart
intervention are set in motion. ❖ Kaplan and Saddock, 1998. Teacher
described the Student learned
❖ It is a psychological disequilibrium in a person who confronts principles of the principles of
a hazardous circumstance that for him constitutes an important crisis crisis
problem which can neither escape nor solve. ❖ Caplon intervention intervention

PURPOSES OF CRISIS INTERVENTION

❖ To provide a correct cognitue perception of the situation.
❖ To assist the individual in managing the intense and
Goals of crisis Black
overwhelming feelings associated with the crisis.
intervention board
❖ To reduce the intensity of individual’s emotional, mental,
Teacher listed Students gained
physical and behavioural reactions to stress.
out the goals of knowledge on
❖ To help individual’s return to their level of functioning before goals of crisis
crisis
the crisis. intervention
intervention
❖ To assist the individuals in recovering from the crisis and to
prevent serious long term problems from developing.
 PRINCIPLES OF CRISIS INTERVENTION LCD
Techniques of ❖ Be specific use concise statements and avoid overwhelming
crisis the patient with irrelevant question or excessive detail encourage
intervention Teacher Students
the expression of feelings. enumerated the understood the
❖ A calm, controlled presence reassures the person that the nurse techniques of techniques of
can help. crisis crisis
❖ Listen for facts and feelings, seeking clarification, intervention intervention
paraphrasing and reflection are effective strategies.
❖ Allow sufficient time for the individuals involved to process
information and ask questions

GOALS OF CRISIS INTERVENTION

❖ Reduction in disequilibrium or relief of symptoms of crisis.
❖ Restoring to pre-crisis level of functioning.
❖ Some understanding of the relevant precipitating events.
❖ Identification of remedial measures.
❖ Connecting the current situation with past life experiences and
conflicts.
❖ Initiating new modes of thinking perceiving feeling and
developing new adaptive and coping responses

TECHNIQUES OF CRISIS INTERVENTION

❖ Catharasis:
Crisis therapy ➢ The release of feelings that takes place as the patient talks Black
about emotionally charged areas. board
 Teacher Students
described the understood
❖ Clarification: crisis therapy crisis therapy
➢ Encouraging the patient to express more clearly the
relationship between certain events.

❖ Reinforcement of Behaviour:
➢ Giving the patient positive reinforcement to adaptive
behaviour.

❖ Support of Defences:
➢ Encouraging the use of healthy, adaptive defences and
discouraging those that are unhealthy or maladaptive.

❖ Increasing Self-Esteem:
➢ Helping the patient to regain feelings of self-esteem.

❖ Exploration of Solutions:
➢ Examining the alternative ways of solving the immediate
problem.

CRISIS THERAPY
❖ Definition:

Refers to the methods used to offer immediate, short – term help

to individuals who experience an event that produces emotional,
mental, and physical and behavioural distress or problems.
 ❖ Principles:
• Use comfort strategies.
• By acceptance of the person.
• Establishing rapport and positive concern social relationship to
lesson anxiety and to create sense of hope worthfulness.
• Let the family and the client understand that coming for help is
a good indication and a sign of strength and judgement.
❖ Problem solving techniques:
• In 1910, John Dewery has suggested certain problem – solving
techniques.
i. Identify and define the difficulty or problem.
ii. Suggest possible solutions.
iii. Choosing from among alternatives.
iv. Consider consequences.
v. Encourage the client to utilize solutions.
vi. Evaluation.
❖ Group Work:
• Nurse and group help the patient to solve the problem and
develop new coping strategies.
• Nurse will be active, focal and present problem oriented.
• The group and client follow the nurse as a role model and ideal
example uses similar therapeutic techniques. Flash
Setting of crisis • Mostly crisis groups focus on people who have common traits cards
intervention or exposed to common stressor.
• A group facilitate the members to express common concerns Teacher Students learned
and experiences, foster hope and provides mutual support. described the about settings of
❖ Family Work: setting of crisis crisis
• Identify the individual and family affected with crisis. intervention intervention
Involving the family in client care is essential, nurses has to have
knowledge related to family dynamics.
 • Provide calm and conductive, comfortable environment to the
client, help to establish good rapport and IPR between client and
his family identify the stressor and suggest possible attacking of
the problem, utilize the bet suiting approach to resolve the crisis.
• Plan the psycho educational programmes for education and
support. • Provide information to family about system of mental
health, body-mind relationship, effect of mental illness.
• Provide opportunity to ventilate, share and mobilize the
resources.
• Increase use of informal and formal support networks.
• Family interventions consist of educational, supportive,
cognitive and behavioural strategies.
❖ Patient Education:
• The therapeutic team members will educate and counsel the
client and his family about problem resolving techniques,
Black
Role of nurse in alternative adaptive coping strategies, importance of having
board
crisis balance mind and emotional maturity.
intervention. • In evaluation phase of crisis intervention, patients and their Teacher Students learned
families, anxiety will be reduced and cognitive abilities will be explained the about role of
increased, educate the public to identify the crisis situations and role of nurse in nurse in crisis
victim’s. crisis intervention
intervention
SETTINGS OF CRISIS INTERVENTION
❖ Hospitals:
o Outpatient units
o Inwards
o Emergency room settings

❖ Mental health care centres.

