CISM, comment

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When reading through the blog I stumbled across the post ‘Critical Stress’. I am so pleased to see that someone not only has posted about this, but that it struck a chord in others as well. As an RN in a cardiac ICU I care for patients with chronic cardiac illnesses. Many of these patients stay with us for weeks and even months. Our most chronic patients tend to be those with end stage heart failure. In January of this year one of my patients that I had cared for over many months, passed away. This was a different sort of trauma than that of those who work in the ED or EMS experience. It wasn’t grusome, bloody, and no children were involved. I don’t think I gave the event enough justice because it wasn’t a blatant traumatic experience. Over the next two weeks following his passing, I began having terrible mood swings, I had sleep disturbances, and I began resenting my career as a nurse. Luckily I have an insightful and compassionate nurse manage who recommended bringing in the Critical Incident Stress Management team. When she first mentioned it to me I had no idea what it involved. A week later a group of nurses from my unit gathered for a meeting with the CISM team that they called a “debriefing”. It was a series of open ended questions that started a conversation amongst the group. In the end there were tears, confessions of fear and anger, frustrations, and sadness. Just to have permission to talk about our lives as critical care nurses and the amount of death that we see, we all felt more balanced afterward. It is important for health care workers to care for themselves and be able to recognize the effects of long term stresses related to caring for chronically ill patients. Thank you for posting a passage about stress management for those in the health care industry.

Original Post
December 30, 2008
Title: Critical Stress
I personally feel this is an important issue that is frequently swept aside in many critical incident situations. I have been both an EMT and an RN for many years, but have had very few debriefing sessions. Several occasions were warranted, such as a when an entire family perished in an MVC on Christmas Day, co-workers who were killed on their way into work, a colleague who successfully overdosed; to name just a few. The emotional and behavioral keynotes were especially noteworthy. It is no wonder that so many of my colleagues have turned to substance abuse and psychotropics to seek refuge. As for myself and a few others, we have turned to a higher power; after all there has to be more and a “better place.” I pray that is not a hollow promise. I and my co-workers have experienced many of the emotional stress responses: a. Agitation b. Anger c. Anxiety d. Apprehension e. Depression f. Fear g. Feeling abandoned h. Feeling isolated i. Feeling lost j. Feeling numb k. Feeling overwhelmed l. Greif m. Guilt n. Irritability o. Limiting contact with others (I found I withdrew and cuddled up with my Lab and quilting) p. Panic (what if I can’t make it through this shift?) q. Sadness r. Shock s. Startled t. Suspiciousness u. Uncertainty (constantly checking and rechecking your work, documentation, etc.) v. Wanting to hide (that never happened to me) w. Worry about others (BIG TIME!!). References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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