Crisis Interventions: Aguilera’s (1998) Crisis Theory

Crisis Interventions: Aguilera’s (1998) Crisis Theory

Ana-Maria Brissette

Student ID: 101011107

NURS 1074

George Brown College

Instructors: Brigitte Couture and Patricia Robinson  

Introduction

Hospitalization and critical illness can be causing a situational crisis that develops from an unexpected event (Michalopoulos & Michalopoulos, 2009). A crisis is characterized by an individual not able to utilize the usual methods of coping when dealing with an obstacle, a state of disequilibrium occurring (Woolley, 1990).

Using Aguilera's (1998) crisis model, which is based on the concept that event perception, situational supports, and coping mechanisms are balancing factors that influence equilibrium in a crisis, nursing professionals can recognize and assess behaviors to develop interventions restoring the pre-crisis level of functioning (Chase, 2013).

Emily, who was newly diagnosed with breast cancer is hospitalized for further investigations, is feeling angry, helpless, withdrawn, crying, refusing to eat, and doesn't see the "point" of treatments. She is losing hope of a positive outcome. Her family lives in a different city and is not able to visit her often.

Application of the Crisis model for interventions (Aguilera, 1998)

To determine if a client is in crisis, the healthcare provider could utilize Aguilera's (1998) paradigm to evaluate if all three balancing factors are present or absent. Aguilera (1998) emphasizes that perception of the event, situational support, and coping mechanisms, are influencing elements that restore balance when facing a crisis. This model is a guide to be used by nursing professionals to assess client’s adaptive mechanisms (Aguilera, 1998) and ability to maintain equilibrium, and, if the individual is unable to cope with a stressful event, provide effective interventions (Woolley, 1990).

 First, based on this framework, the nurse evaluates Emily’s perception of the event, how engaged she is in the problem, how she sees her situation, and if it is causing her inability to function properly (Michalopoulos & Michalopoulos, 2009). In this case, the client is confused and angry. She does not see the "point" of the treatments, feels hopeless, and sees her situation as being unsolvable. Her perception of the event is distorted, and the balancing factor is absent. In these cases, the client usually relies on her family as a situational support (Chase, 2013).

As the second balancing factor that is mentioned in Aguilera's (1998) model, situational supports are resources that provide a person with the means to cope with stressful situations. Usually, these are personal relationships with friends and family and professional relationships with healthcare providers (Chase, 2013). Emily is so distraught and angry about her condition that she has isolated herself. She is unable to see the importance of family and professional support. Her difficult situation and lack of meaningful support are the stressors that lead to the crisis, establishing that the second balancing factor is missing in Emily's case (Aguilera, 1998).

Aguilera (1998) considered that coping mechanisms, the third balancing factor, are relevant when crises occur. Coping mechanisms are behaviors and responses that help individuals manage stress (Chase, 2013); they are adjustive mechanisms that are used to maintain emotional stability (Aguilera, 1998). Emily's response to stress is crying, feeling angry and hostile towards nurses, isolating herself, and refusing to eat and talk about her concerns. Her coping mechanisms are destructive; therefore, guidance is needed to help her adopt new effective coping skills (Michalopoulos & Michalopoulos, 2009).

Analysis of the challenges for the client

Hospitalization and critical illness are events that affect the balance of everyday living; they disrupt plans and hopes, and new problems occur and require solutions to be found. Clients who effectively deal with stressful situations are seeking to solve the problem, are not blaming others, and are expressing their feelings and concerns in an open, honest manner. They focus on problem solving and accept help. Those who adopt ineffective coping mechanisms such as withdrawal, repression of the emotional anguish, blaming others, and refusing to accept help are prone to crisis (Michalopoulos & Michalopoulos, 2009).

Emily's perception of the event is affected; she sees her illness as an impediment to continuing her usual activities and a disruption of her future. Being unable to see a solution to her health problems, she lost any hope. Behaviours such as aggression, withdrawal, and denial are common reactions to stressful situations, and these are used by Emily as a defensive mechanism for her situation (Aguilera, 1998). Too distressed to talk to her family and accept support and advice, she isolated herself. Feeling helpless, angry, and scared, she refuses to eat and is verbally aggressive to nurses, refusing everything offered. She is not able to clearly see and adjust to this stressful situation; her defensive mechanisms and support system are missing.

Based on Aguilera's (1998) model, the healthcare provider analyzes the client's behavior and reactions, determines whether they are usual or unusual, evaluates her perception of the problem, and assesses her support system. Having established that all balancing factors are absent, effective crisis interventions are necessary to regain a normal level of functioning (Woolley, 1990)

Intervention

Once it is established that crisis management is necessary, the helper can plan and implement specific interventions to promote emotional balance. A good assessment of the client and her situation is required to develop specific interventions, and using Aguilera's (1998) crisis model can help recognize which balancing factors are absent to address them individually and to regain stability (Woolley, 1990).