User talk:Sb10ok/crisis

Initial critiques and thoughts about the page
Hey guys this is Steph:) Sb10ok (talk) 19:20, 17 September 2014 (UTC) I guess I will start us off! So I noticed that as far as the references go for Personal section, there are no footnotes that are linked with it to show us where they got there information from. I think it would be great if we could try and find a reference for that information. Furthermore, in the "see also" section, they mention the topic of Mid-life crisis, I think it would be good to elaborate on that in the Personal section. Lastly, I find this page quite bland, maybe a few images would make it more captivating. Let me know what you think! (I am manually adding this comment back to the talk page --LynnMcCleary (talk) 12:37, 23 September 2014 (UTC))
 * I agree with Steph, especially about spicing the page up a bit and adding references to make the information credible! I also noticed that the page is primarily about how crises occur, and there really isn't any information on how to cope with them. That being said, I think we should add a whole section about communicating with someone in Crisis, or at least add that information to the Personal Section. In the same section they touch on types of personal crises including medical emergencies or illness related, so I think it would be good to elaborate on that a little bit (because it's relevant to nursing) and then add in the part about how to communicate with someone in crisis! In the See Also section, there is a link to Crisis management but even that page does not mention communication in crisis! We have some work to do here guys!! Jc13ex (talk) 19:40, 17 September 2014 (UTC) (I am manually adding this comment back to the talk page --LynnMcCleary (talk) 12:40, 23 September 2014 (UTC))
 * I think that in order to keep your focus on communication, you might want to steer away from mid-life crisis.--LynnMcCleary (talk) 15:54, 23 September 2014 (UTC)

Hey guys! Sorry I'm so late on this! I`m liking the ideas so far! The points I have are not necessarily problems, but I think that they would improve the page! 1) I feel as though we can add more to the headings under the ``Definition`` (i.e. ```Poverty-Related``, ``Economic``, and ``Environmental``). I think that adding maybe Social, Spiritual and maybe mental or things like that could be beneficial to give readers a few more different types of crisis. 2) I also think that we could explain ``crisis`` relative to different groups of people (i.e. different cultures, age groups, etc.), just to expand on the information!

When I was thinking about these I couldn`t really decide whether they were good or bad ideas, so feel free to give me your thoughts (positive or negative)! :)

Kb14ie (talk) 16:11, 24 September 2014 (UTC)
 * These are relevant to enhancing the article. For your assignment, you'll need to figure out what is needed to make it easy for readers to understand how communication is affected by crisis. It might be that different types of crisis have different effects on communication. That would be worth figuring out - especially if you decide you want to add more examples. --LynnMcCleary (talk) 02:20, 23 September 2014 (UTC)

Group, After reviewing the crisis page on Wikipedia, I have noticed a few things that I liked and a few things that I think we could definitely discuss, and then further make changes to. 1)	What I have noticed about the page is that they briefly state at the beginning that crisis can happen to a single individual, but then throughout the definition part, they do not expand at all. I don’t believe that this is something wrong with the page, however I think that if we add a very brief description into the definition, it will give the reader a better understanding. 2)	In the employment and underemployment section, I feel that the paragraph wasn’t relayed properly as a crisis. When I read it, I did not get the sense of it being a crisis at all, however I feel that we could change the wording a little bit to make it sound more like a crisis. These are just a few things that I noticed. I am interested to see what you guys have to say about it. Ba13qy (talk) 00:50, 18 September 2014 (UTC) — Preceding unsigned comment added by LynnMcCleary (talk • contribs)

Hey guys, So I was thinking that since were are all in the same lab today, maybe we could have a brief 10 minute meeting to put our ideas in order and see where we would like to begin. Sb10ok (talk) 15:33, 23 September 2014 (UTC) Steph!

Early comments from Lynn
This is a decent start for your group. Your group will have to pull together to do some work to get to the point of doing your research for the page. I am available to help with the assignment and Giulia is available to help with the technical aspects of Wikipedia. --LynnMcCleary (talk) 02:19, 23 September 2014 (UTC)
 * Thank you for letting me know about the mix up as you learn editing. I've reinstated earlier comments by Sb10ok and Jc13ex that were inadvertently deleted. LynnMcCleary (talk) 12:52, 23 September 2014 (UTC)

Just a reminder to sign your comments on the talk page. You need to be logged in for the signature to work. I can't grade your participation otherwise. --LynnMcCleary (talk) 02:19, 23 September 2014 (UTC)

For your assessments of the crisis article, focus on content that's relevant to understanding how communication might be affected when a person experiences a crisis. Refer to the good article criteria to support why you think existing content should remain as is or be changed. Your plan will eventually need to include how your edits will be coherent within the existing article. Think about what your group needs to learn before you can make any editing suggestions. You have to start to figure this out so that you can be efficient in your search for credible sources.--LynnMcCleary (talk) 02:19, 23 September 2014 (UTC)

I suggest you also refer to the talk page of the crisis page. I agree with comments there that there is plenty of opportunity for you to enhance the page. --LynnMcCleary (talk) 02:19, 23 September 2014 (UTC)

The group's initial plan for action
Hello everyone! I wanted to start off by mentioning a few things I didn’t say on my initial post. I appreciate the fact that throughout the article, there is a neutral tone. Lets keep it that way ☺. Also, I found that for the most part this article is well written and very to the point. Based on the brief meeting we recently had, I believe that we have come to an understanding on what our main goals are for this article. We would like to make this article a verifiable source by assuring that all the information on here credible. We will do so by adding resources to all information and displaying it with the use of footnotes. Secondly, we want to focus on how the communication between a patient and healthcare providers (specifically nurses) in a crisis can be affected. Lastly, we would like to elaborate on the possible effects of communication for patients coping with these types of circumstances. So I guess our next step will be to get informed! Let me know your thoughts Sb10ok (talk) 22:02, 24 September 2014 (UTC) Steph!
 * So just to sum up, our edits, as agreed on today, will include:

On that note, we can even go deeper with #3 and talk about how someone who has experienced crisis directly (e.g. illness) is affected compared to someone who is not directly experiencing crisis (e.g. family) because they feel it too, but maybe not in the same way - I think that would be interesting to research and further elaborate on. What do you guys think about that? Jessie 00:01, 25 September 2014 (UTC) — Preceding unsigned comment added by Jc13ex (talk • contribs)
 * 1) fixing up the references so that everything that was previously uncited has a citation
 * 2) add information on how to communicate with someone in crisis (from a nurse's point of view)
 * 3) add information on how crisis affects someone's communication

Steph and Jessie, I really like the sounds of all of those ideas, especially the one about going a step further and discussing how crisis affects both the family and the person going through it. Also, when reading the page I found that it was very undescriptive. I feel that once we get going on references, communication, and the specific topic of crisis, we should look at potentially modifying the current information so that the reader has a better image in their head. That way we are taking both a non verbal and verbal approach. How does everyone feel about that? I feel that this page could be changed a lot and we as a group could make it a whole lot better just focusing on these small portions. Ba13qy (talk) 00:22, 25 September 2014 (UTC)

Hey guys! I really like the ideas going here! I agree on focusing on the communication aspect of crisis! I think we have a pretty good start. I just took another look at the page and I find that it looks relatively bland. I was thinking maybe we could add a picture or two when we add our section on how to communicate with a person in a crisis! Maybe we could also add something on what is actually considered a crisis to a nurse too. Let me know what you guys think! Kb14ie (talk) 00:24, 26 September 2014 (UTC)

Professor advice about summaries and collaboration
Sb10ok, talk, Kb14ie, and Ba13qy  you have a lot of information. I know that some of you will be looking for secondary sources to replace the primary sources you found. I recommend textbooks – parts of textbooks really. Mental health nursing textbooks, social work textbooks, and mental health textbooks should have relevant information. Books about crisis intervention would also be relevant but you’d have to be careful about getting overwhelmed. I noticed a couple of books on a google book search that had information about Roberts seven stage crisis intervention model (that I hadn’t heard of before) that seemed to be relevant for you.

I have some suggestions for you for your next steps – to help you keep your work manageable and within the scope of this assignment. You have the potential to get overwhelmed by the amount of information that you have.

See the course page for information about your tasks due October 22.

As you're summarizing relevant information from your sources, keep your focus on what you could add to the crisis article about communication. You will come across irrelevant information. Don't let yourself get side tracked by it (if you want you can keep it in mind to make additional editing suggestions but keeping focused will help you keep the scope of this assignment reasonable). Thinking about the communication model we learned about the first week of class might help you focus and organize your information. Your summaries should be between 250 and at most 400 words for each source. Try not to make them long. If there aren’t 250 words worth of information in your source, don't blather on to fill space. I am looking for summaries I can understand and that are logical and coherent. You'll need to really focus in on the heart of the relevant findings. You should be aiming to tell your group members what the key messages are in your sources and how you think the information fits or doesn't fit with the article (it's okay if you logically determine that it wouldn't add to the article). If there is repetition within your sources, you should note that. Each summary should have a citation that is acceptable for Wikipedia and that has the information needed for a reader to verify your interpretation by finding your source. Links that only work within the university aren’t user friendly for me or your group members. If there is information that you can’t paraphrase, indicate quotes with quotation marks and page numbers.

When you've got your summaries done, hopefully there will be some themes and repetition among your summaries. Your job then is to collaboratively decide on what deserves to be suggested as an edit for the article and craft summaries of what your group found that could be incorporated in the article. That might be citations for information that is already there or new information. Discuss why your new information is relevant to the article.

I can copy the crisis article over to your sandbox so you can practice editing before you make any suggestions to the editors of the article. If you want me to do that, let me know by email or by using my user name in a response to this post. As always, I'm available to guide you.

For your discussion, try to use conversation threads to help you organize and keep track. You may also need some headings. Don't forget to sign your posts. I look up your contributions by user name for grading. If you don't sign your posts, you won't get credit for them when I'm grading.LynnMcCleary (talk) 02:15, 9 October 2014 (UTC)

Article Summaries
Jessie's Sources

I switched out my primary source with an article titled 'Crisis Intervention' from the RNAO. I also decided that the textbook 'Patient & Person' would not be as relevant as another article that I found titled 'Conflict and Crisis Communication', so my sources are more based on crisis intervention models now. Anyway, here are my summaries of them!

Registered Nurses’ Association of Ontario. (2006). Crisis intervention. Toronto, ON: Registered Nurses’ Association of Ontario.

The Registered Nurses' Association of Ontario defines crisis intervention as "a process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources" (RNAO, 2006). The goal of crisis intervention is for the person in crisis to return to a state of normal or higher functioning (a pre-crisis state). A crisis can either be seen as a danger to an individual, in which case they would use defence mechanisms to come out of the crisis state, or as an opportunity, in which case they can grow by developing new coping mechanisms. The RNAO established recommendations for nursing practice in crisis situations, which consist of the following:
 * 1) Crisis intervention is founded on a particular set of values and beliefs, and guiding principles
 * 2) Knowledge of three core components of crisis intervention theory (to identify people in crisis): an event that triggered crisis, the individual's perception of the event, and their usual coping mechanisms
 * 3) Delivery of crisis intervention is based on an integrative framework: develop rapport and maintain contact, identify the problem and explore coping mechanisms/develop a plan of action or intervention
 * 4) A wide range of therapeutic communication skills is used for effective intervention
 * 5) Be involved in all aspects of intervention

The ABC model of crisis intervention consists of:
 * A - basic attending skills (making the person comfortable, remaining calm, etc.)
 * B - identifying the problem and therapeutic interaction (explore their perceptions, identify sources of emotional distress, identify impairments in behavioural functioning, use therapeutic interactions)
 * C - coping (identify coping attempts, present alternative coping strategies, follow up post-crisis)

(I omitted some recommendations, including the recommendations for education and recommendations for policy and organization as they are not as relevant to the topic)

Vecchi, G. M. (2009). Conflict and crisis communication. Annals of the American Psychotherapy Association, 12(2), 32-29.

Vecchi emphasizes the difference between someone in conflict and someone in crisis. A person in conflict is often rational and goal-oriented, and are interested in talking to someone (the communicator). Someone experiencing a crisis displays irrational thinking, unclear motives and resists communication. The focus in a crisis situation is on expressive and identity needs, such as expressing emotions or saving face. In a crisis, the person is beyond their ability to cope. Thus, it is vital that the communicator builds a trusting interpersonal relationship with the person in crisis. The goal of the communicator is to influence the person to change, rather than force them to.

The Behavioural Influence Stairway Model, as proposed by Vecchi as a crisis intervention model, involves four stages:
 * 1) Active listening: Active listening is important because the person in crisis wants to be heard and understood, so it is important for the communicator to develop a relationship and create an environment for the person to do so comfortably. The core group elements of active listening consist of mirroring, paraphrasing, emotion labelling and summarizing. The supplementary elements consist of effective pauses, open-ended qustions, minimal encouragement and "I" statements.
 * 2) Empathy: Empathy is a natural byproduct of active listening. It involved identifying with and understanding the person in crisis's situation and feelings. Empathy is used to see the situation from the point of view of the person in crisis. At this stage, tone of voice is very important because the communicator wants to distinguish empathy from sympathy (pity).
 * 3) Rapport: Up to this point, the person in crisis has done the talking and the communicator has actively listened and empathized. Next, a relationship built on trust and mutual affinity is developed so that the person in crisis is open to listen to the communicator. The communicator can then talk about precursors to end the crisis (themes, defence mechanisms, minimizations, blend concepts)
 * 4) Influence: The goal of this stage is to produce an effect without forcing the person in crisis. They should be ready at this point in the relationship to accept suggestions from the communicator and work together to identify solutions. However, if the communicator moves too quickly through previous stages, it is difficult to reach this stage in the relationship.

An important concept in this model is verbal containment, which consists of making contact with the person in crisis as soon as possible, and to keep them engaged. This is to occupy them so they cannot hurt themselves, as well as keeping them talking so that they can provide more information and it is easier to make decisions. It helps the communicator to assess the needs of the individual, reduce their anxiety, develop a positive relationship and reduce their expectations.

Woolley, N. (1990). Crisis theory: A paradigm of effective intervention with families of critically ill people. Journal of Advanced Nursing, 15(12), 1402-1408. doi:10.1111/1365-2648.ep8529911

The crisis theory puts emphasis on the family of the individual in crisis, rather than the patient themselves. A crisis event can either be viewed as a danger, having negative effects on mental health, or as an opportunity, in which the individual is more open to therapeutic intervention. (This concept is similar to the RNAO's view of crisis as threat/opportunity)

The state of the ego is one of the most important determinants of mental health. To balance the demands and pressures coming from internally and externally, the ego uses a process of emotional equilibrium called synthesis. In crisis, disequilibrium can occur, at which point the individual needs a coping mechanism to deal with it. To assist individuals in regaining emotional equilibrium, intervention is used. The overall goal of a crisis intervention is to get the individual back to a pre-crisis level of functioning or higher.

The steps of crisis intervention, as defined by Woolley (1990) are:
 * Assess the situation based on behaviour patterns of the individual
 * Decide what type of help is needed (make a plan of action)
 * Take action/intervention, based on the individual's skills to regain equilibrium

Family members tend to start the grieving process in advance, which is called anticipatory grieving. Their needs are subdivided into four categories:
 * 1) Initial anxieties and informational concerns - shock and confusion are common emotions
 * 2) Emotional support and interfamily contact - many people look towards their significant others in times of crisis for support; families are often reluctant to discuss the situation with people outside of the immediate carers/family; tension can be reduced by allowing them to express their feelings (emotional catharsis)
 * 3) Involvement with care/intervention - once the individual is in a stable condition, the family should be given the opportunity to take a part in their care, which builds trust between the carer/communicator and the family
 * 4) Personal needs - hunger, thirst, etc.

Jc13ex (talk) 02:56, 15 October 2014 (UTC)

Steph's Sources

Source 1

Title: Nursing Best Practice Guideline: Shaping the future of Nursing, (Electronic book). Appendix C- - Assessment of coping skills and support systems. (PAGE 53). Executive Director: Doris Grispun, RN, MScN, PhD. Date: August 2002.

The reality is that clients deal with crises in various ways and communicate their emotions both verbally and non-verbally subsequently. Thus, this leads them to act out in certain manners such as: withdrawing themselves, crying, physically acting out their distress, using defense mechanisms, putting things on hold, making rash decisions without coming up with a solution, etc. Furthermore, in some severe cases, clients can have more of a difficulty adapting to a crisis and can have a harder time controlling their emotions. In these situations, suicidal, alcoholic or drug tendencies, troubles with the law and avoidance of utilizing helping resources can come into play.

Some great questions to help assess the ability of a client to cope can be with the use of the following questions:
 * 1.	What did the client turn to help manage stressful situations in the past?
 * 2.	Are there specific things that helped or disproved the client’s ability to cope in the past situations?
 * 3.	How well can the person deal with these issues now?

Support systems are a big part of the coping process but, can also be the cause of the crisis itself. It has been found that 2/3 of mental health crises have been caused by the said social system. These types of mental health crises can include: marital issues, divorce, abandonment or other conflicts with parents, family struggles, etc. It is essential that these social systems be accessible for these people in a crisis. Good communication with a strong support system is a key component to the success of a client resolution of a crisis. Though, it is also important not to assume automatically that family are a client’s support system, they could seek the same support from elsewhere.

Source 2

Title: Effective crisis management. Author: Saxton, Louise. Date: November 2013. Source: Practice Nurse;11/15/2013, Vol. 43 Issue 11, p31

Regardless of how subtle or severe the client’s crisis is, it is essential for all members of the health care team to be keep good communication and know what is happening at all times. It is important for someone in crisis to communicate how they’re feeling and to discuss any changes in their moods. Ideally, this assessment would be taken in a calm area that would make the client able to focus on their symptoms.

The clients will be communicating with the health care team both verbally and non-verbally and it is essential for the professionals to do the same. Ways that a nurse for instance could effectively verbally communicate with a client in crisis are by doing the following.

Verbal communication:
 * •	Introducing yourself and letting the client know why you’re there.
 * •	Offering comfort and specify that you are there to help.
 * •	Be respectful and ask how they would like to be addressed.
 * •	Use a soothing voice that keeps communication clear and simple.
 * •	Always stay calm and be alert for coworkers in the area.
 * •	If there are concerns of safety with being alone with the client, ask a coworker to assist.
 * •	Try not to be condescending or authoritative with client.

Non-verbal communication:
 * •	Keeping a calm and open posture by relaxing your shoulders and keeping the arms down and hands open outwards.
 * •	Avoid getting to close into the client’s personal space.
 * •	Try not to duplicate any negative body language that the client may be exhibiting.
 * •	Prevent from making threatening gestures like pointing, crossing of the arms and putting your hands on your hips
 * •	Don’t smile visibly when a client is having delusional or hallucinations because it could very well be misjudged.
 * •	Try keeping client and yourself in an open area.
 * •	Judge the arrangement of the environment.

Source 3

This is a New source that I found that I think explains quite clearly the various phases of a client that is going through a mental health crisis :)

Mental Health Crisis Management, Wild Iris Medical Education, Inc, Judith Swan, MSN,RN & Persis Mary Hamilton, EdD, MS, RN, CNS http://www.nursingceu.com/courses/468/index_nceu.html#top

There are said to be three phases of a mental health crisis:


 * 1.	Initial threat or triggering event: Individuals are presented with the issue. In order to cope with this new situation, they use different types of defense mechanisms; these could include: compensation, rationalization ;and denial. If the issue halts at this point and the problem is resolved then there wont be a crisis.
 * 2.	Escalation: when initial threat continues and the defense mechanisms begins to fail, the level of anxiety that an individual may face could become severe and cause some serious distress. At the level of escalation, ;clients often become disorganized and have difficulty performing normal functions including: thinking, sleeping and functioning. Trying new mechanisms are started to see if the problem can be solved to try and ;reestablish emotional balance.
 * 3.	Crisis: Once the attempts have been made to find new mechanisms to cope with, and the situation fails again; the anxiety level of the client deepens. At this point, individuals typically panic and either chose to fight ;or flight. Possible resolutions at this point on could be to look at the issue from another perspective and rethink the solution.
 * 4.	Personality disorganization: Once all new perspectives and mechanisms have proven to be inadequate, the anxiety of the client may lead them to serious life ineffectiveness. Signs of confusion, depression, suicide ;and the violence towards others or themselves could be occurring.

In a mental health crisis, specific aspects significantly affect the emotional balance of clients. The perception is how a person sees the importance of specific parts of their lives such as: health, job, financial status and overall reputation. Furthermore, another aspect that strongly influences a client emotional balance is the trust in their support system in helping them throughout their crisis. Lastly, an individuals coping mechanisms are aspects that reduce anxiety and aids them to solve their problems; examples of these methods include: sleep, rejection, physical exercise, meditation and thinking Sb10ok (talk) 19:47, 19 October 2014 (UTC)

Kwaku's Sources I changed all my sources as the last ones were not very relevant to what we were trying to ahcieve.

Source 1 Chapter 3 of Lanceley, F. J. (2003). On-Scene Guide for Crisis Negotiators, Second Edition (2nd ed.). London: CRC Press.

In this chapter, crisis is defined as any situation where one's ability to cope is exceeded. People in crisis are controlled by their emotions and how they feel and thus do not reason very well. It describes that one in crisis does not just "snap", rather there is a psychological build-up of pain and stress that they could not normally relieve through their usual or any other regular coping mechanism. In order to relive stress, the patient may engage in many different types of behaviours. These behaviours are sometimes self-destructive. Crisis affects a patient in many ways. In order to detect crisis in a patient, must be familiar with the changes in an individual. Some of these ways include: Crisis intervention is defined as an assortment of techniques intended to return individual to normal functioning level and get him past possibly dangerous impulses. Kb14ie (talk) 00:31, 22 October 2014 (UTC)
 * 1) 1 Patient may experience increasingly constricted and narrow thinking and emotions.
 * 2) 2 Patient may have a lowered attention span and may not be able to decipher the difference between big problems and small problems.
 * 3) 3 Patient may have disorganized approach to problem solving.
 * 4) 4 Often those in a crisis may begin to change or alter their social networks (ie repair old relationships)

Source 2 Chapter 5 of Stiefel, F. C. (2006). Communication in cancer care. New York: Springer.


