Posts Tagged ‘Forensic Nursing Critical Incident Stress Management’

“Critical Incident” Stress in the Workplace, comment

October 4, 2010

In the thirty-five years of my professional career as a Registered Nurse, I have been involved in a wide variety of ‘critical incidents’; from the birth of an anacephalic baby, to MVCs with amputated limbs, to the loss of a patient to whom I had grown attached, to the death of someone too young, on our procedure table, that may not have happened if we had been able to care for him sooner.

 This last incident was the only time I had the privilege of a defusing and formal debriefing.  The hospital where I worked at the time, didn’t have a formal program.  We were given the chance to talk to our Child Advisor (I’m not sure of her exact title) when we, the cath lab staff, were so distraught over losing this patient during an angioplasty, on the table.  When I look back at this, I recognize it was very rudimentary, but it definitely helped us better than nothing at all. 

I’m thinking this is something I need to pursue for the facility where I work now.  There have been and always will be incidents that cause our professional staff emotional and/or physical ‘trauma’.  To provide a program that gives support for staff when they experience an untoward event with one of their patients, is only right when we ask them to provide Relationship Based Care. 

Original Post
April 4, 2004
Title: “Critical Incident” Stress in the Workplace

Many health care professionals at one time or another have experienced a “critical incident’ that has caused them strong emotional or physical reaction. The critical incidents vary from threats / assault, suicide, accidents, deaths or injury. These experiences may impair their ability to work safely and effectively in their care of patients for weeks or even months after the incident has occurred.

Nurses and other health care professionals are often expected to carry on after these incidents by simply relying on their own coping skills. However the use of formal debriefing in the workplace has been found to be a key component of recovery. Debriefing has produced many positive side effects for staff and their employers including:
• increase in team cohesiveness and mutual support.
• reduced sick time
• increased awareness of critical incidents and their impact
• decrease in staff turnover

Many hospitals and health care facilities have incorporated a formal model, the “Critical Incident Stress Management” (CISM) program that includes:
1. Defusing – a chance for to talk immediately after the incident, 45 to 60 minutes to restore order in a chaotic situation.
2. Formal Debriefing – longer, structured meeting including other professionals – chaplains, social or mental health workers.
3. Follow-up – possible long-term therapy to be arranged.

The best remedy for a nurse who has suffered this kind of reaction is often to get back to work as soon as possible; “to accelerate normal recovery in normal people with normal reactions to abnormal events.”

Should these programs not be adequate in reducing the after-effects, individuals and their co-workers should be aware of reaction symptoms that may occur. The following symptoms may be displayed:

Physical: nausea, rapid heart rate, dizziness, thirst, chills & headaches
Cognitive: poor concentration, disorientation, nightmares, memory
disturbances
Emotional: grief, guilt, fear, depression, anger, exaggerated responses
Behavioural: withdrawn, loss of appetite, sleep disturbances,
hyperalertness

Being aware of these symptoms when they occur and responding ethically and professionally will ensure that safe and effective patient care is maintained.

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CISM, comment

August 16, 2010

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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