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CRISIS AND NURSING INTERVENTION

2. 12-06-2013 CRISIS AND NURSING INTERVENTION

3. LOGO CRISIS AND NURSING INTERVENTION CHAPTER - 9

4. 12-06-2013 CRISIS AND NURSING INTERVENTION DEFINITIONS Crisis is an acute

time limited phenomenon experienced as an over whelming emotional reaction to a stressful
event or the perception of that event. It is the struggle for equilibrium and adjustment when
problems are perceived as insolvable. Crisis intervention is a short term focuses on the solving of
the immediate problem, aims to establish the former coping pattern and problem solving ability.
It is usually limited to 4 – 6 week period after which resolution will be attained.

5. TYPES OF CRISIS 11-06-2013 CRISIS AND NURSING INTERVENTION 1 2 3

Maturational -each development stage can be referred to as the same. Situational -arises from an
external rather than an internal source. Adventitious –it is not a part of every day life, is
accidental and unplanned

6. Gerald Caplan -1960s defined crisis theory and outlined crisis intervention. Caplan identified
four distinct phases of crisis. 12-06-2013 CRISIS AND NURSING INTERVENTIONErich
Lindermann - 1940s conducted study of the grief reactions of close relatives of victims in a club
fire. This study formed the foundation of crisis theory and clinical intervention. She showed that
preventive intervention in crisis situations could eliminate or decrease serious personality
disorganisation and other psychological consequences from the sustained effects of severe
anxiety. CRISIS THEORY

7. 1206-2013

8. FOUR PHASES OF CRISIS PROCESS 1st phase - A person confronted by a conflict or

problem that threatens the self concept responds with increased feelings of anxiety. The increase
in anxiety stimulates the use of problem solving techniques in an effort to solve the problem and
lower anxiety. 2nd phase - If the usual defence response fails, and if the threat persists, anxiety
continues to rise and produce feelings of extreme discomfort. Individual functioning becomes
disorganised. 12-06-2013 CRISIS AND NURSING INTERVENTION

9. 3rd phase - If the recovering attempts fail, anxiety can escalate to severe and panic levels, and
the person mobilises automatic relief behaviour, such as withdrawal and flight. (compromising
needs or solutions should be made) 4th phase - If the problem is not solved, anxiety can over
whelm the person and leads to serious personality disorganisations. This maladaptive response
can take the form of confusion, suicidal behaviour, yelling and running aimlessly. 12-06-2013
CRISIS AND NURSING INTERVENTION

10. Systemic evaluation facilitates the child’s progress towards his or her maximal level of
function, especially as it changes during the various stages of development. CRISIS AND
NURSING INTERVENTION The plans to care are then implemented through direct
intervention. The nurse establishes goals in collaboration with the child,family and the
interdisciplinary team members. Systematic process deals with recurrent actual or potential
crisises and the impact of these events. Appraising Crisis Systematically:

11. Contents 12-06-2013 HOSPITALISED CHILD1 TERMINAL ILLNESS AND DEATH2 3

NURSING MANAGEMENT– COUNSELLING

12. HOSPITALISED CHILD Preventive Best ------ Promotive Hospitalisation Curative

13. Rehabilitation 12-06-2013 CRISIS AND NURSING INTERVENTIONPromotion of health

Prevention of health Care for sick and injured development Accomplish therapeutic goals
child’s Develop positive attitude to others the Lesser the stress separation to Feel more
secure threat Provides diversion and relaxation minimise HOSPITALISED CHILD Functions
Of Hospitalisation

14. PRINCIPLES OF HOSPITALISATION 1.Nurse should begin to build a working

relationship with the patients and the child from the first contact with them. 2.Nurse should be
aware that all behaviour is meaningful. 3.Nurse should accept the parents and the child exactly as
they are. 4.Nurse should have empathy for parents and children. 5.Nurse should let them know
that their problems are of importance, the nurse is there to aid their solutions.

15. PRINCIPLES contd… 6.Nurse must be willing to acknowledge the parents rights to their
own decisions concerning their children. 7.Nurse permits the parents and the child to express
even negative emotions. 8.Nurse should ask questions limited to a single idea or reference.
9.Nurse should speak the language understandable to parents and the child 10.Health team
members should help the parents to feel that there is unity among them.

