Key Takeaways
- A crisis is a sudden event that overwhelms normal coping abilities and requires immediate intervention
- Crisis intervention is short-term, focused on restoring the person to their pre-crisis level of functioning
- The goals of crisis intervention are ensuring safety, reducing symptoms, and restoring coping ability
- Situational crises are precipitated by external events; maturational crises occur during developmental transitions
- The LPN/LVN provides immediate support and ensures patient safety while facilitating access to resources
Crisis Intervention
A crisis occurs when a person's usual coping mechanisms are overwhelmed by a stressful event. The LPN/LVN must recognize crisis situations and provide immediate, supportive intervention.
Understanding Crisis
Definition: A crisis is a sudden, overwhelming event that disrupts a person's emotional equilibrium and exceeds their normal coping abilities.
Characteristics of Crisis:
- Temporary state (usually resolves in 4-6 weeks)
- Requires immediate intervention
- Normal coping is inadequate
- High anxiety and distress
- Potential for growth or deterioration
- Perception of event is key
Types of Crises
| Type | Description | Examples |
|---|---|---|
| Situational | External event precipitates crisis | Job loss, divorce, accident, diagnosis |
| Maturational | Developmental transitions | Puberty, parenthood, retirement |
| Adventitious | Unexpected, disaster-related | Natural disasters, violence, terrorism |
Phases of Crisis
| Phase | Description |
|---|---|
| Pre-crisis | Baseline functioning, normal coping |
| Impact | Event occurs, initial response |
| Crisis | Coping fails, high distress |
| Resolution | New coping developed or deterioration |
Crisis Response
Normal Crisis Responses:
- Anxiety and fear
- Confusion
- Difficulty concentrating
- Emotional numbness or outbursts
- Physical symptoms (headache, GI upset)
- Sleep disturbance
- Social withdrawal or clingy behavior
Goals of Crisis Intervention:
- Ensure immediate safety
- Reduce acute symptoms
- Restore pre-crisis functioning
- Develop new coping skills
- Connect with support resources
Crisis Intervention Steps
Roberts' Seven-Stage Model:
| Stage | Action |
|---|---|
| 1 | Assess lethality - Safety first |
| 2 | Establish rapport - Connect with person |
| 3 | Identify problem - Understand the crisis |
| 4 | Deal with feelings - Validate emotions |
| 5 | Generate alternatives - Explore coping options |
| 6 | Develop action plan - Create specific steps |
| 7 | Follow up - Ensure continued support |
Safety Assessment
Immediate Concerns:
- Risk of suicide
- Risk of harm to others
- Ability to care for self
- Immediate physical safety
- Presence of weapons
Questions to Ask:
- "Are you thinking about hurting yourself?"
- "Do you feel safe right now?"
- "Is there anyone who might hurt you?"
- "Do you have access to weapons?"
Nursing Interventions for Crisis
| Intervention | Purpose |
|---|---|
| Stay calm | Model regulated behavior |
| Provide safe environment | Physical and emotional safety |
| Active listening | Show understanding |
| Validate feelings | Normalize crisis response |
| Focus on present | Avoid overwhelming with too much |
| Simple, clear communication | Reduce confusion |
| Help prioritize | Identify most pressing issues |
| Connect with resources | Facilitate professional help |
| Involve support system | Activate family/friends |
Communication During Crisis
Effective Approaches:
- Speak calmly and slowly
- Use simple, short sentences
- Repeat information as needed
- Focus on one issue at a time
- Avoid arguing or judging
- Offer limited choices
- Provide structure
Helpful Statements:
- "I'm here to help you."
- "You're safe right now."
- "Let's focus on one thing at a time."
- "What would be most helpful right now?"
- "Who can we call to support you?"
De-escalation Techniques
For Agitated Patients:
| Technique | Description |
|---|---|
| Maintain distance | Respect personal space |
| Stay calm | Keep voice and body relaxed |
| Listen actively | Let them express feelings |
| Acknowledge feelings | Validate without agreeing with behavior |
| Offer choices | Restore sense of control |
| Set limits | Clear, non-threatening boundaries |
| Remove audience | Reduce stimulation |
Abuse and Violence Assessment
Signs of Abuse:
- Unexplained injuries
- Injuries inconsistent with explanation
- Delayed treatment seeking
- Excessive fear or anxiety
- Withdrawal
- Controlling accompanying person
- Minimizing injuries
Nursing Response:
- Interview patient alone
- Ask direct but non-judgmental questions
- Document objectively
- Report as required by law
- Provide safety resources
- Respect patient's decisions
Referral Resources
Crisis Resources:
- 988 Suicide and Crisis Lifeline (call or text 988)
- Crisis text line (text HOME to 741741)
- Emergency department
- Crisis stabilization units
- Mental health providers
- Domestic violence hotlines
- Social services
The LPN/LVN Role
What LPN/LVNs Do:
- Recognize crisis situations
- Provide immediate support
- Ensure safety
- Report to supervising RN
- Document observations
- Assist with connecting to resources
What LPN/LVNs Report:
- Suicidal or homicidal statements
- Signs of abuse
- Severe agitation
- Psychotic symptoms
- Inability to care for self
- Statements of hopelessness
On the NCLEX-PN
Expect questions about:
- Recognizing crisis situations
- Priority interventions for crisis
- De-escalation techniques
- Safety assessment and intervention
A patient who just learned of their spouse's sudden death is pacing, crying uncontrollably, and unable to answer questions. What is the LPN's priority action?
A patient in the emergency department becomes increasingly agitated, pacing and raising their voice. Which de-escalation technique should the LPN use FIRST?
A female patient has bruises in various stages of healing on her arms. When asked, she says she "fell." Her partner answers all questions for her. The LPN should: