Discuss the differences between verbal and non-verbal communication.



for the

Health Care


Concepts, Practice, and Evidence

Gwen van Servellen


© 2009 Jones and Bartlett Publishers

Chapter 15
Communicating with Patients in Crisis

© 2009 Jones and Bartlett Publishers


  • Define crisis response
  • Individuals and groups in crisis
  • Dysfunctional communication in times of crisis
  • Relevance of stress and adaptation in periods of crisis
  • Adaptive and maladaptive coping responses

© 2009 Jones and Bartlett Publishers

Objectives Continued

  • Stressors, coping resources, and stress resistance resources
  • Differentiate between situational and developmental crisis
  • Stages of crisis resolution
  • Interventions to manage highly anxious patients
  • Interventions to manage agitated and/or confused patients

© 2009 Jones and Bartlett Publishers

Definition of Crisis and Crisis Responses

  • More change is required of an individual than capable to deal with at the time
  • Assumptions
  • Not all crises are incapacitating
  • Persons experience crisis in isolation of others
  • Persons can worsen each others responses through further excitation
  • Crisis is not the same as the stressor itself

© 2009 Jones and Bartlett Publishers

Dysfunctional Aspects of Crisis Communication

  • Difficulty in perceiving accurately
  • Abilities of processing information may be impaired
  • Ability to express ideas, thoughts, and emotions may be limited
  • Perceived state of disorganization can increase these deficits

© 2009 Jones and Bartlett Publishers

Impact: Over Stimulation and Under Stimulation

  • Over stimulation
  • Rapid bombardment or excessive stimuli
  • Not too much but stimuli are noxious
  • Exceed tolerance level
  • Inability to hear, speak, and if they do hear, unable to move

© 2009 Jones and Bartlett Publishers

Stress Theories and Understanding Crisis

  • Levels of anxiety and effects on patients; mild to severe and panic
  • Stress and adaptation
  • Lazarus and Folkman (1984) coping always discussed when stress effects are analyzed
  • Studies of stress of different kinds; and stress of the same kind across several groups of individuals

© 2009 Jones and Bartlett Publishers

Adaptive Coping Responses

  • Seek information
  • Seek comfort/support from friends or family
  • Search for solutions to the problem(s)
  • Self-talk that will help them feel better
  • Seek professional counseling or advice

© 2009 Jones and Bartlett Publishers

Types of Crisis

Developmental Crises: interruption or unsatisfactory passing from one psychosocial task and developmental phase that correspond also to physical developmental growth

Situational: Crisis emanates from precipitating events that occur and are typically out of the person’s realm of expectancy.

© 2009 Jones and Bartlett Publishers

Caring for Patients in Crisis

  • Do not re-victimize in the process of helping
  • Establish an emotional or psychological connection with the patient and family
  • Do not challenge the validity of the crisis situation or underestimate its effect
  • Practice active listening skills, direct straightforward approach, become aware of personal responses and their impact

© 2009 Jones and Bartlett Publishers


Crisis is unavoidable; many illness or injury events can be perceived as a crisis to the patient and family. More needs to be known about the unique expression of crisis across individuals and communities.

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