Most people will experience a crisis at some point in their lives. A crisis may be precipitated by a physical or emotional illness, an unfortunate circumstance, a natural disaster, or a change from one life stage to another. A crisis exists when the resources available to meet the challenge does not equal the impact of the challenge for the specific individual. High anxiety and a sense of being overwhelmed accompany the client’s subjective complaints. Events precipitating a crisis in one individual may not result in a crisis for another.
Crisis intervention requires skillful use of the nurse’s therapeutic techniques. The nurse may encounter individuals in crisis in any hospital setting, any outpatient setting, or in a home health setting. Nurses who work in the school systems also encounter individuals in crisis. Because the client feels vulnerable and out-of-control, it is important for the nurse to be direct, but supportive. The client needs a structured interaction. Effective crisis intervention may occur with just one session with the nurse, or it may require several sessions. The client can expect to return to pre-crisis levels of functioning with assistance.
A crisis includes four phases that were first described by Caplan in 1964. In phase one, the individual experiences a stressor and anxiety results. In phase two, the individual experiences increased anxiety and a sense of being overwhelmed. Coping strategies used to resolve the stressor do not match the impact of the stressor. Phase three is characterized by mobilization of resources to resolve the stressor. Professional assistance may be needed at this point. Phase four is characterized by symptoms indicating inadequate resolution of the crisis. For example, the client may experience psychotic symptoms, suicide attempt, or other negative symptoms (Scott & Varcorolis, 2006).
Crises may be defined as maturational, situational, or adventitious. Maturational crises may occur when an individual moves from one stage of life development to another. For example, the client may experience a crisis state following a marriage, birth of a child, or retirement. As an individual moves from one maturational level to another, coping skills effective for the previous life stage may no longer be effective; thereby putting the individual in a state of disequilibrium.
Situational crises may occur when an individual experiences a stressful situation, such as loss of a job, divorce, loss of a family member, illness, or change of job. Many individuals cope with the changes without feeling overwhelmed.
Adventitious crises include natural disasters, national disasters, or crimes of violence. The events are unexpected. For example, most of our country experienced some symptoms of crisis following the acts of terrorism directed at New York and Washington on September 11, 2001. Individuals in our country coped with the adventitious crisis by staying at home, listening to the news for minute-by-minute updates related to national security, refraining from being in large crowds and public places, praying, and decreasing flights on commercial airplanes. All of these coping strategies helped most individuals to feel fairly safe and to function in their everyday schedules.
Rape or other violent crimes, such as kidnapping or robbery may precipitate an adventitious crisis. The client is likely to experience a state of disequilibrium following such events, and intervention is likely to be necessary. Clients need the support of the nurse who is accepting, understanding, and objective.
Behavioral or physical indicators of crisis include: anxiety, anger, guilt, fatigue, flashbacks, irritability, inability to concentrate or complete a task, procrastination, lack of motivation, low self-esteem and self-doubt. Victims of crisis may resort to substance abuse, suicidal or homicidal ideation or aggressiveness. Withdrawn behavior, insomnia, changes in eating habits, feelings of helplessness and hopelessness, forgetfulness, work problems, and somatic complaints are further behaviors indicating crisis. Clients may experience a variety of these symptoms before making the decision that they need professional help. As feelings of helplessness and hopelessness increase, the client’s desire for help increases.
The first step in crisis intervention is assessment. It is essential that the nurse learn about the precipitating event (s) from the client’s perspective. In the assessment phase, it is important that the nurse inquire about the symptoms experienced, coping strategies already used, past coping skills, and support available to the client. During the assessment phase, it is important also to assess for suicidal and homicidal risk, and use of substances.
Typical nursing diagnoses for the client experiencing a crisis include: anxiety, ineffective coping, rape-trauma syndrome, post-trauma syndrome, disturbed thought processes, risk for violence, self– or other-directed. Once the nursing diagnoses are identified, appropriate goals are determined with the client.
Interventions that the nurse uses with the client include:
Offering the client time to discuss the situation, lending an objective point of view, and making suggestions for coping strategies will help the client return to a state of equilibrium.
Evaluation, the final step in the nursing process, is important. When the nurse has determined that the client has experienced behavioral change, a sense of well-being and control, and has identified or implemented positive coping strategies, it can be said that crisis intervention has been effective. During the evaluation phase, it is also helpful to summarize for the client how far he has come in the process toward equilibrium, the strengths available, and strategies to use in the future if similar situations arise.
Scott, C. M. & Varcarolis, E. M. (2006). Crisis, in E. M. Varcarolis, V. B. Carson & N. C. Shoemaker (Eds.) Foundations of Psychiatric Mental Health Nursing (5th Ed.) (pp. 456 – 472). St. Louis: Saunders Elsevier.