 * Good communication is crucial to palliative care. It can lead to a greater sense of well-being and can decrease feelings of distress commonly experienced by those diagnosed with terminal illness and their families. Psychological and psychiatric morbility are common problems for cancer patients as 25-50% of them suffer from psychological distress. Effective communication with the health professionals can help patient and the family of the patient with this distress.
 * Good communication is important for for many things in a health care setting. These include: understanding disease, outcomes patient behaviour, ability to cope, psychiatric and psychological health, as well as patients satisfaction of care, and compliance with treatment. It is also good to communicate as patients like to be part of the decision making process and they normally want more information to be shared with their relatives.
 * As time goes on and the disease becomes worse, communication becomes more difficult. Even though it may be difficult, health professionals should not avoid open communication. They should provide honest information and use appropriate language. It also important that the health professional pays attention to not only their verbal communication but also their non-verbal communication.

Kb14ie (talk) 00:31, 22 October 2014 (UTC)

Source 3 Chapter 4 from Lanceley, F. J. (2003). On-Scene Guide for Crisis Negotiators, Second Edition (2nd ed.).


 * Active listening is defined as seeing circumstance from another's perspective and letting the other person know that the negotiator understands their perspective. Active listening is particularly effective when used by negotiators as many of the patients have never had anyone truly listen to what they are saying.
 * Listening is a very powerful tool that is not difficult to use. The negotiator does not have to work very hard, just closely listen to what is being said. Negotiators are often heard to "talk the subject out" which is a large burden for many reasons and becomes ineffective as the patient begins to feel as though negotiator is more wise than they. The primary skill of a good negotiator is listening and not "sweet talking". Through this they an build the trust and rapport by demonstrating empathy, understanding and objectivity.
 * Negotiators are not to make any assumptions as to how the the person feels about a situation. Values influence what people think is important and thus behaviours. Subject's (patient's) values and expectations will often be different than the negotiator's and thus negotiator's should have a non judgmental attitude.
 * An important aspect of listening is that negotiator demonstrates that they are listening and tuned in. Negotiators also much listen to the emotional reactions from patient as well. Emotional labelling -first active listening skill to be used as an incident- demonstrates that the negotiator is tuned in emotionally and experiencing it (i.e. "you sound angry"). A negotiator should label every emotion that they notice. There are other techniques negotiators can use to show that they are actively listening such as paraphrasing and reflecting/mirroring -repeating last word or phrase subject said and putting question mark behind it. Negotiators can also use silence as one of their tools to build rapport and encourage patient to keep talking. Kb14ie (talk) 00:31, 22 October 2014 (UTC)

Bradys Summaries

Hello all. I have read my 3 sources, also making the chance from a primary source to a secondary source and here are my summaries for discussion!

Source #1 Title: Mental Health Crisis services: What do service users need when in crisis? Journal of Mental Health (J MENT HEALTH), 2009 Apr; 18 (2): 99-110. (17 ref). Research can be shown that people in crisis do not always like to be hospitalized when they are dealing with a crisis because it may not benefit them. There is a general belief that people would like to have a crisis residential center where they can still be treated for the crisis that they are going through, however they don't feel like they are stuck in a hospital, they are given some freedom to do the things that they want. The study that was done expressed that 85% of people agreed to the fact that some people do not need to be in a hospital setting to get care

Source #2 Title: Communication Breakdown Author: Rosso, Anne Source: Collector. Sept 2014, vol 80 issue 2, p36-40 Being a manager of being in a positon that requires you to communicate with people all the time, it is important to have good communication skills. Some people can be good at what they do, but due to not having good communication skills, they struggle to keep a good relation with their workers. This article identifies 3 reasons why people fair to communicate the message they want to get across; 1)	Perception: Not giving the person who is speaking any attention 2)	Lack of relationship: Workers do not like bosses that only approach them when they feel they have to. Need to have a relationship with your co-workers 3)	Lack of confidence: People are afraid to make mistakes but what they do not realize is that putting themselves out there and taking chances will create better relationships People usually fall into two listening categories; 1)	Inductive: Details first and then point 2)	Deductive: Point and then detail if there is time Bosses, managers, or people that have a profession with dealing with people all of the time, it is important that they are credible, they build and maintain relationships, and if there is a time for criticism, they deliver it in a professional way.

Source #3 Nursing Management. Nov2003, Vol. 34 Issue 11, p4-4. 1p. This source is very brief and does not leave a lot of room for summarizing, however there are a couple good points that stand out which I believe will help us realize how important our communication skills are to patients and to the profession of nursing The article discusses that as nurses, we are subscripted to doing things a certain way, and following a certain procedure while working. From a patients perspective, it is important to them that we follow this script and put things in the correct place to help the patient. Saying such things to the patient as, “I am here for the benefit of you, and if there is anything that you need, feel free to ask.” This puts the patient in a very good position so that they know they are being taken care of. From a nursing standpoint, communication is huge and this article states that it is important to always put the right foot forward when dealing with a patient. Small things such as saying to the patient, “Is there anything else that I can help you with while I am here?” can make a huge difference in the patient, and within the stress of the nurse.

