Crisis Intervention:. A process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources.
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Crisis Intervention: • A process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources. • The goals of crisis intervention are rapid resolution of the crisis to prevent further deterioration, to achieve at least a pre-crisis level of functioning, to promote growth and effective problem solving, and to recognize danger signs to prevent negative outcomes.
BACKGROUND: • As recently as 1969, there was no crisis intervention textbook, only a rich collection of readings edited by Howard Parad and Gerald Caplan in 1965. • Signifying the growth of crisis in health services, there are now many texts whose interdisciplinary authors represent interest in crisis work: • Crisis intervention is everyone’s business, not the specialty of a particular discipline. • Extensive studies in the 1950’s established this premise about crisis care. • It is an essential element of comprehensive mental health services, and just as important as emergency medical treatment of acute physical injuries.
summary of recommendations: 1) Crisis intervention is founded on a particular set of values and beliefs, and guiding principles. 2) Knowledge of the three core components of crisis intervention theory (a precipitating event, perception of the event, and the client’s usual coping methods) is fundamental to identify clients in crisis. 3) The delivery of crisis intervention is based on an integrative framework. 4) A wide array of therapeutic communication skills is a pre-requisite to effective intervention with clients in crisis.
summary of recommendations: 5) A comprehensive holistic assessment is performed prior to engaging in any plan to resolve crises. 6) Nurses are directly involved in all aspects of crisis intervention including assessment, intervention, referrals and linkages, and short-term follow up. 7) Teaching and educating clients, families, colleagues, and the community about crisis intervention and prevention are essential to promote mental health. 8) Education and ongoing learning opportunities are required for nurses to implement best practices in crisis intervention.
The ABC Model of Crisis Intervention: • A: ATTENDING SKILLS - Introduce yourself and your role in a respectful, friendly and CALM manner. • B: BEHAVIOURAL & SOCIAL PROBLEM IDENTIFICATION AND THERAPEUTIC INTERACTION - including crisis assessment covering affective, behavioural and cognitive domainsand risk assessment , done in a warm and gentle environment. • C: COPING - Identify client’s current coping attempts, Encourage client to think of other creative coping strategies.
Robert’s Seven stage model of Crisis Intervention • CRISIS ASSESSMENT (including risk assessment); • ESTABLISH RAPPORT & THERAPEUTIC RELATIONSHIP; • IDENTIFY MAJOR PROBLEMS (including crisis precipitants); • DEAL WITH FEELINGS & EMOTIONS; • GENERATE & EXPLORE ALTERNATIVES; • DEVELOP & FORMULATE ACTION PLAN; • ESTABLISH FOLLOW-UP PLAN & AGREEMENT.
Communication Strategies in Crisis Intervention: • Use Silence. • Use non- verbal communication. • Paraphrasing, empathy building and understanding. • Reflective feelings. • Allowing the expression of emotions.
Case Scenario # 1 • Faisal just started his first year at AKUH in Karachi. He is originally from Sialkot. You walk down the hall 0f the hostel where you both live and see his door is open. Faisal just got off the phone so you stop to say hello. Faisal’s face is blank, and his eyes look scared. You ask what's the matter. He looks down and says in a numb voice, "My sister just called. She told me my dad had a heart attack and died."
Case Scenario # 2 • Dalia is an international student from India. Pamela is Dalia's roommate. Pamela comes to you to say that Dalia has been waking up screaming from nightmares several times a week since the semester began. She always wants to sleep with the lights on, and sometimes Pamela walks into the room to only to find Dalia sitting on the bed or the floor, rocking and crying. Dalia recently told Pamela that she has had dreams of her father chasing her as if he wants to hurt her. Pamela is concerned because Dalia is becoming more and more withdrawn and won't eat.
Case Scenario # 3 • Cindy is a from Georgia. She just found out that her roommate was raped last spring, and she knows the guy who she said raped her. She’s angry and upset, but mostly feeling helpless. She comes to you for advice for her roommate. • WHAT CAN YOU DO OR OFFER?
WHAT IS CONFLICT ??? • A conflict is an opposition of people, forces, or other entities. • Conflict is defined as a difference of opinion regarding ideas, wishes or desires. • A conflict exists when two people wish to carry out acts which are mutually inconsistent. • Basically: a disagreement A disagreement through which the parties involved perceive a threat to their needs, interests or concerns.
Conflict is a natural phenomenon, neither inherently good or bad, but there may be positive or negative outcomes.
Conflict Responses: • Emotional responses • Feelings we experience in conflict. • Range from anger and fear to despair and confusion. • Cognitive responses • Our ideas and thoughts about conflict such as the “inner voice” or internal observations we have. • Physical responses • Include such responses heightened stress, bodily tension, increased perspiration, shallow or accelerated breathing, nausea, and rapid heartbeat.
