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Course: Mental Health Nursing

Topic: Models of Crisis Intervention

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the primary, secondary and tertiary prevention strategies for crisis.
Identify barriers to effective intervention.
Discuss the role of the nurse during the stages of crisis and disaster.
Identify the demands experienced by nurses who work in crisis intervention.

Contact info: info@nursesinternational.org

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Definition of Crisis Intervention

An overwhelming event, which may include:

Divorce
Violence
The passing of a loved one
The diagnosis of a serious illness

Crisis intervention

A short-term management technique designed to reduce potential permanent damage to an individual affected by a crisis.

Wang & Gupta, 2021

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Roberts' Seven-Stage Crisis Intervention Model

Plan and conduct a thorough biopsychosocialand lethality/imminentdanger assessment
Make psychologicalcontact and rapidly establish the collaborativerelationship
Identify the major problems, including crisis precipitants
Encourage an exploration of feelings and emotions
Generateand explore alternatives and new coping strategies
Restorefunctioning through implementation of an action plan
Planfollow-up and booster sessions

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage I: Psychosocial and Lethality Assessment

Assess the client'senvironmental supports and stressors, medical needs and medications,current use of drugs and alcohol, and internal and externalcoping methods and resources.
Ascertain a suicide attempt

Ask about suicidal thoughts and feelings.
Estimate the strengthof the client's psychological intentto inflict deadly harm.
Gauge the lethalityof suicide plan.
Inquire about suicide history.
Takeinto consideration certain risk factors.

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage II: Rapidly Establish Rapport

Facilitated by genuineness, respect, and acceptance of theclient:

Good eye contact
Nonjudgmentalattitude
Creativity
Flexibility
Positive mental attitude
Reinforcing small gains, and resiliency

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage III: Identify the Major Problems or Crisis Precipitants

Focuses on the client's current problem.

These are often the ones that precipitated the crisis.

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Stage IV: Deal With Feelings and Emotions

Allow the client to express feelings and “vent”.

Explain their story about the current crisis situation.

Rely on “activelistening” skills.

paraphrasing
reflecting feelings
probing

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage V: Generate and Explore Alternatives

The clinician and client beginto put options on the table.
Example:

A ‘no-suicide’contract or briefhospitalization.
Ensure the client's safety; or discussalternatives for finding temporary housing.
Consider thepros and cons of various programs for treating chemical dependency.

Alternatives aremore effective when they are generated collaboratively.

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage VI: Implement an Action Plan

Strategies are integrated into an empoweringtreatment plan or co-ordinated intervention.
For example for a suicidal youth, an action planmay involve several elements:

Involvingparents or significant othersin the removal of all lethal items to safeguard the environment
Scheduling phone calls,subsequent clinicalcontacts, events to look forward to
Decreasinganxiety and sleep loss (medicationmay be indicated)
Decreasing isolation
Hospitalization

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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Stage VII: Follow-Up

Post Crisis Evaluation:

Physical condition of the client (e.g., sleeping,nutrition,hygiene);
Cognitive mastery of the precipitatingevent
An assessment of overall functioningincluding, social, spiritual,employment, and academic
Satisfactionand progress with ongoing treatment
Identification of current stressors and a plan to deal with them
Needfor possible referrals (e.g., legal, housing, medical)

Roberts & Ottens, 2005

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

The nurse should ask the client about feelings of suicide after a crisis or overwhelming event.

True
False

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Primary Prevention of Crisis

Aims to prevent disease or injury before it occurs
Achieved by preventing exposures to hazards
Altering unhealthy or unsafe behaviors
Increasing resistance to disease or injury
Examples include:

Legislation and enforcement to ban or control the use of hazardous products

To mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)

Education about healthy and safe habits
Immunizations

Institute for work and Health, 2015

Contact info: info@nursesinternational.org

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Secondary Prevention

Aims to reduce the impact of a disease or injury that has already occurred.
Achieved by detecting and treating disease or injury as soon as possible.
Encouraging personal strategies to prevent re injury or recurrence.
Implementing programs to promote health.
Examples include:

Regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer).
Daily, low-dose aspirins and diet and exercise programs to prevent further heart attacks or stroke.

Institute for work and Health, 2015

Contact info: info@nursesinternational.org

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Tertiary prevention

Aims to soften the impact of an ongoing illness or injury.
Achieved by helping people manage long-term, often-complex health problems and injuries.
Examples include:

Cardiac or stroke rehabilitation programs, chronic disease management programs.
Support groups that allow members to share strategies for living well.
Vocational rehabilitation program when they have reached maximum level of recovery.

