INTRODUCTION

Every individual has undergone one type or another type of stressful situation one time or

several times in their life. When healthy individual use these opportunity for their growth and

development the sick or unhealthy personals feels some difficulties or they may need some

assistance to adjust with these stress. This condition is known as crisis and the help done to

overcome it is known as crisis intervention. Lack of crisis intervention results in adaptation of

maladaptive coping mechanisms and improper development of the individual.

DEFINITION – CRISIS

“A sudden event that occurs in one’s life, which disturbs the individual homeostasis, and

usual coping mechanisms will not resolve the problem” (Largerquist,2001).

A crisis is defined as a point that requires a change in the usual method of functioning. The

change requires adaptation, learning and growth.

A crisis can refer to any situation in which the individual perceives a sudden loss of his or her

ability to use effective problem-solving and coping skills.

CRISIS PRONENESS

Hendricks (1985) suggests that certain individuals are more prone to crisis than others. They

are those have;

dissatisfaction with employment or lack of employment

history of unresolved crisis

history of substance abuse

poor self esteem, unworthiness

only superficial relationship with others

difficulty in coping with everyday situations

under utilization of resources and support system

aloofness and lack of caring.

Individual personality traits also have to consider with these factors as what is a crisis for one

is merely an occurrence for another.

CHARACTERISTICS OF A CRISIS

1. Crisis occurs in all individuals at one time or another and is not necessarily equated

with psychopathology

2. Crises are precipitated by specific identifiable events

3. Crises are personal by nature, what may be considered a crisis situation by one

individual may not be so for another

4. Crises are acute, not chronic, and will be resolved in one way or another within a brief

period

5. A crisis situation contains the potential for psychological growth or deterioration.

TYPES OF CRISES

1) Maturational or Developmental crisis: Eric Ericson proposed that maturational crises

are a normal part of growth and development, and that successfully resolving a crisis

at one stage allows the child to move to the next. The child develops positive

characteristics after experiencing a crisis. If he or she develops less desirable traits,

the crisis is not resolved. Maturational events include events such as leaving home for

the first time, completing school or accepting the responsibility of adulthood. The

accomplishment of developmental tasks will impact the interpretation of crisis events

during the transition of an individual from one stage of life to another.

2) Situational crisis: A situational crisis occurs whenever a specific stressful event

threatens a person’s bio-psycho-social integrity and results in some degree of

psychological disequilibrium. The event can be an internal one, such as a disease

process or any number of external threats. A move to another city or a job promotion

can initiate a crisis even though they are positive events. If a person enters a new

situation without adequate coping skills, a crisis may develop that results in

dissonance.

3) Adventitious crisis: it is initiated by unexpected, unusual events that can affect an

individual or a multitude of people. In such situations, people face overwhelmingly

hazardous events that may entail injury, trauma, destruction, or sacrifice. National

disasters, violent crimes and natural disasters are examples of this type of crisis.

4) Socio-cultural crisis:

Social crisis is one arising from the cultural values that are embedded in the social structure.

Eg: The loss of job stemming from discriminatory practices based on age, race, sex, sexual

preference or class is a primary example of a socio-cultural crisis. They type of job loss

various markedly from job loss due to illness or poor performance, additionally. Crisis that

relates to deviant acts of others whose behaviour violates social norms, such as robbery, rape

and incest, may be classified as socio-cultural crisis.

Crisis from socio-cultural sources are generally loss amenable to control by individuals. Very

often, cultural views & public social policies may be a component of either the identification

or the resolution of this crisis. Whenever the crisis originates outside the individual, it is

usually beyond the ability of the individual alone to control and manage.

PHASES OF CRISIS

Kaplan (1964) outlined four specific phases through which an individual progress in response

to a precipitating stressor and results in the state of acute crisis. In describing the phases of

crisis, it is important to consider the balancing factors. These include the individual’s

perception of the event, situational supports and coping mechanisms. Successful resolution of

the crisis is more likely if the person has realistic view of the event, if situational supports are

available to help solve the problem, and if effective coping mechanisms are present.

Phase 1: The individual is exposed to a precipitating stressor. Anxiety increases, previous

problem-solving techniques are employed.

Phase 2: When previous problem solving techniques do not relieve the stressor, anxiety

increases further. The individual begins to feel a great deal of discomfort at this point. If the

coping techniques that have worked in the past are attempted, a feeling of helplessness may

develop if they do not succeed this time.

Phase 3: The individual may try to view the problem from different perspective and new

problem solving technique may be used and resolution of the problem may occur.

