Crisis Intervention Teaching activities and resources

A crisis is defined as: “An emotional upset, arising from situational, developmental, biological, psychological, socio-cultural, and/or spiritual factors. This state of emotional distress results in a temporary inability to cope by means of one’s usual resources and coping mechanisms. Unless the stressors that precipitated the crisis are alleviated and/or the coping mechanisms are bolstered, major disorganization may result. It is recognized that a crisis state is subjective and as such may be defined by the client, the family or other members of the community” (Hoff, 1995; Ontario Ministry of Health and Long-Term Care, 1999ab; RNAO, 2006).

Nurses have an important role to play in delivering effective crisis intervention to meet the needs of clients experiencing a crisis (RNAO, 2006). Evidence demonstrates that crisis care should be incorporated into all areas and units of health care and used when working with clients (RNAO, 2006). It is important for nurses to recognize that crisis intervention is integral for all environments and contexts where care is provided, including hospital and community settings (RNAO, 2006).

Models of crisis intervention

A crisis intervention is defined as: “A process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources (Hoff, 1995). 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 [Hoff, 1995]” (RNAO, 2006, p. 16).

Crisis theorists postulate that there are three core components to any crisis.

1. A precipitating event that produces an experience of stress;
2. Perception of the event that leads to feelings and emotions that are overwhelming or confusing.
3. Compromised coping mechanism that does not allow the individual to function emotionally, occupationally and interpersonally.

Source: RNAO, 2006.

While there are many models of crisis intervention, in any crisis intervention the focus is always on increasing the client’s level of social, occupational, cognitive and behavioural functioning (RNAO, 2006). Crisis intervention uses a client-centred approach that takes into consideration the client’s unique rights, feelings, values, perceptions and wishes (RNAO, 2006). While tools (e.g., interview guides, mental status, risk assessment etc.) may aid in assessment by providing a structured approach to the process, they are not a substitute for empathy, knowledge, clinical judgment and expertise.

It is worth noting that experienced and trained nurses usually apply all phases of the crisis framework and move beyond assessment and referral to include creative problem-solving strategies—which encompass social determinants of health (RNAO, 2006). Too often nurses assume that some clients are incapable of problem-solving and never proceed beyond risk assessment and referral. “Moving out of one’s comfort zone and making changes to one’s clinical practice involves education, risk taking and an openness to change. Nurses need to assume initiative and responsibility for lifelong learning to maintain currency and competence within their multi-faceted crisis intervention roles” (RNAO, 2006, p 31).

For more information, see Resources in this section.