Nursing the adult with acute care needs.

What is the crisis theory? The crisis theory is a psychological theory mainly used in mental health areas but there is now reasoning that it should be used in general nursing in an acute setting. It looks at how people cope with a crisis. There are many definitions of what a crisis is Parbury (1993) defines it as a crisis is generated by a situation which places demands upon a person that exceed that persons available and useable coping resources and capabilities.

There are two types of crisis Maturational crisis which is caused by normal stress of development i.e. puberty, marriage, starting work etc. This is a crisis for some people due to not being able to make the role changes necessary. Situational crisis is caused by a sudden traumatic event which is unavoidable we have no control over what happens. This also could involve losing your role such as a housewife. Mrs. Brown has a situational crisis as she did not expect or plan to have stroke it has also taken away her role as housewife which will mean another change to cope with. Her husband may be having as maturational crisis as he may have to take his wifes role of looking after the house.

There are certain factors which make individuals susceptible to crisis. These factors are: Perception of the event

Coping skills- coping mechanisms

Support systems - situational

Perception of the event helps with how the person will cope. Aguilera (1990) emphasizes that the event must be perceived realistically because a distorted view of a situation creates mounting tension and anxiety. Mr. Brown has an unrealistic perception of his wife's condition which could hinder his problem solving as well as his wife's which could mean it would take a lot longer to reach equilibrium. This would not adhere to Caplans (1964) theory that a person can only be in crisis for 4-6 weeks so this would show his theory as time limiting.

Coping mechanisms are what is needed to be able to cope with stress. Coping mechanisms are psychological methods of coping with stress, they also reflect the positive side of dealing with stress.

Situational supports are our normal social networks from which we receive a sense of security and they provide an important resource for support. These support networks would include family, friends and in hospital nurses and the multi-disciplinary team.

The three things I have just defined are what Caplan (1964) and Aguilera (1990) describe as balancing factors which are critical in determine whether the demands of a stressful event will be met by available resources. If one or more of these balancing factors are missing this may affect the persons ability to resolve the problem meaning there would be a crisis.

There are also phases of crisis which Aguilera and Messick list four develepmental phases

. There is an initial rise in tension as habitual problem solving are tried

2. There is lack of success in coping as the stimulus continues and more dicomfort is felt.

3. A further increase in tension acts as a powerful internal stimulus and mobilizes internal and external resources.

4. If the problem continues and cannot be solved or avoided, tension increases and a major disorganization occurs.

It is important to recognise these phases with people who are in potential crisis as nurses can then intervene to either prevent a crisis or reduce its poptential negative effects.

Mrs. Browns perception is very difficult to ascertain due to communication problems which is frustrating for her and the nursing staff as there is trouble with intervention. However Mrs. Brown does seem to understand her condition in some ways as she knows that she cannot walk. Mr.Browns perception is distorted so this balancing factor is missing so could place him in crisis.

The crisis theory does not just deal with the patient it also looks at the family as they too have to deal with the patients crisis whether it be a terminal diagnosis or whether to place them in a nursing home.

My aspect of nursing care with Mrs. Brown is communication as it is very difficult and frustrating. Communication is the act or action of imparting or transmitting information. Verbal communication is Mrs. Browns problem this has been addressed by giving paper and pen and using body language. Thiis is a crisis for Mrs. Brown in itself as she has gone form normal communication to learning how to communicate again but in a different form. The nursing Staff are having trouble with Mr. Brown as he can not understand why his wife cannot speak to him although he has had it explained many times by nurses and the Doctor looking after her. It has been explained but he seems to be in denial which could impair his coping mechanisims meaning he could go into crisis. Mrs. Brown has two daughters who are coping as they understand their mothers condition and are communicating verbally as well as non-verbally their are trying to help their father cope which is good as this is how support networks should work.

Nurses are often involved with clients in crisis situations as just being hospitalized can be stressful and if this is not recognised by the nursing staff on admission then they could potentially go into crisis.