Phase 4: If the resolution does not occur in the previous phases disorganization may occur.

Cognitive functions are disordered, emotions are liable and behaviour may reflect the

presence of psychotic thinking.

The effect of balancing factors in a stressful event:

A. Balancing factors present B. One or more balancing factors

absent.

Human organism

State of equilibrium

State of disequilibrium

Need to restore equilibrium

Realistic perception of the event Distorted perception of the event

Adequate situational support

Adequate coping mechanisms

Resolution of the problem

Equilibrium regained

No crisis

No adequate situational support

No adequate coping mechanisms

Problem unresolved

Disequilibrium continues

crisis

Stressful eventStressful event

CONTINUUM OF CRISIS RESPONSES

After the precipitating event the person’s anxiety rises and four phases of a crisis emerge. In

the first phase the anxiety activates the person’s usual methods of coping. If these do not

bring relief and there is inadequate support, the person moves to the second phase, which

involves more anxiety because coping mechanisms have failed. In the third phase new coping

mechanisms are tried or the threat is redefined so that old ones can work. Resolution of the

problem can occur in this phase. However, if resolution does not occur, the person goes on to

the fourth phase, in which the continuation of severe or panic levels of anxiety may lead to

psychological disorganization.

Predisposing factors: These are the risk factors that influence both the type and amount of

resources the person can elicit to cope with stress. Examples include genetic background,

intelligence, self concept, age, ethnicity, education, gender, belief system, etc.

Precipitating stressors: Stimuli that the person perceives as challenging, threatening, or

demanding and that require excess energy for coping. Examples are life events, injury,

hassles, strains, etc.

Appraisal of stressor: An evaluation of the significance of a stressor for a person’s well-

being, considering the stressor’s meaning, intensity, and importance. For example the

hardiness, perceived seriousness, anxiety, attribution, etc.

Coping resources: It is an evaluation of a person’s coping options and strategies like finances,

social support, ego integrity, etc.

Coping mechanisms: These are the efforts which directed at stress management. Problem

solving abilities, compliance and defence mechanisms are directed towards it.

Continuum of coping responses: A range of adaptive or maladaptive human responses, social

changes, physical symptoms, emotional wellbeing.

THE STUART STRESS ADAPTATION MODEL RELATED TO CRISIS RESPONSE:

CONTINUUM OF CRISIS RESPONSE

PREDISPOSING FACTORS

PRECIPITATING STRESSORS

APPRAISAL OF STRESSOR

COPING RESOURCES

COPING MECHANISMS

CONSTRUCTIVE DESTRUCTIVE

ADAPTIVE RESPONSES MALADAPTIVE RESPONSES

growth Pre-crisis Disorganization

CRISIS INTERVENTION

Individuals experience crises have an urgent need for assistance. Crisis intervention is used to

help the individual or family to understand and cope with the intense feelings. The aim of this

intervention is the resolution of immediate crisis and the restoration of the individual to his

pre crisis level of functioning or possibly to a higher level of functioning.

DEFINITION

“Crisis intervention is an active entering into the life situation of a person, family or group

who is experiencing a crisis, to decrease the impact of crisis event and to assist the individual

to mobilize his resources and regain equilibrium” (Parad et al, 1975)

“Crisis intervention is an active but temporary entry into the life situation of an individual, or

a group during a period of stress” (Mitchell & Resnik, 1981)

Crisis intervention refers to the methods used to offer immediate, short-term help to

individuals who experience an event that produces emotional, mental, physical, and

behavioral distress or problems.

PRINCIPLES OF CRISIS INTERVENTION

1. Urgency: Intervene immediately if the crisis is emotionally traumatizing and can

immobilize the person.

2. Priority: It is to increase stabilization. Crisis intervention occurs at the spur of the

moment and in a variety of respect and settings as trauma can arise instantaneously.

3. Equality: Treat them with dignity, respect and equality during crisis situation.

Consider them as individual human being and respect their emotions.

4. Privacy: Personal information about patient should be kept confidential and should

not reuse or disclose.

5. Be specific: Use concise statements and avoid overwhelming the patient with

irrelevant questions or excessive detail.

6. Calm approach: A calm and controlled presence reassures the person that the nurse

can help and encourage the expression of feelings.

7. Provide understanding: Gather information about what has happened and listen to the

individual, recount the event, and encourage the expression of difficult emotions that

relate to the event. Allow sufficient time for the individual involved to process

information and ask questions.

