Critical Incident Stress Debriefing

athomas91 · Nov 26, 2003

i have found that ED nurses in general are very good at stress debriefing each other w/o the assistance of outsider influence... i am very familiar w/ the stress debriefing - a good friend of my is a psychiatrist that specializes in trauma - one of the very few in the u.s..... gets called all over the country..... my husband is also a trooper who is on their CISD team - has gotten called out a few times....

however in the ED - i have found that nurses know instinctively what needs to be done - and they do it for themselves and each other - MOST ED nurses are extroverted and rather in touch w/ how they feel and what is normal - and what is not..... I feel this is a strong reason they do not use the offering of this by others.... i wouldn't.

flashpoint · Nov 26, 2003

Last time I went to a CISD, the person who was in charge kept getting in people's face because a lot of them were still unsure of how we felt about the event. She kept telling people "You know how you feel and you won't feel any better until you say it aloud!" Fine...that was her take on the situation, but I was still pretty much in shock...I was going from angy to sad to happy to outraged. When I expressed that she said that I should be able to pin it down to one feeling or another. Also...the person in charge made a "rule" oif no swearing (which is pretty hard for a lot of our firefighters and nurses) and no attacking the perpetrator (grandmother beat her granddaughter to death). I persoanlly needed to attack the perpetrator...lots of anger at her at the time...lot of others felt the same way. I've never really felt like the CISD helped...always seems that once you've said your piece you're done talking even if more comes up that you want to get out...usually end up walking out of there feeling worse and a lot of us who are close get more out of getting together in one guy's garage and having playing cards...a few have a beer or two while we play cards, but it's rare.

Also...if the CISD is held 24-72 hours later, it always seems that most of the people involved in the event are back at work...

Flygirl05 · Nov 26, 2003

The reason I was so upset from a particular trauma was because the kid i was working on was one of my younger sisters' old boyfriends. I didnt know him really well, but initiating compressions on a 14 yo kid kills me! There were so many family members and friends there... (it was a triple casualty mvc) and many of those friends were people i knew from high school. i went to the debrifing but didnt really find it helpful. i felt much better after talking to the other nurses that were working with me and on the other kids. they also had their funerals together at the high school, and i attended- mostly to support my sister- but it helped too.

Trauma Columnist · Nov 27, 2003

I'm a prehospital RN on a rural fire dept and also an ER RN. We use CISD occasionally in the hospital. The one incident which I still remember was 8 years ago while I was on orientation in my current position. EMS brought in a 4 y/o girl that had been tortured to death over a 90 minute period. I couldn't get past the fact that an adult male had hit this baby in the face, knocking out her teeth. (Sorry if this is too graphic). This is just the thing CISD is good for. It was handled very professionally and compassionately too. My preceptor quit over this incident (it was the end of a long and violent summer). CISD is good.

damaro · Nov 27, 2003

Thank you all so much for your replies. This is definately helping me to see this issue from another angle.

CCL"Babe", BSN, RN · Nov 27, 2003

I have been involved in CISD as both a pre-hospital nurse/firefighter and with some issues in the ED. I've found that generally CISD seems to work better pre-hospital. As another member pointed out- it is often hard to get the ER team together when they are all off. Usually no matter what the handlers are pretty good, I'm glad I never had to face the one described above. I think ER administration tends to be negative about it as well.

veetach · Jan 3, 2004

we recently had a serious house fire and a very well known firefighter lost his life. It was ugly and affected many people in our immediate EMS community. To show respect for the firefighter the helicopter transported him as a traumacode to our facility.

It was chaos and extremely stressful for our staff. CISD was offered to the EMS and fire crews but not to the ED staff. I really dont think anyone would have attended anyway.

I agree with athomas, I think the members of the ER team can basically counsel each other.

flashpoint · Jan 4, 2004

I know this is an old post, but...one reason I also don't do the CISD thing...two of the CISD people in the area are two of my least favorite people. They're both pushy and arrogant and I've seen them both be downright nasty to patients. I've also heard them talking about events after CISD...not really saying things like, "So and so said this" or anything, but talking about parts of the event that they would not know about unless they were actually there or unless they heard it at CISD. We've had a lot of problems with confidentiality with these two. Yes, they've both been reported, ye, we've asked that they not be facilitators for CISD for us, but they always seem to turn up.

Overall, I think CISD is a good thing. I went once (out of my area) when I was a paramedic student and it did make a difference...also really helped me bond witha preceptor that I really didn't like or get along with. I still think that a lot of the time, though, we're better off just talking about it amongst ourselves...firefighters / EMTs / nurses have a bond about them and most of the time, that is what gets us through!

Dragonnurse1, ASN, RN · Jan 4, 2004

I went to the only one offered by our ER and it was useless. The hospital offered us two people. One was our nurse manager which so many of us disliked and distrusted and the other was a hospital chaplin (female) that would be better at being a wall flower and has not had much experience in life in general.

After a really traumatic night we (all the night shift nurses) walked to the parking deck and once there we always had our own "debriefing". We covered the event and talked about anything that went wrong or we felt could had been done in a better way. Tears and anger was worked through and then we would go to breakfast. by the time we would get home 99% of our stress was gone and we could sleep - recharging for the next night.

It is hard for nurses to talk to "outsiders", people who have not seen the things we have.

Trauma Columnist · Jan 4, 2004

You are so right (last poster). As an ER RN I too find that we comfort each other the best!

stressednurse · Jan 4, 2004

Maybe teaching debriefing skills to the spouses of nurses would save more marriages. We do seem to de-fuse (quick, shortly after an event debriefing) with whom ever is available and the significant others are usually that after work.

I was on a CISD team in Pittsburgh for a few years and I am sure I was helpful to many people, sorry to hear of the stories of intolerant and pushy debriefers.

As a team though we did find we needed to debrief each other after some of the cases we helped with. Such trauma, meaness, evil intent and just down right lack of respect for human life.

There was more than one occasion I just went home and vomited.