Ba13qy (talk) 05:10, 20 October 2014 (UTC)

Discussion
So based on what we have so far between Steph and I, it looks like we have a pretty good basis of information on the process of someone going through a crisis, and different ways that family members/health care professionals/other people can help them cope with it. I think the important thing when we decide what information to post on the crisis page is to make sure our information is applicable to the general public. So although we are basing a lot of this stuff on nursing theory and the professional relationship between the nurse and client, we should make sure that people who are dealing with a family member in crisis, etc. are able to apply the knowledge the same way as professionals in a clinical setting. Jc13ex (talk) 20:10, 19 October 2014 (UTC)


 * Great point Jessie, I think that it will be very important for us to keep in mind that most of the people that will be viewing this crisis page will either be in a crisis themselves and looking for suggestions on how to deal with their situation or others could potentially be looking for some information on how to help someone that is in a crisis. Having read through all of our summaries, I have seen a few common themes including: defense mechanisms, communication and coping, which is what I think our main focus will be on. Furthermore, I'd like to specifically point out that Kwaku's third article summary on Active listening for me really stood out. I think its important to focus on that aspect as well, especially for the people who will be using this page to try and help someone in a crisis. We will have a lot of sorting to do to see what aspects of all of our articles we want to keep to put on the actual page. I look forward to hearing from you guys! Sb10ok (talk) 21:22, 20 October 2014 (UTC)


 * I like that! We could go in a direction along the lines of "What to look for in a person in crisis" and then "how to deal with it". Let me know what you guys think about that! It's definitely going to be difficult to sort through everything and find the most important parts so let's stick to common themes (like Steph said) and concepts that are easy for regular people reading the page to understand and apply to their own situations. Jc13ex (talk) 21:29, 20 October 2014 (UTC)


 * I like Jessie's idea of producing information relevant to those who are actually in a crisis! Having said this I like her third source as it focuses of the family going through the crisis rather than the patient as most other sources tend to do! It is a good source to broaden the information that we will be putting up! I also like Steph's source regarding mental health crisis! It provides us with another angle to look at what a crisis is from another perspective! Brady's second source is great as well as it regards a situation many of us are familiar with - communication of our managers. I feel as though this one is very relatable and thus is a great contribution to our page. Keep up the good work guys! These are all good sources for those in a crisis!

Kb14ie (talk) 00:31, 22 October 2014 (UTC)

Group, I am really liking all of the sources that I am reading and the ideas we are going with. I have not switched out the duplicate that Steph and I have, however I will do that tomorrow. Having said that, I think that we really need to take a good look and use a good chunk of the information from that source because I feel that it really relates to what we are trying to do. I do 100% agree with Kwaku on Jessie's 3rd source as it is very important to look at the family, not just the patient. I think that we have many good points here and you guys have brought up most of them. However, Kwakus 3rd source touches on how active listening is so important to all communication, but I believe we can easily relate this back to the topic of crisis. Ba13qy (talk) 02:57, 22 October 2014 (UTC)

So here are my suggestions on where we should go from here:
 * I believe we should take Jessie's suggestion and create a new subtopic that specifically addresses "ways to manage crisis" and in here we can focus on ways that family members or people themselves could go about coping with their situations. We could in here also take kwaku's second source's information on the importance of listening and Jessie's third article summary that talks about family going through the crisis.
 * Secondly, I think we could embellish the definition section by adding the steps of crisis and other little bits of our summaries that could apply and be relevant.
 * Lastly, I believe that we could add to the Personal section the bit about mental health communication.

We just need to keep in mind that we want to make this page as useful and as credible as possible. Additionally, we should remember that are main focus is on the communication aspect of a crisis. Does anyone have anything else to add? Sb10ok (talk) 00:02, 23 October 2014 (UTC)

Steph, I really like where you are going with all of that. I think that we need to start with a general basis and then go into detail as much as we can, starting with Kwaku's second source and Jessie's third source. Also, I added another source which we could get some information from, but I really believe that Stephs source on effective communication is going to be where we get most of our detailed information. Ba13qy (talk) 01:01, 23 October 2014 (UTC)


 * I like the sound of all this guys! It's starting to come together which is awesome. I just want to make sure that if we are using my source about the family members, we definitely need to supplement that with information on how to actually help the family members through it, because it is their personal crisis as well. That article really just touches on what the family members go through, so we should take it further and say "This is what they need, and as a carer, this is how you provide it" which is along the lines of the direction we are heading anyway. I also agree that we should include Kwaku's source about active listening because that is pretty much the basis of helping someone in crisis. Great ideas everyone!!! Jc13ex (talk) 22:58, 23 October 2014 (UTC)

Article Edits
Hey guys, I've copied the Definition and Personal sections of the crisis page so we can make our edits then move them to the sandbox of the actual page! Not sure if we want to edit the Definition section or not so it's in here anyway just in case we want to supplement what is already there to expand the scope of the definition :) Jc13ex (talk) 23:27, 2 November 2014 (UTC)

Definition

A crisis is any situation in which the ability for one to cope is exceeded (Lancely, 2003). To be in a crisis means that the situation cannot be dealt with by an individual or a group's regular coping methods because the problem is out of the normal scope of a given system. Due to this, one may develop, or attempt to develop, new coping mechanisms - which can be positive or negative. When one is in a place that is considered to be crisis setting, it is much more likely for them to be guided by emotional instincts rather than logic and reasoning. Emotional instincts tend to lead to irrational decisions which may not only affect the individual, but also anybody in their surrounding environment. This is why it is more desirable that it is detected early when one is in a crisis situation (such as lowered attention span). There are many ways by which crisis can be detected. One may undergo many behavioral and other changes due to their inability to cope with the crisis. [THESE ARE OUTLINED IN "PERSONAL" HEADING] Kb14ie (talk) 03:58, 3 November 2014 (UTC)

Crisis has several defining characteristics. Seeger, Sellnow, and Ulmer[2] say that crises have four defining characteristics that are "specific, unexpected, and non-routine events (or series of events) that [create] high levels of uncertainty and is a threat or a perceived threat to an organization's high priority goals." Thus the first three characteristics are that the event is:
 * 1) Unexpected (i.e., a surprise)
 * 2) Creates uncertainty
 * 3) Is seen as a threat to important goals

Venette[3] argues that "crisis is a process of transformation where the old system can no longer be maintained." Therefore the fourth defining quality is: the need for change. If change is not needed, the event could more accurately be described as a failure.

