“Peace is a gift to each other.”
– Elie Wiesel
Note the stages of crisis development
Identify common behaviors in a crisis state
Explain types of crises
Discuss three phases of crisis intervention
Identify key communication skills and practices for crisis intervention
Stress is rampant in our modern world. All too often, this stress escalates to a crisis. A crisis is a debilitating imbalance in one’s internal equilibrium caused by a sudden stressor or threat to the self (Boyd, 2008). When people experience an overwhelmingly stressful life event with which they are unable to cope, a crisis is often the result (Flannery & Everly, 2000).
People in crisis can be found everywhere, including in healthcare facilities (Allen, Currier, Hughes, Reyes-Harde, & Docherty, 2001). Indeed, nurses frequently encounter people in crisis—whether they are patients, family members, or even other staff. Therefore, some of the most useful skills a nurse can have are crisis-intervention skills. Crisis-intervention skills are therapeutic skills used to intervene successfully and safely with individuals in crisis (Townsend, 2015).
Nurses in regular healthcare facilities encounter individuals in crisis more often than nurses in mental health facilities. This is because many people in regular healthcare facilities are being treated for serious injuries or catastrophic illnesses—both common causes of crisis.
STAGES OF CRISIS DEVELOPMENT
Caplan (1970) describes crises as developing in four distinct stages, beginning with a stressor and ending in a panic state. The stages are as follows:
The patient is exposed to an overpowering precipitating stressor. In response, the patient attempts to remove the stressor for relief of discomfort.
The patient is unable to remove the stressor and unable to cope with the discomfort. Anxiety begins to build.
The patient activates all available internal and external resources at a maximum level to remove the stressor.
The patient is unable to remove the stressor, and anxiety builds to a panic level. Cognitive functioning is impaired, emotions become labile (mood swings), and behavior caused by psychotic thinking may emerge.
Crisis states are generally not chronic or long-term in nature. Indeed, the human body cannot maintain a crisis state indefinitely. Most crises are self-limiting, lasting no longer than four to six weeks.
COMMON CRISIS STATE BEHAVIORS
When people are in a crisis state, they may display certain specific characteristic behaviors. Knowing what these characteristic behaviors are can help nurses identify when someone is in a crisis state. These characteristic behaviors include the following:
The person appears agitated, disturbed, tense, or anxious, with increasing levels of emotional distress (perhaps indicated by uncontrollable crying).
The person exhibits a decline in overall cognitive function, losing the ability to concentrate or think clearly, becoming overwhelmed by emotional stress.
The person becomes confused or forgetful or exhibits disorganized thinking ...