16. MODERN CONCEPTS OF HOSPITALISATION Parent Support Self Care groups Visiting
Care By Parent Unit CONCEPTS OF HOSPITALISATION

17. Tape recording could be made and played.Siblings should be accompanied by parent and
who have been exposed to infections is not permitted. Siblings of 2 – 12 years are permitted in
some hospitals for certain hours and older siblings fro any time. If parents are unable to visit
frequently, grandparents, uncles or aunts may visit instead. Visiting is determined by child’s
need to see parents. Flexible unlimited visiting any time 2 – 8 pm visiting- early morning to
bedtime VISITING

18. Parents of seriously ill children could stay whole night if they desire.If there is no dietary
restriction, food should be brought from home. Sometimes they can have food with children.
Some hospitals provide a waiting rooms for parents. Should not prohibit parents to stay at
child’s bedside if they desire. ROOMING- IN
19. Nurse can observe parent’s skills, attitudes, techniques and any problem in parent child
relation.Nurses’ responsibility is to meet needs of child, prepare parent for this, interpret
medical procedures, diagnostic tests, health teachings etc. When parents are nearby, children
can continue to learn and grow throughout hospital experience. Main fear about separation is
eliminated. Child gets attention from familiar person. Parents live with child, to involve
whole family in care of sick. CARE BY PARENT UNIT

20. Parents may feel comfortable enough to move away from hospital routine and ventilate their
feelings and concerns to relieve anxiety and stress.This may be conducted by nurses, play
therapists or by child life program staff, who act as facilitators or develop a support system
among parents. Parents with common concern should emotionally support and comfort.
PARENT SUPPORT GROUPS

21. Time and method depends on child’s cognitive abilities, emotional state and readiness to
learn.Help to learn self-care skills. Assess abilities of child SELF CARE

22. Dietitian, physiotherapist work together focusing different facet of growth, toward full
developmentPsychologists and psychiatrists help with serious emotional problems. Hospitals
may have school teacher or a recreational specialist to create pleasant situation. All members
needed to foster in every area of growth and development. Professional team work is important
GROWTH AND DEVELOPMENT OF HOSPITALISED CHILD

23. PLAY IN ILLNESS 3 year old Christie was due to receive a course of radio therapy. A play
program was designed to prepare her for the experience, which involved Christie lying on a large
sheet of paper on which her outline was drawn. The purpose of this was to explain the
importance of lying still during the radio therapy session. To emphasis this, a water spray was
used to show that when she moved it was difficult to spray the correct part of her body.

24. FUNCTIONS OF PLAY IN ILLNESS Diversional activities Social development Emotional

expression Development of moral value Creative expression

25. TYPES OF PLAY Dramatic play Energy release Creative play PLAY

26. Drawings TECHNIQUES OF THERAPEUTIC PLAY INCLUDE: Stories Music Puppets

Pets

27. SUITABLE PLAY FOR VARIOUS AGE GROUPS

28. INFANT • -Baby likes to pat and hug. • -Toys should be soft to hug and provide comfort. • -
Brightly coloured, washable toys. • -Large enough that cannot be aspirated. • -Have smooth
edges. • -Soft stuffed animals, soft balls, bath toys, • -Rattles, pots and pans.
29. Rocking horse or chairTelephone Push-pull toys Nest of blocks. Engages in parallel
play. Dolls Likes to place things in containers and dump them out. Enjoys exploring
drawers They may have favourite toys TODDLER

30. Video tapes.Drums, horns Dolls, dishes Paint with brush, finger paints Crayons,
simple puzzles Creative play, and dramatic play.  Engages in imitative play They exchange
ideas with others. It is the beginning stage of cooperative play. PRESCHOOLER

31. Skipping rope, dress up materials, table games, bicycle.Doll house, dolls, puppets and
music. Collection of things will be his hobby. Attention span increases, play is more
organised, more competitive. SCHOOLER

32. Telephone, easy puzzles, radio, hand puppets, and cut outs.Ball on string They pay
attention to special interest. Play will not acquire great energy expenditure. ADOLESCENT

33. A research study conducted by Uttara Chari, Uma Hirisave, and L. Appaji in 2012 reported
the benefits of play therapy in paediatric oncology. The study was conducted with a 4 year old
girl diagnosed with acute lymphoblastic leukaemia and outcome was examined using a
combination of qualitative and quantative assessments. The play therapy manifested in better
illness adjustment and general mental well being, enhanced coping and normalisation.