❖ Community Settings:
o Stress
o Home visits
o Outreach centres

❖ Telephonic counselling and hotline:

o Crisis calls
o Ventilation calls
o Information calls
o Suicide prevention and crisis intervention centres
o Schools
o Offices
o Private practice

ROLE OF NURSE IN CRISIS

INTERVENTION
❖ Phases and techniques of crisis intervention are similar to the
steps of nursing process.
Phase 1 – Assessment:
Assess the following
 Ability to perceive the problematic situation.
 Identification of precipitating event or stressor and when it
occurred.
 Balancing factors.
 Nature and strength or adequacy of clients.
 Supporting systems and coping resources, strategies that can be
used.
 Client’s abilities and limitations in dealing with the problem.
  Needs of the client. Eg: self-esteem, role mastery, dependency
and biological function.
 Nature of crisis and its effects on the individual and family
 Associated behavioural problems. Eg: suicidal potentialities.
 Physical and mental status of an individual.
 H/O previous exposure and adapted strategies.
 Exploration of problematic situation.

Phase 2 – Nursing Diagnosis:

 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: ineffective 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:

 Nurses have to use reality oriented approach.
 Remain with the individual who is experiencing panic anxiety.
 Establish a rapid, positive working relationship by
o Showing unconditional acceptance.
o Active listening.
o Attending to immediate needs.
o Appropriate communication techniques to make the client to
feel more comfortable.
 Discourage lengthy explanation by rationalizing the situation.
 Provide adequate situational support and guidance.
 Promote conducive atmosphere for ventilation of true or real
overwhelming, intense emotional feelings.
 Handle the feeling gently, don’t give false reassurance.
 Maintain consistency.
 Clarify the problem, assist the individual to determine
precipitating factor of crisis.
 Accept the intense emotional feelings. Eg: anger, guiltiness
etc.....
 Client should not develop dependency over the counsellor.
 Utilize external support systems and new social networks to
provide assistance and plan of action.
 Advise for follow up visit
❖ A shields has described four levels of crisis intervention, it will
be often helpful to consult with others.
❖ When deciding which approach has to be used.

➢ Environmental Manipulation:
 It provides situational support; it will directly change the
client’s physical or interpersonal situations.
 For eg: if an individual is facing problem in working
environment to avoid stress, he may change another job.
➢ General support:
 Warmth, support, acceptance, empathy, caring, concern and
reassurance have to be provided to provide general support

➢ Generic Approach:
 To reach high risk individuals and large groups as early as
possible a specific method will be used to the persons who have
similar problem.  Eg: grief, disasters.
 Debriefing a therapeutic intervention will be used to recall the
traumatic events and to clarify painful experiences and to prevent
maladaptive responses.

➢ Individual Approach:
 Nurse has to understand client’s specific psychodynamic that
lead to the present crisis and must use the intervention to develop
and adaptive response to the crisis.

➢ Evaluation of crisis resolution and anticipatory:

 The nurse and the client has to evaluate and reassess whether
the intervention has resulted in a positive resolution of crisis or
not expected outcome, behavioural change has been achieved or
not. Whether the client returned to the normative level of
functioning if not achieved modified strategies.
 Eg: additional treatments have to be planned to resolve crisis, if
achieved similar strategies has to be reinforced

SUMMARY
❖ A crisis in the mindset requires the ability to think of the worst
case scenario while simultaneously suggesting numerous
solutions.
❖ Came to know regarding the introduction, incidence and the
history, the various definitions, meaning of crisis, the various
types of crisis which occur according to situation, the phase
involved and the signs and symptoms of crisis which are
worsening the situation, process of crisis, the various
characteristics of crisis, the various phases of crisis namely phase
1 to phase 4, the various factors responsible for crisis.
❖ In crisis intervention: introduction, definitions, purposes of
crisis intervention, principle, goals, the pre-requisites required,
the various techniques to be adapted, phases of crisis intervention,
interventions according to the crisis, the modalities the crisis
intervention model, the crisis therapy, the various settings where
crisis intervention is performed and the role of nurse in crisis
intervention.

CONCLUSION
❖ The turning point of a disease when an important change takes
place indicating either recovery or death.
❖ Individuals are more open to receive help during crisis. A
person may have experienced the crisis within 24 hours or within
a few weeks before seeking help.
❖ Crisis intervention plays a crucial role during this period. This
is a time limited and directs approach to help the patient cope
with crisis.

❖ Crisis intervention is not aimed at major personality change

but rather to do, restore functioning and enhance the personal
growth.
BIBLIOGRAPHY
❖ Navdeep Kaur Brar, text book of advanced nursing practice,
Jaype Brother, medical publishers. Page no: 882 – 885
❖ R. Sreevani, A guide to mental health and psychiatric nursing,
4th edition, Jaype Brother. Medical publishers. Page.no: 334 –
337
❖ Neeraj Sethi, essentials of psychiatry for nurses, second
edition, lotus publishers. Page. No: 120 – 124
❖ K.P. Neeraj, essential of mental health and psychiatric
nursing, volume 1, Jaype Brothers, medical publishers. Page .no:
210 – 212
❖ www.wikipedia.com