8. Encourage independent function: Self reliance is ultimately the goal. Assist the person

in confronting reality. Empower them by allowing them to make informed choices

and encourage focusing on one implication at a time. It should emphasis on restoring

their self reliance and ability to cope independently.

TECHNIQUES OF CRISIS INTERVENTION

1. Catharsis: The release of feelings that take place as the patient talks about emotionally

charged areas. Eg: “Tell me about how you have been feeling since you lost your

job”.

2. Clarification: Encouraging the patient to express more clearly the relationship among

certain events. Eg: “ I have noticed that after you have an argument with your

husband you become sick and can’t leave your bed.”

3. Suggestion: Influencing a person to accept an idea or belief, particularly the belief that

the nurse can help and that the person will in time feel better. Eg: “ Many other people

have found it helpful to talk about this and I think you will, too.”

4. Reinforcement of behaviour: Giving the patient positive responses to adaptive

behaviour. Eg: “That’s the first time you were able to defend yourself with your boss,

and it went very well. I am so pleased that you were able to do it.”

5. Support of defences: Encouraging the use of healthy, adaptive defences and

discouraging those that are unhealthy or maladaptive. Eg: “Going for a bicycle ride

when you are so angry was very helpful because when you returned you and your

wife were able to talk things through”.

6. Raising self esteem: Helping the patient regain feelings of self-worth. Eg: “You are a

very strong person to be able to manage the family all this time. I think you will be

able to handle this situation, too.”

7. Exploration of solutions: examining alternative ways of solving the immediate

problem. Eg: “You seem to know many people in the computer field. Could you

contact some of them to see whether they might know of available jobs?”

ROLE OF NURSE IN CRISIS INTERVENTION/STEPS OF CRISIS INTERVENTION

Stuart’s stress adaptation model of psychiatric nursing care explain following steps in crisis

intervention;

Assessment

Diagnosis

Outcome identification

Planning

Implementation

Evaluation.

Assessment:

It is the first step in crisis intervention. At this time data about the nature of the crisis and its

effect on the patient must be collected. The nurse establishes a working relationship with the

patient and perform the following assessments like;

Ask the individual to describe the event that precipitated this crisis

Determine when it occurred

Assess the individual’s physical and mental status

Determine if the individual has experienced this stressor before. If so, what method of

coping was used? Have these methods been tried this time?

If previous coping methods were tried, what was the result?

Assess suicide or homicide potential, plan and means

Assess the adequacy of support systems

Determine level of pre crisis functioning. Assess the usual coping methods, available

support systems, and ability to problem solve.

Diagnosis:

The assessment data are analysed and appropriate nursing diagnoses reflecting the

immediacy of the crisis situation are identified. The common diagnoses are;

o Anxiety

o Fear

o Ineffective individual coping

o Impaired verbal communication

o Powerlessness

o Hopelessness

o Sleep pattern disturbance

o Risk for injury

o Dysfunctional grieving

o Disabled family coping.

Outcome identification:

The outcomes of the intervention have to be determined by the nurse and patient together.

They have to sit together and have to discuss the various aspects of the stress and the needs of

the patient. Based on the conversation final outcomes identify and determines. The most

important thing is the stabilization of the patient. The patient must be the beneficiary for the

interventions. It must help the patient to identify various precipitating factors that threatens

the patient’s health and wellbeing, how to ensure safety of the patient, effective coping

mechanisms that he can use during such situations, how to use such situations for further

development and to ensure social support.

Planning:

In the planning phase, the nurse selects the appropriate nursing actions based on the nursing

diagnoses made and also the specific outcomes identified. The type of crisis, individual’s

strength and weakness and available resources for support are also taken into consideration.

Alternative solutions for the problem are explored, and steps for achieving the solutions are

identified. The expected outcome of nursing care is that the patient will recover from crisis

event and return to pre crisis level of functioning or to a higher than pre crisis level of

functioning.

Interventions:

Nursing interventions can take place on many levels using a variety of techniques. Shields

(1975) represent a hierarchy from the most basic to the most complex levels of interventions.

Each level includes the interventions of the previous level, and the progressive order indicates

that the nurse needs additional knowledge and skill for implementing high level

interventions.

Environmental manipulation:

Environmental manipulation includes interventions that directly change the patient’s

physical or interpersonal situation. These interventions provide situational support or remove

stress. Important elements of this intervention are mobilizing patient’s supporting social

systems and serving as a liaison between the patient and social support agencies. For

example, a patient having difficulty on the job may take one week of sick leave to be

removed temporarily from that stress.

