Let’s talk about stress

Debriefing, supports key to returning to typical functioning despite stressors

By Andrea Bodie
Wednesday, February 5, 2014

Day to day work in health care creates a certain levels of stressors that are often overlooked. Health experts identify that for every major critical incident, there are statistically many more events of mild to moderate intensity that are not discussed. That can mean much-needed intervention or supports aren’t being accessed.

All those little things can add up. When you’re constantly dealing with ongoing stressors, your mind and body can be overwhelmed and overloaded. Unaddressed or unacknowledged, those little stressors can add up and start to build up. That can impact not only the way we feel but also how we function.

And that’s normal. The pace of today’s world is intense. We have more information coming at us than we ever have, greater demands placed on us and high expectations. So what’s a body – especially one that hasn’t quite evolved beyond when safe/not safe meant you were being chased by a tiger…or not – to do?

“The cumulative stressors – being asked to do one more thing, needing a break but being unable to take one – can often lead to us reacting to things with an overreaction. If you’re feeling irritable and thinking ‘Are you kidding me?’ you may be reacting to stress, not the situation,” says Isabelle Jarrin, Clinical Nurse Specialist - Mental Health at Health Sciences Centre. “That may be when you need to sit back and take a break from things, go for a run, watch a movie or call up a friend and go for coffee.”

Why?

Because, Jarrin explains, when we’re coping with our stressors, we function differently. When you’re overwhelmed and irritable, how kind are you going to be to your coworkers?

If you’re thinking you’re the one person who can escape stressors, think again. Research shows the very nature of health care exposes people to trauma. In fact, of 314 nurses surveyed on work related trauma, half of them were exposed to different types of trauma. Of those, 40 per cent experienced poor health and 10 per cent experienced moderate to severe depression.

Trish Bergal’s regional research of nurses in the ICU shows that six out of nine nurses met the criteria for Post Traumatic Stress Disorder or were vulnerable to it.

Beyond typical work-related stressors are critical incidents. These are events that overwhelm our usual coping strategies and may create an intense emotional response. Most often, critical incidents are beyond what we “normally” experience. A critical incident may be an unexpected death or tragic loss, assault, serious injury of yourself or someone close to you, just to name a few possibilities.

So what’s a health care provider to do?

Despite the fact that several people on the same shift may experience the same incident, it is possible for them to all have very different reactions to the same incident. That’s why there is no one type of support or intervention that will work best for everyone. Each individual needs to be mindful of getting the support and help they need.

“It’s challenging when an event happens and everyone responds differently,” says Jarrin. “To some staff, it’s no big deal while others feel the event was horrible and are struggling to work.”

Often this can set up difficult dynamics in a workplace in the midst of an already challenging time. Kindness is important during these moments, because different responses are completely normal. A person’s personal history, where they’re at in their life, how stressed they are, how well they are managing stressors…these are all factors that can impact how we may respond to a critical incident.

“Everyone has their own experience of a critical incident,” says Linda Newton, former Critical Incident Stress Management Clinical Director at HSC, now retired. “Managers need to take care of their staff and provide support.”

One element that has been found consistently important following a critical incident: talking about it. That’s one discovery made by Critical Incident Stress Management (CISM) teams, which are trained and ready to help teams debrief after a critical incident at Health Sciences Centre and St. Boniface Hospital.

The goal? To help a team debrief in a structured way following a critical incident. A CISM debriefing not only allows for early intervention, it also helps identify if further supports or interventions are necessary. Completely confidential and focused on processing the emotional experience of an incident, they can often be very helpful in providing clarity, group support and peer support.

But they’ve also been shown to help people recover from trauma faster, stabilize the situation and help people return to the way they typically function sooner than if a debriefing doesn’t take place.

Why?

Because talking about an upsetting event can help process what happened…not from a place of blame, but from a place of understanding. It can help a person restore their sense of control, assess and problem solve what took place and debriefing in a group setting can provide information an individual might not have had before talking about the event in a structured, supportive setting. It allows a person to feel more empowered as they gain a sense of completion with the event. All of this leads to greater health for an individual and a workplace.

Unresolved stressors or work-related trauma can ultimately lead to three options: a person leaves the unit or profession, they survive but are less engaged or they thrive and are change agents.

The first CISM model was created by Jeff Mitchell and George Everly to help police, emergency technicians and fire fighters process critical incidents. The concept was a strong one, with research to support the benefits of debriefing and how talking helped people move through the trauma and return to how they typically function much more quickly.

In the 1990s, a program modelled after the BC fisheries program was customized for health care and piloted at Health Sciences Centre. The pilot was so successful in helping facilitate the recovery process for people that one to two hour CISM debriefings became part of the facility’s culture. Today, St. Boniface Hospital also has a CISM team.

“You can see a physical shift in a debriefing. Often when we begin, people’s body language is tense and closed off. By the end, they typically appear more relaxed,” says Jarrin.

Volunteers are part of the CISM debriefing team and are called upon when there is an incident. Often debriefings take place within days of the event.

“You can’t prevent PTSD but the goal is to help people get back to where they were as fast as you can by whatever means you have to get there,” says Newton. “There is a visceral response early in a traumatic situation. We can’t stop that. It’s a biological response. But we can diminish the power of the image and help them regroup and get back to reality.”

Beyond the structure of a CISM, it’s important to watch out for one another. Sometimes we feel uncomfortable asking colleagues how they’re doing or if they could use some extra support but it maybe be exactly what’s needed.

Jarrin uses the example of a broken leg. “If someone has a broken leg, often people ask questions and check in. If someone is experiencing depression, we may feel awkward in talking about it,” she says. “But we need to have this on our radars and our relationships need us to take the time to ask.”

It doesn’t have to be complicated, she says. Often asking how it’s going, if someone is okay, if they need to talk or if you can help can be very helpful for someone who is feeling overwhelmed. For additional things to consider saying, click here.

“It’s about being kind and gentle with one another. We don’t know what’s going on for them. We don’t know what they’ve been going through,” says Jarrin. “We don’t need to fix anybody but we do need to be aware of the stressful incidents that take place in health care environments and remember there are benefits to support.”