Institute for work and Health, 2015

Contact info: info@nursesinternational.org

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Critical Thinking Question

The nurse suggests that a client who has PTSD after experiencing a traumatic event consider joining a support group.

Which kind of prevention is this?

Primary
Secondary
Tertiary

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Barriers to Mental Health Care

Limited Availability of Medication and Health Professionals:

The WHO reports that nearly 20% of countries do not have at least one common antidepressant, one antipsychotic, and one antiepileptic medication available in primary care settings.

Limited Affordability:

The high cost of psychiatric treatment, often due to high medication prices, poses significant financial barriers to patient care.

Unite for Sight, 2021

Contact info: info@nursesinternational.org

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Barriers to Mental Health Care

Policy Limitations:

According to WHO, a global lack of comprehensive mental health policies is a key barrier to public access to mental health care.

Lack of Education may prevent an individual from:

Recognizing mental illness.
Seeking treatment.
Impairs families’ abilities to provide adequate care for mentally ill relatives.

Unite for Sight, 2021

Contact info: info@nursesinternational.org

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Barriers to Mental Health Care

Stigma:

Multiple studies have found that stigma associated with mental illness often prevents patients from seeking care and adhering to treatment.

Clients may then choose to distance themselves from the labels that mark them for social exclusion.

Unite for Sight, 2021

Contact info: info@nursesinternational.org

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Critical Thinking Question

Discuss the impact that stigma may have on mental health treatment.

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Nurse’s Role in Crisis Intervention

Therapeutic Communication
Develop rapport
Maintain contact
Identify the problem
Explore coping mechanisms
Assess risk to life
Negotiate an action plan
Implement the plan
Follow up on the plan
Educating clients, families, colleagues, and the community about crisis intervention
Teach about prevention

RNAO, 2002

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

Create an action plan with a client who expresses the desire not to live anymore after their spouse died in a traumatic car accident.

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Demands on the Nurse in Crisis Intervention

Fatigue Management Tips

Prioritize sleep by decreasing off-work obligations as much as possible.
Relaxation techniques to aid in sleep onset.
Create a pre-sleep, bedtime routine and keep sleeping environment comfortable, dark, cool, and quiet.
Avoid alcohol, spicy foods, and nicotine for at least 2-3 hours prior to sleep time.
Avoid caffeine at least 5 hours before bedtime.

Hittle, Wong, & Caruso, 2020

Contact info: info@nursesinternational.org

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The Nurse and Crisis Intervention: Self Care

Short naps (15-30 minutes) can help to decrease fatigue during work hours.
Longer naps (1.5 hours) can help prevent fatigue before working night shift.
Watch for signs and symptoms of fatigue in self and coworkers (e.g., yawning, difficulty concentrating, emotional instability, flawed logic, poor communication).
Report to a manager when feeling too fatigued to work.

Hittle, Wong, & Caruso, 2020

Contact info: info@nursesinternational.org

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Nurse in Crisis Intervention

Other strategies to combat the work related fatigue include:

Nutrition
Exercise
Meditation/ Mindfulness
Journaling
Yoga

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Critical Thinking Question

Discuss the importance of self-care for the nurse involved in crisis intervention.

What self-care interventions might you apply to your own practice?

Contact info: info@nursesinternational.org

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References

Australia Institute of Professional Counsellors, (AIPC). (2011). Crisis Intervention: Crisis Intervention in Counselling part-2. https://www.aipc.net.au/articles/crisis-intervention-in-counselling-part-2/

Hittle, B. M. , Wong, I.S., & Caruso C.C. (2020). Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers. CDC. https://blogs.cdc.gov/niosh-science-blog/2020/04/02/fatigue-crisis-hcw/

Institute for Health & Work . (2006). Primary, Secondary and Tertiary Prevention. https://www.iwh.on.ca/what-researchers-mean-by/primary-secondary-and-tertiary-prevention

Contact info: info@nursesinternational.org

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References

RNAO (2002). Crisis Intervention. Nursing best Practice Guidelines. https://rnao.ca/sites/rnao-ca/files/Crisis_Intervention.pdf

Roberts A.R. & Ottens, O.J. (2005).Brief Treatment and Crisis Intervention: The Seven-Stage Crisis Intervention Model: A Road Map to Goal Attainment, Problem Solving, and Crisis Resolution. Oxford Journal. 5,(4):329-339. https://triggered.edina.clockss.org/ServeContent?rft_id=info:doi/10.1093/brief-treatment/mhi030

Unite for Sight (n.d.). Module 6: Barriers to Mental Health Care. https://www.uniteforsight.org/mental-health/module6

Wang D, Gupta V. (2021 May 3). Crisis Intervention. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559081/

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