Crisis intervention: Nursing

A crisis is a sudden, temporary, overwhelming emotional reaction caused by a stressful event perceived as a threat. Crisis intervention is a short-term management method used by health professionals in clients who are experiencing a crisis.

Now, there are three main types of crises: developmental, situational, and existential crises. Developmental crises are predictable and expected occurrences during life. Common examples of developmental crises include graduation, new job, marriage, the birth of a child, and retirement. Situational crises are unpredictable random and unexpected events. Common examples of situational crises include severe illness, job loss, unwanted pregnancy, divorce, and the death of a loved one. Finally, existential crises are usually related to one’s life's meaning, purpose, and freedom. One common example of existential crisis occurs when an older person reflects on their life and accomplishments only to feel unfulfilled and dissatisfied.

Now, regardless of the type of crisis, there are typically four main phases. During the first phase, the client encounters a stressful situation or a precipitating event that disrupts their psychological balance and causes discomfort and anxiety. As a result, the client activates problem-solving and coping mechanisms to resolve the crisis.

If the client fails to resolve the crisis, they enter the second phase. During the second phase, discomfort and anxiety continue to rise, and the client starts perceiving this stressful situation as a threat, resulting in it affecting their daily function and quality of life. Since problem-solving and coping mechanisms have failed, the client switches to a trial and error method, which uses various mechanisms in an attempt to resolve the crisis.

But, if the trial and error method fails, the client enters the third phase, which is associated with further negative impact on their daily function, severe panic, and even physical symptoms, such as sweating, shaking, and increased heart rate. As a result, the client might make compromises in their life by reevaluating their needs and readjusting priorities. Some might reach out to external help and medical professionals, like nurses, psychologists, or psychiatrists.

If all previous coping mechanisms fail, the client enters the fourth phase and develops severe personality dysfunction, confusion, depression, or even violence against others. During this phase, the client can even develop suicidal thoughts and present with suicidal behavior, such as self-harm.

Now, clinical manifestations during crises vary from person to person. Some clients can be angry, easily agitated and offended, and present with aggressive behavior, like yelling and shouting. Other clients might feel overwhelmed, depressed, anxious, and hopeless. They can also be emotionally unstable, lose interest in everyday activities like hobbies, and have challenges in communication at home, work, or school. Lastly, clients going through a crisis have a hard time completing simple tasks or staying focused, and they usually prefer to be alone.

Finally, the treatment can be either non-pharmacological or pharmacological. Non-pharmacological treatment includes counseling, expression and validation of feelings, improvement of the current life situation, and development of new problem-solving and coping mechanisms. On the other hand, pharmacological treatment usually includes the administration of selective serotonin reuptake inhibitors, which can help relieve symptoms of panic attacks.

Now let’s move onto the nursing care you will provide for a client during a crisis. Your priority goals are to maintain safety, assist in resolving the crisis, and promote return to pre-crisis functioning.

First, take steps to maintain your client’s safety. Assess their mood and observe their behavior, and determine if there is a risk of your client’s self-harm or harm to others. Immediately report to the healthcare provider if your client expresses suicidal ideation, has attempted suicide, or expresses the intent to harm others. Follow your facility procedures to address suicidality and promote safety, and continue to monitor your client’s mood and behavior.

Then, assist your client in resolving the current crisis. Begin by establishing a rapport with your client. Speak to them calmly in a low-toned voice, listen actively, and use supportive body language to show them that you are concerned about their feelings. Be sure to convey acceptance and support, and reassure them that they are in a safe place.