Apart from natural crises that are inherently unpredictable (volcanic eruptions, tsunami etc.) most of the crises that we face are human-created. Hence, the criteria of their being 'unexpected' depends upon failure to notice the onset of crisis conditions. Some of our inability to recognize crises before they become dangerous is due to denial and other psychological responses [4] that provide succour and protection for our emotions.

A different set of reasons for failing to notice the onset of crises is that we allow ourselves to believe that we are doing something for reasons that are false. In other words, we are doing the wrong things for the right reasons. For example, we might believe that we are solving the threats of climate change by engaging in economic trading activity that has no real impact on the climate. Mitroff and Silvers [5] posit two reasons for these mistakes, which they classify as Type 3 (inadvertent) and Type 4 (deliberate) errors. The effect of our inability to attend to the likely results of our actions can result in crisis.

From this perspective we might usefully learn that failing to understand the real causes of our difficulties is likely to lead to repeated downstream 'blowback'. Where states are concerned, Michael Brecher, based on case studies of the International Crisis Behavior (ICB) project, suggested a different way of defining crisis as conditions are perceptions held by the highest level decision-makers of the actor concerned:[6]


 * 1) threat to basic values, with a simultaneous or subsequent
 * 2) high probability of involvement in military hostilities, and the awareness of
 * 3) finite time for response to the external value threat

Personal

A personal crisis occurs when an individual's ability to cope is exceeded (Lancely, 2003).

[This is preceded by events of an extraordinary nature triggering extreme tension and stress within an individual, i.e., the crisis, which then requires major decisions or actions to resolve. Crises can be triggered by a wide range of situations including but not limited to extreme weather conditions, sudden change in employment/financial state, medical emergencies, long-term illness, and social or familial turmoil. Crises are simply a change in the events that comprise the day-to-day life of a person and those in their close circle, such as the loss of a job, extreme financial hardship, substance addiction/abuse and other situations that are life altering and require action that is outside the "normal" daily routine.]

The information in the square brackets needs to be cited!

Additions Jc13ex (talk) 02:24, 3 November 2014 (UTC)

A person going through a crisis experiences a state of mental disequilibrium, in which the ego struggles to balance both internal and external demands (Woolley, 1990). In this case, said person resorts to coping mechanisms to deal with the stress. Various coping mechanisms include (Nursing Best Practice Guideline):
 * High emotions (crying, physical withdrawal)
 * Defence mechanisms (denial, repression)
 * Making rash decisions
 * Acting out
 * Putting things on hold

In some cases, it is difficult for an individual undergoing a crisis to adapt to the situation. As it is outside of their normal range of functioning, it is common to see a struggle to control emotions. This lack of control can lead to suicidal tendencies, substance abuse, trouble with the law and general avoidance of resources available for help.

One such resource used to aid an individual in crisis is a social support system, which can come in the form of family, friends, coworkers, or health professionals. It is important that a support system consists of people that the individual trusts. Although these support systems play a crucial role in aiding an individual through a crisis, they are also the underlying cause of two thirds of mental health crises (Nursing Best Practice Guideline). The aforementioned mental health crises can include marital issues, abandonment, parental conflict and family struggles.

In order to aid someone in crisis, it is crucial to be able to identify the signs that indicate they are undergoing an internal conflict. These signs, as well as the aforementioned coping mechanisms, include (Vecchi, 2009); (Lancely, 2003):
 * Irrational and/or narrow thinking
 * Lowered attention span
 * Unclear motives
 * Disorganized approach to problem solving
 * Resistance to communication
 * Inability to differ between large and small issues
 * Change/alteration to social networks

Ways to Manage a Crisis (we could also call this subheading "Crisis Intervention" ... thoughts? Jc13ex (talk) 02:25, 3 November 2014 (UTC)


 * I think "Ways to Manage a Crisis" is a lot broader which would leave it more open for others to add more information, however, using "Crisis Intervention" will allow us to put more specific information out there and would probably be a lot more helpful to those in need.

Kb14ie (talk) 04:01, 3 November 2014 (UTC)

Stephs addition

References Folks, based on the changes that you have made, along with the new sources that we have used, there were 5 new ressourses that were used. They include: Chapter 4 from Lanceley, F. J. (2003). On-Scene Guide for Crisis Negotiators, Second Edition (2nd ed.).

Chapter 3 of Lanceley, F. J. (2003). On-Scene Guide for Crisis Negotiators, Second Edition (2nd ed.). London: CRC Press

Woolley, N. (1990). Crisis theory: A paradigm of effective intervention with families of critically ill people. Journal of Advanced Nursing, 15(12), 1402-1408. doi:10.1111/1365-2648.ep8529911

Vecchi, G. M. (2009). Conflict and crisis communication. Annals of the American Psychotherapy Association, 12(2), 32-29.

The Registered Nurses’ Association of Ontario (2006)

Ba13qy (talk) 02:33, 5 November 2014 (UTC)

Ways to Manage a Crisis
In crisis, disequilibrium can occur which is when the individual needs a coping mechanism to deal with the situation. Such coping mechanisms can include: sleep, rejection, physical exercise, meditation and thinking (Judith Swan, MSN,RN). To assist individuals in regaining emotional equilibrium, intervention can be used. The overall goal of a crisis intervention is to get the individual back to a pre-crisis level of functioning or higher with the help of a social support group. As said by Judith Swan, there's a strong correlation between the client's emotional balance and the trust in their support system in helping them throughout their crisis. The steps of crisis intervention, as defined by Woolley (1990) are: to assess the situation based on behaviour patterns of the individual, decide what type of help is needed (make a plan of action) and finally to take action/intervention, based on the individual's skills to regain equilibrium.