General support:

It includes interventions that convey the feelings that the nurse is on the patient’s side and

will be a helping person. The nurse uses warmth, acceptance, empathy, caring and

reassurance to provide this type of support.

Generic approach:

The generic approach is designed to reach high risk individuals and large groups as quickly

as possible. It applies a specific method to all people faced with a similar type of crisis. The

expected course of the particular type of crisis is studied and mapped out. The intervention is

then set up to ensure that the course of the crisis results in an adaptive response.

Grief is an example of a crisis with a known pattern that can be treated by the generic

approach. Helping the patient to overcome ties to the deceased and find new patterns of

rewarding interaction may effectively resolve the grief. Applying this intervention to people

experiencing grief, especially with a high risk group such as families of disaster victims, is an

example of the generic approach.

Individual approach:

It is a type of crisis intervention similar to the diagnosis and treatment of a specific problem

in a specific patient. The nurse must understand the specific patient characteristics that lead to

the present crisis and must use the intervention that is likely to help the patient develop an

adaptive response to the crisis. This approach is useful in situational and maturational crises

and also in homicidal or suicidal risk. In addition it is applied if the resolution of the crisis

has not been achieved using a generic approach.

Evaluation:

It is the last phase of crisis intervention, when the nurse and the patent evaluate whether the

intervention resulted in a positive resolution of the crisis. Specific questions the nurse might

ask include the following;

Has the expected outcome been achieved, and has the patient returned to the pre crisis

level of functioning?

Have the needs of the patient that were threatened by the event been met?

Have the patient’s symptoms decreased or been resolved?

Does the patient have adequate support systems and coping resources on which to

rely?

Is the patient using constructive coping mechanisms?

Does the patient needs to be referred for additional treatment?

The nurse and the patient should also review the changes that have occurred. If the goals have

not been met, the patient and nurse can return to the first step and continue through the phases

again.

SETTINGS FOR CRISIS INTERVENTION

In hospital settings;

Nurses work in many settings in which they see people in crisis. Hospitalizations are often

stressful for patients and their families and are precipitating causes of crises. The patient who

becomes demanding or withdrawn or the spouse who becomes bothersome to the nursing

staff is a possible candidate for crisis intervention. The diagnosis of an illness, the limitations

imposed on activities and change in body image because of surgery can all be threats that

may precipitate a situational crisis. Simply the stress of being dependent on nurses for care

can precipitate a crisis for the hospitalized patients.

Nurses who work in obstetric, paediatric, geriatric or adolescent settings often observe

patients or family members undergoing maturational crisis. The anxious new mother, the

acting-out adolescent, and the newly retired depressed patient are all possible candidates for

crisis therapy. If physical illness is an added stress during maturational turning points, the

patient is at an even greater risk.

Nurses itself may undergo crisis in their work settings. Increased work load, disharmony

between colleagues, in appropriate behaviour of patients and relatives, humiliation from

authorities, accidental mistakes, etc. may lead to crisis for nurses if effective coping

mechanisms not adopted. So the nurses must be aware about these things and should be

practicing proper coping mechanisms. It help them, identify, if any of their colleagues or

patients undergo crisis and to intervene that.

In Community settings:

Community and home health nurses work with patients in their own environments and can

often spot and intervene in family crises. The child who refuses to go to school, the man who

refuses to learn how to give himself an insulin injection, and the family with a member dying

at home are possible candidates for crisis intervention. Community health nurses are also in

an ideal position to evaluate high risk families such as those with new babies, ill members,

recent deaths, and a history of difficulty coping.

Nurses in community mental health centres, department of psychiatry, managed care clinics,

schools, occupational health centres, and home health agencies also may see patients in crisis

such as those experiencing depression, anxiety, marital conflict, suicidal thoughts, illicit drug

use, and traumatic responses.

Community health nurses also may develop crisis if they are not adequately prepared.

Implementation of new programmes without awareness programme may be a difficult

situation for the nurses. Sometimes counter transference may be stressful phenomena for the

nurses. Unfavourable working conditions, lack of resources, cultural deviations, etc. also may

cause crisis for nurses.

Crisis intervention can be implemented in any setting and should be a competency skill of all

nurses, regardless of speciality area.

MODALITIES OF CRISIS INTERVENTION

Community based crisis intervention modalities have recently been developed. They are

based on the philosophy that the health care team must be active and go out to the patients

rather than wait for the patients to come to them.

