TREATMENT MODALITIES

CRISIS INTERVENTION

Assumption 1.Crisis - is a temporary state that occurs when stress overwhelms an

individual’s usual coping

mechanisms - self-limiting resolving within

6wks

Predisposing Factors

a. Disastrous eventb. Threatened loss of a basic

gratificationc. Failure to cope with stressd. Perceived absence of situational

support

Phases a. Anxiety in response to a perceived

threat or eventb. Disorganization with increased

general anxietyc. State of emergency with resolution

or defeatd. Breaking point

Types

1. developmental-maturational crisis2. Situational crisis3. Victim crisis

Characteristics of intervention1.Increases the likelihood that a crisis

will be positively resolved2. Offers immediate help and

reestablishes equilibrium3.Restores the Pt’s precrisis level of

functioning4. Teaches the Pt’s new ways of

problem solving

Phases of interventiona. Assess -nature of the crisis -effect on the Pt -coping mechanisms

-support systems

b. Begin planning

-formulate dynamics -explore options -designate steps to arrive at

solutions

c. Intervene through -environmental manipulation -general support -generic or -individual approach

Environmental manipulation

-provides direct situational support or removes stress

ex. Arranging for someone to stay with the Pt.

General support

-reassures the Pt. that the health care professional understands and will help the Pt.

ex. Providing empathy

Generic approach

-uses a standard intervention for all individuals faced with the same crisis

Individual approach

-uses interventions tailored to a particular Pt.

d. Evaluate whether the crisis has been positively resolved

Technique of intervention1. Take an active, focal, and exploratory approach2. Maintain the Pt’s present

orientation3. Guide intervention through its

phases

e

4. Encourage expression of feelings and an awareness of the links among events, current feelings, and behavior

5. Persuade the Pt. to view the therapist as a helper

6. Promote and reinforce adaptive behavior

7. Do not attack the Pt’s defenses, which are the only means available for coping; doing so will only escalate the crisis

8. Increase the Pt’s self-esteem9. Explore solutions to the problem

causing the crisis

Alternative strategies1. Telephone crisis counseling2. Emergency department CC.3. Home visits4. Family CC.5. Crisis group therapy

Role of the Nurse1. Assess the crisis2. Offer individual crisis therapy3. Organize crisis group4. Participate in disaster work5. Use preventive intervention6. Provide Pt education

II.Therapeutic environment a. Assumption 1. scientific manipulation of the

environment can change the Pt’s personality

2. Pt’s have strengths as well as conflict-free portions of their personalities, so they can constructively influence treatment

3. Successful treatment depends on therapeutic staff involvement at all levels

4. Human behavior can change in response to physical, interpersonal, and cultural environments

Characteristics of intervention1. Focuses on Pt’s interaction with

the environment2. Creates an atmosphere in which

the Pt can develop appropriate responses to individuals and situations

3. Is deliberately planned and structured to modify maladaptive responses

4. Promotes positive insights and responses

Treatment modalities1. Milieu therapy2. Therapeutic community3. Community meeting4. Patient-team meeting5. Therapeutic recreation6. Occupational therapy

7. Music and art therapy8. Horticulture therapy

Technique of intervention1. encourage, develop, and maintain

communication between staff and Pt.

2. Hold weekly staff meeting3. Set limits on and establish external

controls over unacceptable behaviors

4. Foster the Pt’s psychosocial skills5. Assess and implement individual

treatment modalities6. Create a homelike atmosphere7. Focus treatment on action and

problem solving

Role of the Nurse1. Act as a role model primarily in

inpatient setting2. Facilitate and oversee

implementation of intervention3. Structure the Pt’s environment

III. Group approachesa. Assumption 1. human beings are social animals

that desire interaction with others 2. group therapy can alleviate

intrapsychic distress or modify personality traits

3. Therapeutic groups focus on interpersonal, cognitive or behavioral changes.

4. Group dynamics can help modify behavior.

5. Groups offer a safe environment for sharing emotional experiences

B. Stages of group development1. Initial: conflict issues are

dependency and authority2. Middle: conflict issues are intimacy,

cooperation, and productivity3.Final: conflict issues are

disengagement and dissolution

C. Leadership Styles1.Democratic: encourage all members

to participate in decision making2.Autocratic: maintains control over

decision making3.Laissez-faire: relinquishes all control

over decision making and provides little, if any, guidance or support

D. Membership roles in groups1. Task roles: Administrative and goal

oriented2. Maintenance roles: enhance group

interactions3. Egocentric roles; express individual

emotional needs

E. Types of group therapies1. Psychotherapeutic groups2. PSYCHODRAMA3. Multiple-family group therapy

F. Types of therapeutic groups1. Self-help groups2. Remotivation and reeducation groups3. Patient-government groups4. Activity –therapy groups5. Patient-teaching education groups6. Symptom-management groups7. Stress-management groups

G. Role of the nurse in group approaches

1. Group therapy must be conducted by a clinical specialist with a master’s degree and a history of supervised clinical practice with groups

2. Therapeutic groups can be conducted by all nurses in all settings

IV. Family TherapyA. Assumptions1. Dysfunction in a patient usually

originates in the family2. The family is the patient, and the

focus is on family interactions3. The goal is to enable each family

member to function independently

B. Techniques and strategies1. Cotherapy2. Single therapist3. Network therapy4. Role playing

C. Role of the nurse1. A generalist nurse see patients in a

family context, reorganizes functional and dysfunctional behavior patterns, then makes referrals

2. A clinical specialist works as a family therapist and consultant

V. Individual PsychotherapyA. Assumptions:1. Therapy uses interpersonal

relationships to effect positive changes in the patients psychological well-being

2. The need for help is typically expressed as a symptom

3. The patient is anxious and is usually depressed

B. Types1. Crisis intervention2. Time-limited therapy3. Supportive therapy4. Long-term therapy

C. Role of the nurse1. A clinical specialist acts as a

psychotherapist in a therapy

2. A generalist nurse acts as a supportive therapist by counseling and by maintaining the nurse-patient relationship