CAUSES OF CONFLICTS: • Needs - not met • Values - tested • Perception – questioned • Assumption – presumed • Knowledge – inadequate • Expectations – high • Background/ Personal/ social - differences
Conflict Resolution Styles: • Accommodating • Avoiding • Competing • Compromising • Collaborating
Personal Styles of Dealing with Conflict • Turtle (Avoidance) • Teddy Bear (Accommodation) • Shark (Domination) • Fox (Compromise) • Owl (Integration)
Resolving Conflict: Interest-BasedRelational (IRB) Approach Theory: • Make sure that good relationships are the first priority. • Keep people and problems separate. • Pay attention to the interests that are being presented. • Listen first: talk second. • Set out the “Facts.” • Explore options together.
Eight Steps forConflict Resolution: • Understand your perceptual filters, biases, and triggers. • Clarify personal needs threatened by a dispute. • Identify a safe place for negotiation. • Seek first to understand, then to be understood. • Assert your needs clearly and specifically. • Approach problem-solving with flexibility. • Manage an impasse calmly, patiently and respectfully. • Build an agreement that works.
Examples of Ground Rules: • 1) One person speaks at a time. • 2) Make a sincere commitment to listen to one another, & try to understand the other person's point of view before responding. • 3) Discussion to be kept in confidence, unless there is explicit agreement regarding who needs to know further information. • 4) Talk directly with the person with whom there are concerns, and not seek to involve others in "gossip" or "alliance building." • 5) Attack the issues, not the people with whom we disagree. • 6) Agree to disagree.
First we have to try to understand – by putting ourselves in the other person’s shoes.
Each person must be allowed to say how they feel – without being interrupted. In order for it to work: Each person must listen carefully to what the other has to say.
Everyone must make sure they don’t make the situation worse … so NO: put downs revealing of secrets screaming or shouting fighting, kicking, pushing!
Each person must be determined to work together with the others. This means: Taking turns Speaking quietly, but firmly Active listening Talking about how you feel, without blaming anyone.
Now find a solution by brainstorming together. Think of as many ideas as possible!
All parties must take responsibility for their part of the agreement. And stick to what has been decided.
…. And be prepared to talk again if things aren’t improving. How’s about another chat? O.K. That’s cool!
Scenario 1. James and David are going to lunch. The cafeteria is very crowded and each wants to save a seat for a friend. Both students arrive at the same time and choose a space with three vacant seats. James sits at one end and David sits at the other. Both of them want to save the middle seat for their friend. How could they work this out?
Scenario 2. Karen and Ashley want to talk about their plans for the weekend but the only time they see each other at school is during Math class. Mr. Jones, the teacher, also wants everyone’s attention while in his class. He will probably not view their need to talk as being more important than his need to teach Math. How can the girls talk without interfering with the class?
Scenario 3. Sara wants to chat with her friends on the Internet every day when she gets home from school. Her parents insist that she complete her homework before going online or watching television. She feels that since she is a good student that she should be able to do homework on her own time schedule right after dinner. What kind of dialog should she have with her parents?
Scenario 4 Mark is a junior from Texas, and is student of 3rd year. His girlfriend broke up with him a month ago. He has tried repeatedly to get her to talk to him but she refuses. He is drunk and calls her, but she hangs up on him. His roommate, Bob, comes to you and says that Mark is yelling, screaming, and smashing the phone against the wall.
What is bad news? • Bad news can mean different things to different people. • There have been numerous definitions of bad news including, "any information, which adversely and seriously affects an individual’s view of his or her future "or,in situations where there is either a feeling of no hope, a threat to a person's mental or physical well-being, risk of upsetting an established lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life'.
The common denominator is that bad news is a message, which has the potential to shatter hopes and dreams leading to very different lifestyles and futures.
Examples include: • A patient who is told they are HIV positive. • The man who is told his partner has Alzheimer's disease. • The patient who is told the lump has been diagnosed as cancer. • The couple who are told they cannot have children or having an abnormal child.
Breaking Bad News • Breaking bad news is not something that most medical students are eager to try. • Dilbert's advisor Dogbert says: "Never break bad news...it will only get you in trouble.“ • And stories abound about how unskilled physicians blundered their way through an important conversation, sometimes resulting in serious harm to the patient.
The Goal: • Help the patient and family understand the condition • Support the patient and family • Minimize the risk of overwhelming distress or prolonged denial
Breaking Bad News is a SKILL !!!! • Some physicians contend that breaking bad news is an innate skill, like perfect pitch, that cannot be acquired otherwise. This is incorrect. • Physicians who are good at discussing bad news with their patients usually report that breaking bad news is a skill that they have worked hard to learn.
Why is it a critical skill? The Physician’s Perspective High degree of difficulty + Physician anxiety = High risk of performing poorly