A. Mobile crisis programme: Mobile crisis team provide front-line interdisciplinary

crisis intervention to individuals, families and communities. The nurse who is a

member of a mobile crisis team should be able to provide on-site assessment, crisis

management, treatment, referral and educational services to patients, families and

community at large. Nurses are thus able to ensure mental health care for even the

most underserved populations efficiently and cost effectively.

B. Telephone contacts: Crisis intervention is sometimes practiced through telephone

rather than through face-to-face contacts. Individuals use telephone when they are at

the peak of their distress. The nurse must have effective listening skill to provide

crisis intervention to victims. Nurse working for hotline services have extensive

training programs on suicide- potential rating scales, community resources, drug

information, guidelines for helping the caller discuss concerns, and advice on

understanding the limitations of the crisis worker’s role.

C. Group work: People who have common traits on stressors will form a group. The

group provides an opportunity for members to express common concerns and

experiences, foster hope and build mutual support. The nurse’s role in the group is

active, focal and focused on the present. The group follows the nurse’s examples and

uses similar therapeutic techniques.

D. Disaster response: Nurses are called on when an adventitious or social crisis strikes

the community. Floods, earthquakes, airplane crashes, fires, nuclear accidents, etc.

precipitate large number of crises. The nurse has an important role in dealing with

psychosocial problems of victims. The nurse participate in crises operations and acts

as a case finder for persons suffering from psychosocial stress. It is important that

nurses in the immediate post-disaster period go to places where victims are likely to

gather, such as hospitals, shelters, schools, etc. During this period nurse use the

generic approach of crisis intervention so that as many people as possible can receive

help in a short duration of time.

E. Victim outreach programs: It use crisis intervention techniques to identify the needs

of the victims and then to connect them with appropriate referrals and other

resources. Nurses often work in victim outreach programs, where victims are often

seen immediately after the crisis. These victims need thorough evaluation,

empathetic support, and information and help with large system and social

networking system.

F. Crisis intervention centers: It provide emergency psychiatric care and counselling to

victims, experiencing extreme stress or conflict , often involving suicide attempts or

drug or alcohol abuse. These centers provide services 24 hours a day. The services

may be delivered directly on the premises or counselling may be provided directly

over the telephone. The primary objective of crisis intervention centre is to help the

person cope with immediate problem and to offer guidance and support for long-

term therapy.

G. Health education: Nurses are involved in identifying people who are at high risk for

developing crisis and in teaching coping strategies to avoid the development of

crisis. The public also need education so that they can identify those needing crisis

service, be aware of available services, change their attitude so that people will feel

free to seek service and obtain information about how others deal with potential

crisis producing problems.

LEGAL ASPECTS OF CRISIS INTERVENTION

Since 1980, the national crisis prevention institute (NCPI) has trained over 100,000 human

service providers in the technique of non violent crisis intervention. Participants are trained to

recognize an individual in crisis and prevent an emotionally or physically threatening

situation from escalating out of control. Crisis intervention training helps eliminate staff

confusion, develops self- confidence among staff, and promotes team work.

Most people are not required by law to help a person in crisis. However certain individuals

such as police officers, fire fighters, and emergency medical personal are legally responsible

to provide help. In certain states, doctors and nurses are also expected to intervene during an

emergency. Generally these individuals are legally protected as long as they provide

reasonable and prudent care according to a set of previously established criteria, and thus do

not hesitate to aid people who need their help.

The criteria or standards of care for a person providing crisis intervention state that the person

who begins to intervene in a crisis is obligated to continue the intervention unless a more

qualified person relives him or her. Discontinuing care constitutes abandonment, and the care

giver is liable for any damages suffered as a result of the abandonment. Any unauthorized or

unnecessary discussion of the crisis incident by the person intervening is considered a breach

of confidentiality. Touching a crisis victim without the client’s permission could result in a

charge of battery. However, permission can be obtained verbally or by non verbal actions that

express a desire for help. Consent also can be implied. Implied consent is permission to care

for an unconscious crisis victim to preserve life or to prevent further injury. Therefore

“failure to act in a crisis carries a greater legal liability than acting in a favour of the

treatment”.

In cases where a client is injured by the actions of a crisis worker, negligence may be

charged. However, the client must prove that, the worker acted with a blatant disregard for

the standard of care. Usually, the charge is dropped if the caregiver can prove he or she acted

in a prudent and reasonable manner.

PREVENTION OF CRISIS

In modern day concept of prevention has become broad based. Preventive services are

available in four levels. Even though the boundary between these levels cannot be

distinguished accurately, they all have their own importance. They are;

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention.

