Crisis Intervention Teaching activities and resources
This section provides educators with the knowledge and skills required to understand and identify crisis states and support people through crises.
At the end of this section, the educator will ensure students achieve the following:
- Identify the definition of a psychiatric/mental health/addiction crisis and relevant theories, and frameworks regarding crisis intervention.
- Identify mental distress.
- Have a basic understanding of mental health first aid.
- Have the ability to intervene to support a client experiencing a crisis.
- Identify individualized triggers, strengths, resources, resilience, and preventative strategies.
- Understand care planning strategies to prevent and support people through crises.
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.
- A precipitating event that produces an experience of stress;
- Perception of the event that leads to feelings and emotions that are overwhelming or confusing.
- 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.
Teaching and Learning Activities
The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to crisis intervention.
- Self-reflection on personal past crises and coping strategies
- Develop a safety and comfort plan—Appendix F
- Case study—Section 9.3
- Simulation—Section 7.2
- Lived client experience/family experience—Appendix H
- Class assignment that explores local community crisis intervention resources
- Review of films portraying crisis and examining use of crisis interventions
- Lived client experiences/family experiences
- Arts-based approaches
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding crisis intervention. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.
- What makes a crisis? Who defines it?
- What is the relationship between crisis and transition points? Provide examples.
- At what point does a crisis become an emergency? What is the relationship to the Mental Health Act and Legislation?
- What is the relationship between the social determinants of health and crises? See RNAO Social Determinants of Health.
- What would be the issues with developing standardized crisis plans?
- How would you engage in a conversation about crisis prevention and management?
- What happens to your attention span when you are in crisis?
- What are the implications for client care?
- What community resources and options can you offer a client in crisis?
- Should you drive a person who is in crisis?
- What risk assessments might you perform on a client in crisis?
- What opportunities might unfold as a result of a crisis?
Evaluation and Self-reflection
The following tools can be used to evaluate students in their understanding and application of crisis intervention.
- Completed safety and comfort plan—Appendix F
- Test questions
- Ability to perform risk assessments and strengths assessments
- Group assignment to resolve a crisis
- Paper that looks at different theories to crisis
- Completed client debrief post-crisis
- Reflect on your own crisis and strategies to prevent/resolve crisis
- Written/in-person debrief after a client has experienced crisis
- Mental Health Commission of Canada’s Mental Health First Aid
- The Wellness Recovery Action Plan®
- Mental Health First Aid (MHCC) National Psychological Safety Standards
- Crisis Prevention Institute (and training)
- Prevention and Management of Aggressive Behaviour (PMAB)
- RNAO 2015, Person- and Family- Centred Care. Toronto, ON: Registered Nurses’ Association of Ontario.
- RNAO 2006, Crisis Intervention. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2002, Strengthening and Supporting Families through Expected and Unexpected Life Events. Toronto, ON. Registered Nurses’ Association of Ontario.