Critical Incident Stress Debriefing

by LegzRN Sep 14, '11 | 5,449 Views | 16 Comments

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1 Hello ER nurses,

Do any of you out there utilize Critical Incident Stress Debriefings in your facility? I realize that a lot of the things we see "come with the territory" of ED nursing, but I'm talking about the things that truly hit close to home such as acute pediatric deaths or deaths of a colleague within the ED. I'd like to start some type of CISD in my facility, whether it's formal or informal, and I'd like to hear about some of your experiences.

Thanks
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#1 0

Sep 14, '11 by traumaRUs, MSN, APRN, CNS Admin

In the level one trauma center where I worked for 10 years, yes we had it: it was run by the trauma services and included SW, pastoral care (it was a Catholic hospital), EMS personnel and other nurses. They had very set guidelines and were available 24/7.
#2 0

Sep 14, '11 by Whispera, CNS

Where I worked about 10 years ago, we had a team. It was the EAP person and others who went through the training. I was on the team as a psych nurse. I only know of one time the team was "activated." It surely could have been used other times!
#3 2

Sep 14, '11 by EricJRN

I work in neonatal ICU, but in the last few months one of our docs has facilitated two non-mandatory discussion meetings, each one following a pretty traumatic patient encounter. These are informal and I think that staff members appreciate the opportunity. We do not use the Mitchell model for CISD.

For some years there has been some contentious and overly personal debate on EMS discussion boards about whether CISD improves, worsens or has no effect on psychological issues following a traumatic experience.
#4 1

Sep 15, '11 by elkpark

Quote from EricJRN

For some years there has been some contentious and overly personal debate on EMS discussion boards about whether CISD improves, worsens or has no effect on psychological issues following a traumatic experience.

That was my first thought when I saw the title of the post -- I'm in psych, and it's my understanding that the entire CISM model had been discredited a number of years ago.
#5 5

Sep 15, '11 by Rob72

Quote from elkpark

That was my first thought when I saw the title of the post -- I'm in psych, and it's my understanding that the entire CISM model had been discredited a number of years ago.

Yep, along with a study, several years ago, published in the AJP that showed "a strong trend" towards the ineffectiveness of long-term PTSD counselling. Suriviors of (and responders to) the OKC bombing were one of the cohorts, as I recall.

Informal is better. If it is mandatory, people with "adequate" coping skills are unlikely to have patience for those who do not. Those who lack the skills will feel threatened by those who do, and will resent the "callousness".

What you are actually trying to discover/nurture is survivors' mindset, which is well addressed in the psychology of economics, athletic performance and "extreme performers" surveys. Essentially, if survivors perpetually recount the traumatic experience, but do not/are not encouraged to find an integrative model in which they are able to assess objectively, and say, "X happened. I did not plan for/observe these indicators. I will in the future. I can change my day-to-day outlook to be more aware of potential risks. If my preparations are overwhelmed/inadequate, I have an alternate plan and the means to implement it." Without a resolution that incorpoarates the event into a learning model, the trauma is repeated, because the individual recognizes the danger(s), but is unable to formulate a plan for survival. It applies to everything from having a baby to buying/selling stock. Most people just do not look at the process as a decisional framework, with multiple applications.
#6 2

Sep 15, '11 by Esme12, ASN, BSN, RN Senior Moderator

Here are several resources to help you. Check with other local ED's, fire departments, flight crews, EMS, and search and rescue crews to see how they handle debriefing. Some states as a part of their disaster preparedness have teams trained and available for little to no fee. This varies state to state. Most facilities utilize their EAP services as they already pay a fee for these services. Check also with FEMA and your states emergency management services as they would have information also.
http://emedicine.medscape.com/article/765495-overview

http://nimh.nih.gov/health/publicati...te-index.shtml

http://web.archive.org/web/200608112...g/topic826.htm

http://www.criticalincidentstress.com/

http://www.aaets.org/article54.htm

http://www.trauma-pages.com/trauma.php

http://placerchaplains.com/Documents...Debriefing.pdf

http://www.hpsn.com/event/midwest-regional-hpsn/37/

Of course in the old days we would just go out for liver rounds.......

Last edit by Esme12 on Sep 15, '11
#7 1

Sep 15, '11 by SummitRN, BSN, RN, EMT-B

I've researched this subject a good deal. EBP does not support the formal CISD model as applied to the first responder or medical professional. It started as a "this is a theory that sounds good so lets do it" practice. There are several studies that are highly critical of CISD/CISM as at best ineffective and at worst more harmful than helpful. However, it remains well entrenched in the first responder/emergency community.

I agree with many of the posts here: the key points are a debriefing, whatever the model, be informal, voluntary, and run by highly educated professionals.

Here is a well researched article by Dr. Bledsoe on the subject:
http://www.emsworld.com/print/EMS-Wo...-stress/1$2026

Here is a great list of studies and articles on the subject:
http://www.bryanbledsoe.com/data/pdf/cism_debunk.pdf
#8 1

Sep 17, '11 by mwboswell

In my travels and talking with nurses from various regions/locales, I have as of yet to find a place that consistently implements this. They all seem to talk about it and tout it's benefits, but I just don't see it being implemented the way they recommend it.

Mark Boswell
FNP-BC, MSN, CEN, CFRN, CTRN, CPEN, NREMT-P
(And YES, I take the CEN exam every year!)
Support CEN certification and your ENA
#9 2

Sep 19, '11 by nola1202

Quote from mwboswell

In my travels and talking with nurses from various regions/locales, I have as of yet to find a place that consistently implements this. They all seem to talk about it and tout it's benefits, but I just don't see it being implemented the way they recommend it.

Mark Boswell
FNP-BC, MSN, CEN, CFRN, CTRN, CPEN, NREMT-P
(And YES, I take the CEN exam every year!)
Support CEN certification and your ENA

good grief! How many lines on the progress notes do your credentials take up?
#10 0

Sep 19, '11 by mwboswell

Quote from EricJRN

I work in neonatal ICU, but in the last few months one of our docs has facilitated two non-mandatory discussion meetings, each one following a pretty traumatic patient encounter. These are informal and I think that staff members appreciate the opportunity. We do not use the Mitchell model for CISD.

For some years there has been some contentious and overly personal debate on EMS discussion boards about whether CISD improves, worsens or has no effect on psychological issues following a traumatic experience.

Hahah! Eric - my "kudos" is for your football helmet graphic! Gig'Em Ags!!!
#11 2

Sep 19, '11 by mwboswell

Quote from nola1202

good grief! How many lines on the progress notes do your credentials take up?

Hey Nola - as much as they cost me (and I'm still paying on some of them!) you can bet your bottom dollar I'm posting them!!!!!
#12 0

Sep 19, '11 by morte

Quote from Esme12

Here are several resources to help you. Check with other local ED's, fire departments, flight crews, EMS, and search and rescue crews to see how they handle debriefing. Some states as a part of their disaster preparedness have teams trained and available for little to no fee. This varies state to state. Most facilities utilize their EAP services as they already pay a fee for these services. Check also with FEMA and your states emergency management services as they would have information also.
http://emedicine.medscape.com/article/765495-overview

http://nimh.nih.gov/health/publicati...te-index.shtml

http://web.archive.org/web/200608112...g/topic826.htm

http://www.criticalincidentstress.com/

http://www.aaets.org/article54.htm

http://www.trauma-pages.com/trauma.php

http://placerchaplains.com/Documents...Debriefing.pdf

http://www.hpsn.com/event/midwest-regional-hpsn/37/

Of course in the old days we would just go out for liver rounds.......

Yup...even for breakfast....