34. In this study the child initially inhibited, avoided medical toys and engaged in rudimentary
play. Her affect was considered and the interaction with the researcher was limited. As sessions
progressed, she became active and engaged in various types of play. Her initial avoidance of
medical toys followed by repeated enactment of medical procedures carried out on her reflects
the mechanism of play therapy in facilitating catharsis and mastery through re- enactment of
stressful experiences. Thus as sessions progressed, child’s play become similar to those of
healthy children indexing normalisation. This reflects enhanced coping and use of adaptive
defences in play sessions.

35. This help child to return to school after cure.Child will keep busy, feels useful and
important. If child is too ill to return to school, continuing class is important as a link with
outside world. Use of television, radio or computerised self instruction program enhances
contact with school system. Public school teacher is employed by local board of education in
paediatric ward. SCHOOL

36. Unfamiliar procedures. www.themegallery.com Company Logo Witnessing frightening

sights and sounds  Exposed to unfamiliar equipment  Unknown environment  Varied
emotional changes PREPARATION FOR HOSPITALISATION

37. • For well children who do not need immediate hospitalisation • For children who are
scheduled for hospitalisation • For all children of all age group • booklets, films and puppet
shows. • pre admission parties should be conducted. • Familiarising the hospital before admission
and pre hospital counselling

38. BASIC BELIEFS REGARDING CHILDREN • The family is the basic unit of society • Each
child needs love and security to develop feelings of trust and self esteem. • Each child is an
unique individual with different needs based on his or her family background, level of growth
and development and degree of illness • Nurse seeks to promote, maintain and restore health in
both children and their parents.

39. • Each ill child should be under the accountable care of one professional nurse. • The family
and child should be included in planning for therapeutic and nursing interventions and for
implementing and evaluating the plan of care. • Within a safe environment, the ill child needs
expert physical care, emotional support, play that allows for expression of feelings to promote
continued growth.

40. • Parents who have trusted relation with nurses feel welcome whenever they visit and
participate in child care. • Family members and terminally ill child who are at great stress should
be emotionally supported so that child can die with dignity and with feeling of being loved.
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41. GUIDELINES HOSPITAL ADMISSION • Assign a room based on child’s developmental

age, seriousness of diagnosis, communicability of illness and length of stay. • Preparing the
roommates for the new patient. • Prepare room for the child and family • Introduce primary nurse
• Orient to the inpatient facility. • Facilities in the room • Unit ( play room, dining room, lab) •
identification band. • hospital regulations and schedules • Perform nursing admission list • vital
signs, anthropometric measurements • Obtain specimens • physical examination. PRE-
ADMISSION ADMISSION

42. Emergency admission • Appropriate introduction • Use of child’s name • Determination of

child’s age and some judgment made about developmental age • chief complaint from both
parents and child. • general state of health, sensitivity to medication, previous hospitalisation.
ICU admission • Prepare child and parents for elective ICU admission. • Guide the child’s
appearance and behaviour. • Emotional support and answer questions. • Prepare sibling visit. •
Encourage parents to stay with child.