Primordial prevention: It is primary prevention in its purest sense, that is, it focuses on the

prevention of development of risk factors of crisis in individuals who have no such

experience before. From childhood onwards they are brought up in a healthy environment,

and are educated about positive coping mechanisms. Maintenance of good physical and

mental health also is a part of this prevention.

Primary prevention: Primary prevention is lowering the incidence of a crisis or reducing the

rate at which new cases develop. Primary prevention is often described with such slogans as

“An ounce of prevention is worth a pound of cure”, “Curing is costly; prevention is priceless”

or “prevention is better than cure”. Primary prevention activities mainly focus to help people

to avoid stressors or to keep with them more adaptively and change the environment so that

they no longer cause stress but enhance people’s functioning.

So that primary prevention activities include the identification of predisposing factors like

genetic back ground, intelligence, self concept, age, education, gender, and belief systems

and precipitating stressors like life events, injury, and strains and modification of these

factors to prevent occurrence of a crisis. Assessment of coping resources and coping

mechanisms are also a part of this prevention. Thus the primary prevention can be achieved

through health education, environmental change, and providing social support.

Health education strategy involves the strengthening of individuals and groups through

competency building. A competent individual is aware of resources and alternatives and can

cope adaptively with problems. Such individuals approach difficult tasks as challenges to be

mastered. Health education related to increasing self efficiency includes increasing awareness

of issues and events related to health and illness, increasing understanding of potential

stressors and possible outcomes, increasing knowledge of how to acquire the needed

resources, and increasing actual abilities of individual and group.

Environmental change or modification is appropriate when the environment has placed new

demands on the person and when it provides a diminished level of positive reinforcement.

Environmental changes include change in economic, work, housing, and family situations.

Social support systems can be helpful in emphasising the strengths of individuals and

families and focusing on health rather than illness. The need for social support is influenced

by predisposing factors, the nature of stressors, and the availability of other coping resources.

Secondary prevention: It is the stage of crisis intervention. The goal of crisis intervention is

for the individual to return to a pre-crisis level of functioning. It includes early case findings,

screening, and prompt effective treatment.

Tertiary prevention: These are the activities attempt to reduce the severity and associated

disability through rehabilitative activities. Three interventions use in tertiary prevention to

help people are includes development of their strengths and potential; help them to learn

living skills; and access to environmental supports. Development of strengths and potentials

can help patients develop independent living skills, interpersonal relationships and coping

resources and thus help meet their social needs.

SUMMARY

Crises are precipitated by specific identifiable events and are determined by an individual’s

personal perception of the situation. Crises are acute most of the time rather than chronic and

generally last no more than a few hours to a week. It is more important that ‘how it resolved’

than ‘when it resolved’ as individual adapt adaptive or maladaptive coping mechanisms to

overcome the stressors. So it is the nurse’s responsibility to help the patients to utilize most

appropriate coping mechanism which is useful for his growth. Nurses can face with crisis in

all working situation. Therefore all must aware about it and the methods to handle the

situation effectively

References

1. Townsend M.C. Psychiatric Mental Health Nursing. 5th Edition. Jaypee Brothers

Medical Publishers, New Delhi.

2. Stuart G. W. (2009). Principles And Practice Of Psychiatric Nursing. 9 th Edition.

Elsevier Publishers, Noida.

3. Shives L.R. (2005). Basic Concepts Of Psychiatric Mental Health Nursing. 6 th

Edition. Lippincott Williams & Wilkins Publishers, Newyork.

4. Sreevani R. (2010). A Guide To Mental Health And Psychiatric Nursig. 3 rd Edition.

Jaypee Brothers Medical Publishers, New Delhi.

5. Stuart G.W., Laraia M.T.(2001). Principles And Practice Of Psychiatric Nursing.7 th

Edition. Harcourt (India) Private Limited.

6. Bimala Kapoor (2004). Text Book Of Psychiatric Nursing. 1st Edition. Vol;2. Kumar

Publishing House, New Delhi.

7. Neeraja K.P. (2008). Essentials Of Mental Health And Psychiatric Nursing. 1st

Edition. Jaypee Brothers Medical Publishers, New Delhi.

SEMINAR ON CRISIS AND CRISIS

INTERVENTION

SUBMITTED BY: SUBMITTED TO:

Sr. Bindu Joseph Mrs. Maya B Nair.

IInd Yr MSC Nursing Asst. Professor MIMS Con

MIMS Con, Puthukode