The Registered Nurses’ Association of Ontario (2006) proposed the ABC model for dealing with client’s interventions in crises.
 * A - Basic attending skills (making the person comfortable, remaining calm, etc.)
 * B - Identifying the problem and therapeutic interaction (explore their perceptions, identify sources of emotional distress, identify impairments in behavioural functioning, use therapeutic interactions)
 * C - Coping (identify coping attempts, present alternative coping strategies, follow up post-crisis)

Moreover, another method for helping individuals who are suffering in a crisis is active listening; it is defined as seeing circumstances from another perspective and letting the other person know that the negotiator (the helper) understands their perspective. Through this, they establish trust and rapport by demonstrating empathy, understanding and objectivity in a non-judgmental way. It is important for the negotiator to listen to verbal and non-verbal reactions of the person in need, in order to be able to label the emotion that the individual is showing. Thus, this demonstrates that the helper is tuned in emotionally. Furthermore, there are other techniques that can be used to demonstrate actively listening such as: paraphrasing, silence and reflecting or mirroring. The goal in active listening is to keep the person talking about their situation. (Lanceley. F. J, 2003)

Sb10ok (talk) 01:28, 4 November 2014 (UTC)

Feedback
Hi everyone. I was reading the article, which was edited. The article comprehended the good article criteria from the Wikipedia method. It has good sources, which means secondary sources. The article was all written from a neutral point, so it respects the policies and guidelines. Also, it has citations in the texts, so plagiarism is not present. Helping to understand the context about Crisis, the text has examples about the context, which exemplify the information and remember the topic in simple words. In addition, subtopics were created, so it is another factor to clarify the information. In brief, the article was edited in the correct method to add more information about this topic in the Wikipedia resources. Willian Dullius (wd14bt) (talk) — Preceding undated comment added 22:35, 8 November 2014 (UTC)

Hey Crisis group!

Congratulation on posting your edits! Everyone did a great job. It it noticeable that you correctly followed the 5 Pillars of Wikipedia. I found that you had a neutral point of view. It was portrayed well and it did not seem as though you were advocating it was rather providing informative information. In the last paragraph when you explain that active listening is and why it helps in a situation of crisis, I think it would be beneficial to the readers if you were to include more benefits to this method of design with a crisis. Also it is explained how other techniques (paraphrasing, silence and reflecting or mirroring) help improve the effectiveness of active listening. I suggest that to make this point clearer and to show its significance, explain how they aid to demonstrate active listening. As for variability, you had many sources that were accurately formatted and reliable. There were no personal experiences or interpretations. I thought adding a “ways to manage a crisis” was a great idea because it is not only important that people know what crises are, but also how to deal with them. Using the RNAOs ABC model was a great idea because it delivers important information in a way that is easy for people to remember. I found when I read through this section I was able to understand what crisis are and how I could potentially deal with one.

All in all, great job from everyone! Bt13zs (talk) 20:51, 11 November 2014 (UTC)

Feedback from Classmate
Good Evening Crisis Group, as a fellow student I would like to provide feedback on the information presented in your talk page of the article. I will split it into each sub heading and have an overall feedback section as well.
 * Definition:You made some great additions to the opening, and it allowed be to gain a better understanding of crisis without being too lengthy. Great job! However, I have a few tweaks to mention. In the first sentence, I would incorporate the person, so perhaps "in which the ability for one to cope.." is more appropriate. There is also a small typo in the third line, as which is repeated. Also on line three, the sentence "When one is in a place that is considered to be a crisis situation" the word place would better be expressed as setting. Finally, when stating "There are many ways by which crisis can be detected." it would be beneficial to have at least one example that is later discussed in the article under "Personal". Take my suggestions as you wish, all the best in your edits.


 * Personal:Awesome content! You really nailed how one can cope and observe themselves during crisis. It looks to me that the first sentence is repeated from the definition addition. Is this purposeful, as in you want to reiterate that point? Change as you wish. In your first to second line of the second paragraph, the sentence "As it is outside of their normal range of functioning, it is common to see a struggle to control emotions." could be considered for review as I found "to see" unnecessary. You could potentially change it to "...it is common to struggle with control over emotions". On the third line of the second paragraph I found "One such resource..." to be very awkward and would suggest removing such, and add often following resource. I really enjoyed reading this section, take my suggestions as you wish. All the best in your edits.


 * Ways to Manage..: Congrats on your edits, you are almost done! However, I have a few suggestions for you to take as you wish. I found most of the information in this section to be repeated from the section personal, and that may be due to use of same sources. For instance, coping mechanisms and social support group suggestion were aforementioned, and that can be frustrating for a reader so I would suggest collaborating into Personal and maybe renaming it "Personal ways to manage...". I loved the intergration of RNAO's ABC model, and that could be something made separate or brought into collaboration with Personal. Since listening would no longer fit in "Personal ways to manage..." perhaps you could make a nothing sub heading around the idea of listen, perhaps "Benefits of listening in crisis". Finally, titles/subheadings on Wikipedia are to be all lower case after the first word, this was brought to my attention and I thought I would bring it to yours! Great work, take my suggestions as you see fit.


 * Overall: I found your contributions to be great, and they improved flow and content quality of the article for sure. Your sources look to be credible which is important in Wikipedia's good article criterion. Keep up the good work, and take upon suggestions as you wish. Sf13yg (talk) 02:32, 12 November 2014 (UTC)