Dealing with adverse events in the ER.

epinephRN · Sep 10, 2010

It isn't dealt with, unfortunately. Despite the fact that best practices show that nurses need debriefing after such events, it never occurs. It hasn't in any of the places I've worked at. I think this is one of the worst things about health care. I'm sorry you've been through such a difficult experience.

Zookeeper3 · Sep 10, 2010

We have an employee EAP, which is a certified hospital counselor on staff that is on call that can meet with the staff at the end of shift to do a debriefing. As well they are available to have a "staff" meeting to discuss dealing with this type of post traumatic stress you describe.

As to the community, my daughter of near SIDS whom wore a heart monitor, whom ended up with simply reflux... I'd advise a meeting with the picu. We were discharged only after BLS instruction on infants, home monitoring and home visits. This does exist in the PICU to prevent!!!! So link up with them and see what you can do together to do a community event, or what ever your feel is needed to prevent such a needless death.

We were very lucky that my husband responded and we called 911 and then found out how to prevent another attack, with your help, others may prevent the first one that leads to a demise and death. I hope this helps.

GreyGull · Sep 10, 2010

The hospitals I work at prefer to have individuals see a qualified counselor. While group sessions can be useful, they sometimes bring up individual emotional issues that were triggered by an event and should be handled personally and professionally. A person becoming very vulnerable and emotional during a group session of their peers can also have lasting effects and sometimes not in a good way. Individual sessions can be tailored rather than some of the generic advice a counselor must give to group. Some leave group meetings feeling even more unresolved or they repress issues that should be addressed because they want to fit into the group. This is why some CISD programs have fallen out of favor over the past couple of decades. However, I think it is healthy to discuss the situation as a group but only after the counselors and EAP program are made available to the staff. Our Chaplains are also always available during and after a situation for any staff member as well as for the families.

Trauma Columnist · Sep 10, 2010

Critical Incident Stress Debriefing is how it was dealt with in the ER I worked at.

MassED, BSN, RN · Sep 10, 2010

i agree. talk with someone who was there, that can help. you do everything that you can and sometimes they just don't survive. you can try to read up on causes, which may be helpful, but mostly you need to try to let it go and not let the stress of that infiltrate your life (professional and personal) beyond a normal time period. that said, i know it's difficult to not think of those really sad cases that seem to pop into your mind when you least expect it. it will happen. you have to find healthy ways of coping and destressing. good luck to you. it's not easy for anyone, at any time. i don't think the loss of a child is ever easy to cope with, even over time and seeing it previously. it is profoundly sad, so you are rightly experiencing a normal response.

http://emedicine.medscape.com/article/806223-overview

"what kind of person is totally dispassionate in the circumstances of a child's death? do not hesitate to seek assistance from family, friends, clergy, and other professionals."

"the death of a child can create intense feelings of despair, hopelessness, uncertainty, and insecurity in health care workers. this can be an opportunity to vent any personal emotional feelings about the situation."

"validating worthwhile and positive actions that contributed to the overall well-being of the patient, family, and health care team can reinstate a sense of meaning and purpose in clinicians and their work.[color=#004276]4"

http://www.marchofdimes.com/professionals/14332_1196.asp

**canoehead, BSN, RN** · Sep 10, 2010

CISD has been policy as available at all the hospitals I've worked at, but I have never seen in used, except once. The nurse manager was acting as an ER nurse when a SIDS case came in, and she decided to hold a CISD. When regular nurses are involved it has never happened. Maybe no one wants to be the person to admit they are having a hard time.

ERnewbieRN, BSN, RN · Sep 11, 2010

The EXACT same thing just happened at my workplace about a month and a half ago, and I feel the same way... something is just not right, I feel kind of disconnected. It's probably related to a bunch of different things, but I'm sure this contributed. No debriefing, nothing. Too bad we are expected to just suck it up and think it's a normal occurrence. It distorts our perception of reality.

Penelope_Pitstop, BSN, RN · Sep 11, 2010

I'm very sorry to hear about this. I can't imagine what the staff went through that day.

I know that on the MedSurg floor, at least in my experience, things are the same way. My friends and I have a particular "worst night ever." In the course of ONE twelve hour shift on a 35-bed MedSurg floor, a coworker suffered a first-time tonic-clonic seizure in a patient's room and had to be admitted, a chronic patient on our floor coded, and there was a fire in the nurses' station.

This was months and months ago, and that night still haunts me. The images are burned into my head, and for a while I had nightmares of the night repeating again and again.

Everyone has given great advice. I offer my empathy, and I want to remind you that we are here for you. We do understand!

15isto2 · Sep 12, 2010

In my hospital we arrange a "debrief" session after all paediatric arrests, all staff involved ER/ICU/Paramedics/Paeds etc I usually facilitate this. We have access to councelling through occupational health.

A childs death is always a traumatic event despite how "hardeded" you are, I have 19 years experience, 11 of which are purely in Resuscitation of adults and children yet two weeks ago I delt with a 2yo who drowned and found myself in tears for a few days after, so despite experience it is always a really traumatic event