3 Ways Nurses Heal After Mass Casualties

[jeastridge, BSN, RN]

Mass casualties, shootings, horrific motor vehicle accidents, untimely deaths, abuse, lingering deaths that are not peaceful, medication errors, neglect—the list of causes of trauma in nurses is long and impossible to enumerate completely.

We all know what it is: these are the events that keep us awake at night, even though we are bone-tired, worn out in body and soul. Try as we might, we can’t forget that haunting look, the moment of discovery, the pain, the guilt the utter tragedy of traumatic events. A recent article about the killings in El Paso states, “The story of their lifesaving labors at the El Paso hospital, the only one in a 270-miles radius prepared to treat complex trauma patients, is one of heroics in the face of violence, and of the doctors and nurses, who, once the adrenaline rush died down, struggled to live with the horror of what they had experienced." (Surgeons Labored to Save the Wounded in El Paso Mass Shooting)

Oddly, in order to result in lingering mental health side-effects, these tragedies don’t have to happen to us, necessarily. We can experience trauma even after events that have happened to our loved ones or to someone we know or to someone we heard about on the news. Traumatic events are universal: most of us suffer through some in our lifetime. But the residual effects of trauma and the associated losses can be debilitating at times.

What is PTSD?

Post traumatic stress disorder (PTSD) is most commonly associated with veterans and refers to their emotional, physical and psychological difficulties after single event trauma or after multiple events accumulate. We read about their nightmares, their anger, their difficulty sleeping and their problems with everyday life. “PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.” (PTSD: National Center for PTSD). PTSD can be short term or a more persistent condition that hampers the person’s ability to live well and fully.

The Trauma Healing Institute identifies several characteristics of trauma and emphasizes the importance of addressing all aspects of trauma so that true healing can take place:

• Trauma overwhelms normal coping
• Trauma is difficult to put into words
• Trauma shatters dignity
• Trauma destroys choice

Nurses can also experience symptoms of PTSD related to their work in highly charged emergency situations. Most recently, the shootings in Kentucky and Texas have brought to the fore the need for nurses and other medical professionals to care for their minds and spirits after the horror of caring for the victims of shootings, especially those that involve high numbers of mass casualties where lives depend on nurses and other medical professionals to work with efficiency and to cope with multiple needs at one time. But even on routine days, nurses can experience the trauma of caring for victims of accidents or crimes. We can be traumatized by procedures we are a part of that don’t go well, by patients that die on our watch, by places where we feel we didn’t do all we could have done. How do we carry on when these events keep coming up and clouding our thinking?

How can we take care of ourselves during tragedy?

1 - Be alert for signs that you are struggling and get help if needed

If you are normally calm and can deal with adversity or failure well, but then all of the sudden, you are flying off the handle and fussing about things that didn’t disturb you before, it may be time to look deeper and to ask yourself if you may need to get help. It is not unusual to have problems with anger, sleep, attention for a few days or weeks, but if the problem persists, get help with a counselor or other mental health professional. Getting help is important and necessary if the aftereffects of trauma persist.

2 - Sleep

While this bit of advice only applies after the initial episode of trauma, it seems that some recent studies show that sleeping after a traumatic event can help to lessen its after-effects and shorten the length of time that the episode causes distress (Sleep helps process traumatic experiences). While this theory is still being studied, it appears to support what we may feel instinctively—a good night’s sleep helps. The common adage, “Sleep on it,” reminds us that sleep will help restore some order to our confused and disturbed thoughts after trauma.

3 - Connect

After trauma, it is often helpful to spend time with others, to talk about what happened (if that is possible), to join a support group, to let friends and family nurture you if they offer. While traumatic events and PTSD symptoms may lead the sufferer to want to withdraw from others, the healing happens in community and communication.

Nursing can be full of traumatic episodes. As professional nurses, we must continually work to stay healthy in mind, body and spirit so that we can, in turn, help others.

[HarleyvQuinn, MSN, RN, NP]

I'm not sure how well this will translate into the civilian sector, but we ran into this a fair amount in the deployed setting when I was serving as an Army RN. I always noticed after very difficult cases or mass casualty events, I ran into a lot of my peers at the gym after shift. It helped me to work off some of the tension, anger, and other bottled up emotions that come with handling this type of trauma to funnel it into something productive and physical like a workout. Physical activity is also beneficial for your body and your mind and it helps to tire you out, giving you a better chance of getting that much needed sleep afterwards. Some hit the weights, some cardio, some even would give a go at a punching bag.

Debriefing, which I'm sure all emergency and critical care folks are quite familiar with, is also acutely necessary. It gives everyone involved a chance to review the situation, discuss, and even make some sense of what they experienced. It also helps to prepare for the next time you may have to intervene in these situations.

Coming from a psych perspective, I can't say enough how important it is to have healthy coping skills. Whether that's music, art, making bird houses, or even taking pole dancer lessons. Something that you enjoy. People you can talk and vent to. In these type of situations, I strongly discourage using substances to cope. From both military and civilian backgrounds, I've seen many take this path and it always seems to end poorly. If you notice that you're struggling after an experience, please don't be afraid to reach out for assistance. It's far better to make an appointment, be seen and get treated, rather than let things spiral out of control and potentially threaten your career and life. Remember there are a lot of us who have been through the trenches with you. We're here to help if you need us.

[jeastridge, BSN, RN]

On 8/15/2019 at 1:25 AM, HarleyvQuinn said:

I'm not sure how well this will translate into the civilian sector, but we ran into this a fair amount in the deployed setting when I was serving as an Army RN. I always noticed after very difficult cases or mass casualty events, I ran into a lot of my peers at the gym after shift. It helped me to work off some of the tension, anger, and other bottled up emotions that come with handling this type of trauma to funnel it into something productive and physical like a workout. Physical activity is also beneficial for your body and your mind and it helps to tire you out, giving you a better chance of getting that much needed sleep afterwards. Some hit the weights, some cardio, some even would give a go at a punching bag.

Debriefing, which I'm sure all emergency and critical care folks are quite familiar with, is also acutely necessary. It gives everyone involved a chance to review the situation, discuss, and even make some sense of what they experienced. It also helps to prepare for the next time you may have to intervene in these situations.

Coming from a psych perspective, I can't say enough how important it is to have healthy coping skills. Whether that's music, art, making bird houses, or even taking pole dancer lessons. Something that you enjoy. People you can talk and vent to. In these type of situations, I strongly discourage using substances to cope. From both military and civilian backgrounds, I've seen many take this path and it always seems to end poorly. If you notice that you're struggling after an experience, please don't be afraid to reach out for assistance. It's far better to make an appointment, be seen and get treated, rather than let things spiral out of control and potentially threaten your career and life. Remember there are a lot of us who have been through the trenches with you. We're here to help if you need us.

What a wonderful comment! Thank you for including your thoughts here. I know it will benefit many, and I greatly appreciate it. Joy