43. REACTIONS TO HOSPITALISATION Physiological reactions • Temperature elevations: as

response to infections • Convulsions : resulted from rise in temperature • Immobilisation •
Anorexia, vomiting and diarrhoea • Nutritional deficiencies • Fluid and electrolyte imbalance •
Inconsistent weight loss • Lack of growth Psychological reactions • Separation anxiety • Stranger
anxiety • Sleep deprivation • Loss of self control • Fear of darkness • Fear of death • Sensory
overload
44. REACTIONS OF EACH AGE GROUP Neonates • Interruption in the early stages of
development • Impairment of bonding and trusting relationship • Inability of the parents to love
and care for the baby and inability of baby to respond to parents www.themegallery.com
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45. Promote a quite environment Topical aesthetics  Homely routine  Rooming-in 

Nursing implications  Crying  Rejection of feed  Displays excessive irritability  Feeling
routines disrupted  Sleep awake cycle disrupted  Responses  Sensory overload  Sleep
deprivation  Immobilization  Painful invasive procedure  Stranger anxiety  Separation
anxiety  Stressors INFANT

46. Provide night light Explain the procedure in sequence  anaesthetics  Give choices 
Allow the parent to hold the child in her lap to do any procedure  Encourage parental presence
 Wonder why the parents are not rescuing Nursing implications  Think as a punishment 
Frightened to sleep in supine position  Fear of bodily restraint,injury Reactions  Loss of
autonomy and control  Regression  Denial  Despair  Protest  Reactions of toddlers are
expressed as protest, despair, denial and regression.  Separation anxiety TODDLER Stressors

47. Provide night light Explain the procedure in sequence  anaesthetics  Give choices 
Encourage parental presence  Regression Nursing implications  Aggression  Fear of pain 
Fear of body part loss  Fear of ghost  Displace difficulty in separating  Fear of dark
Responses  Painful invasive procedure  Bodily injury  Loss of self control  Separation
anxiety PRESCHOOLER Stressors

48. Encourage peer interaction Explain all the procedure  Utilise topical anaesthetics 
Encourage parental presence  Nursing implications  Demonstrates detailed cause for illness 
Displays increased sensitivity to the environment  Responses  Loss of own control  Loss of
privacy  Fear of death  Painful invasive procedure  Bodily injury  Separation from family
and friends  Loss of self control  Stressors SCHOOLER

49. Explain each steps of procedures prior Parental involvement  Encourage peer group
interaction  Include the adolescent in plan of care  Depression Nursing implications 
Bargaining  Withdrawal  Regression  Anger  Loss of privacy Responses  Separation from
peer group  Fear of death / disability  Fear of disfigurement  Fear of lack of body integrity 
Lack of privacy  Lack of control ADOLESCENT Stressors

50. Encourage to perform the tasks Counselling  Psychological support  Parent support
group and care by parent unit  Maintain parent child relationship  Encourage to obtain help
from other family members or friends  Recognise the need for support  This anxiety could be
recognised by the trembling,coarse voice, restlessness, irritability and withdrawal. Nursing
implications  The anxiety interferes with the parent’s ability to care the child, support. 
anxiety, anger, fear, disappointment,self blame,guilt  Unbearable financial obligations
Reactions  Spread of infections to other members in family  The suffering of the child 
Unknown events and outcomes  Separation from the child  Strange environment in the
hospital  Stressors EFFECTS OF HOSPITALISATION ON THE FAMILY OF CHILD
PARENTS

51. Sibling visits Provision for sibling to remain home  Explanation about the condition 
Guilt Nursing implications  Jealousy  Resentment  Anger  Received little information
about their sibling Reactions  Cared for outside by care providers  Experiencing the changes 
Younger child SIBLINGS Stressors

52. DISCHARGE FROM HOSPITAL • plan for discharge with the assistance of parents, child
and other health team members. • A discharge preparation involves education for family • The
preparation of discharge begins during the admission assessment. • Short and long term goals are
established to meet the child’s physical and psychosocial needs. • For children with complex care
needs, discharge planning focuses on obtaining appropriate equipment and health care personnel
at home. • The teaching plan involves levels of learning, such as observing, participating with
assistance and finally, acting without help. • All families need to receive detailed written
instructions

53. OBJECTIVES OF PLANNING FOR DISCHARGE 1. To make certain that the care given in
the hospital will be continued as necessary at home – the nurse can assist the parent and child to
meet the objective by educating them concerning the illness and the essential requirements for
care. 2. To share information with other appropriate community resources or agencies to enable
them to assist the parents and the child to continue care at home.

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