Chapter 10 Intervening in
by Sheila Hart
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Chapter 10 Intervening in
1. Crisis occurs in all individuals at one time or another and is not
necessarily equated with psychopathology.
2. Crises are precipitated by
specific identifiable events.
3. Crises are personal by nature.
4. Crises are acute, not chronic, and will be
resolved in one way or another within a
5. A crisis situation contains the
potential for psychological growth or
Dispositional crises are acute
responses to external situational
Crises of anticipated life transitions occur with
normal life-cycle transitions that may be anticipated
but over which the individual may feel a lack of
Crises resulting from traumatic stress are those that are
precipitated by an unexpected, external stressor over which the
individual has little or no control and from which he or she feels
emotionally overwhelmed and defeated.
Maturational or developmental crises occur in
response to situations that trigger emotions
related to unresolved conflicts in one’s life.
Crisis reflecting psychopathology is one in which preexisting
psychopathology has been instrumental in precipitating the crisis
or in which psychopathology significantly impairs or complicates
Psychiatric emergencies are crisis situations in which general
functioning has been severely impaired and the individual
rendered incompetent or unable to assume personal
a sudden event in one’s life that disturbs
homeostasis, during which usual coping
mechanisms cannot resolve the problem.
Phase 1: The individual is exposed to a precipitating stressor. Major disorganization of the individual with
drastic results often occurs. Whether or not an individual experiences a crisis in response to a stressful
situation depends on:
Phase 2: When previous problem-solving
techniques do not relieve the stressor,
anxiety increases further.
Phase 3: All possible resources, both
internal and external, are called on to
resolve the problem and relieve the
Phase 4: If resolution does not occur in previous
phases, the tension mounts beyond a further
threshold or its burden increases over time to a
Major disorganization of the individual with drastic
results often occurs. Whether or not an individual
experiences a crisis in response to a stressful situation
The individual’s perception of the event
The availability of situational
The availability of adequate
The minimum therapeutic goal of crisis intervention is
psychological resolution of the individual’s immediate crisis
and restoration to at least the level of functioning that
existed before the crisis period.
A maximum goal is improvement in
functioning above the precrisis
Phases of Crisis
Intervention: The Role of
Assessment. Information is gathered regarding
the precipitating stressor and the resulting crisis
that prompted the individual to seek professional
Planning of Therapeutic Intervention. From the assessment data, the
nurse selects appropriate nursing diagnoses that reflect the immediacy
of the crisis situation. Desired outcome criteria are established.
Appropriate nursing actions are selected taking into consideration the
type of crisis, as well as the individual’s strengths and available
resources for support.
Intervention. The actions identified in the planning phase are
implemented. A reality-oriented approach is used. A rapid working
relationship is established by showing unconditional acceptance, by
active listening, and by attending to immediate needs. A problemsolving
model becomes the basis for change.
Evaluation of Crisis Resolution and Anticipatory Planning. A
reassessment is conducted to determine if the stated
objectives were achieved. A plan of action is developed
for the individual to deal with the stressor should it recur.
Crisis on the Inpatient Unit
A number of characteristics describe anger, including
frowning, clenched fists, intense eye contact, yelling and
shouting, lowpitched verbalizations forced through
clenched teeth, and emotional overcontrol with flushing of
Anger is a stage of the
Anger turned inward results in
Some individuals need assistance to
recognize their true feelings as
Aggression can arise from such feeling
states as anger, anxiety, guilt, frustration,
Aggressive behaviors may be
mild, moderate, severe, or
Aggression may be characterized by sarcasm, verbal or
physical threats, degrading comments, throwing or striking
objects or people, suicidal or homicidal ideation, disturbed
thought process and perception, and anger disproportionate to
Assessing Risk Factors
Prevention is the key issue in the
management of aggressive or violent
The violent individual usually
feels underlying helplessness.
The most widely recognized risk factor for
violence in a treatment setting is past
history of violence.
Diagnoses that have the highest association with violent
behavior include schizophrenia; organic brain disorders;
mood disorders; antisocial, borderline, and intermittent
explosive personality disorders; and substance use
The “prodromal syndrome” describes a set of behaviors
that are predictive of impending violence. They include
anxiety and tension, verbal abuse and profanity, and
Dysfunctional grieving may be used when
anger is expressed inappropriately and the
etiology is related to a loss.
Risk for self-directed or other-directed
Outcomes evaluate success of the
individual in maintaining anger at a
manageable level and the prevention of
harm to self or others.
overwhelms local resources and threaten
the function and safety of the
leaves victims with a damaged sense of
safety and well-being and varying degrees
of emotional trauma
Grieving is a natural response.
Common behavioral responses include anger;
disbelief; sadness; anxiety; fear; sleep
disturbances; and increases in alcohol, caffeine,
and tobacco use.
Children may experience separation anxiety,
nightmares, and problems with