STRESS AND DEBRIEFIN

G

C R I TI C

A L I NC I D

E N T ST R E S S D

E B R I EF I N

G

CRITICAL INCIDENT STRESS DEBRIEFINGA health promotion model that provides immediate emotional

support and education about normal stress reactions, and may reduce the risk of chronic and disabling emotional and physical consequences

STATISTICSAll employees face some exposure to violenceAlmost 2 million people in the US are assaulted each year while

at work. Healthcare providers have the highest percentage

EXPOSUREEvidence indicates that exposure to workplace violence and

other stressful situations, increases the risk of stress-related illnesses

This includes acute stress disorders, PTSD, and adverse medical outcomes

A CRITICAL INCIDENT(AN ACUTE STRESS RESPONSE)

Refers to a powerful and overwhelming event that lies outside the range of usual human experience.

It has the potential to exhaust one’s usual coping mechanismsCan result in psychological distress and disrupting of normal

adaptive functioning

ENCOUNTERSA violent or traumatic situation evokes powerful emotions

beyond one’s usual ability to mobilize coping resourcesIntense anxiety often ensues and the person’s response is

numbness, in a state of shock, then intense fear followed by anger

FUNCTIONOrdinarily, critical incidents are so emotionally overwhelming

that the person has difficulty functioning and often resorts to using distorted thinking and coping.

This presents as fear, intense anxiety and depressionSome may blame themselves, withdraw or deny any effects

COPINGIndividual coping responses often depend on the type of

stressor and vary from one traumatic event to anotherChronic, cumulative stress reactions, as well as acute

responses, are the basis of critical incidents

STRESS REACTIONS (EMOTIONAL)ShockAngerDisbeliefGuiltTerrorSadnessDepressionFear

STRESS REACTIONS (BEHAVIORAL)Social WithdrawalAlienationHypervigilanceExcessive change in communication or interactionsIrritability and agitationMaladaptive coping responses, such as drinking excessively or

using other mind-altering substances

STRESS REACTIONS (BIOLOGICAL)Sleep disturbancesAppetite disturbancesTremblingGI DisturbancesNightmaresHyperarousalAutonomic nervous system arousalStartle response

STRESS REACTIONS (COGNITIVE)Decreased concentrationConfusionIntrusive thoughtsSelf-blameDecreased self-confidence and self-esteemFlashbacksForgetfulnessUpsetting dreams and images

CISD TEAMSTypically consist of mental health professional and non-mental

health professionalsInterventions offered within 2-7 days post trauma

DEBRIEFINGSIs NOT psychotherapyIs an opportunity to process the experiences and put them into

perspectiveParticipation is voluntary

INTRODUCTORY PHASEReview the ground rules including the goals of a CISDMaintain confidentialityProvide immediate emotional support from feedback of peersEncourage the person to speak for themselvesInform the person that this is NOT psychotherapy

FACT PHASEEach person describes what happened regarding themselves,

the incident and their behavior during the eventRetell the story to promote cognitive re-struction of the event

and experience emotional releaseDescribe sensory perceptions during the event, such as smells,

sounds or sights

THOUGHT PHASEAsk participants to reveal their first thought during the eventParticipants affirm and validate their own thoughts and

feelingsParticipants repair their cognitive perception of safety, trust,

power, self-esteem, and intimacyParticipants share what thoughts they will carry with them

REACTION PHASEParticipants focus on their own reactions or emotions during

and subsequent to the event (on both them and others)Assess emotional responses: crying, anger, fear, horror, guiltAnxiety promotes order. Help participants focus on and express

their feelings to gain more information about the normalcy of one’s feelings and thoughts about the event

SYMPTOM PHASETransition from an emotional level to a mind cognitive level

EDUCATIONAL PHASEDiscuss stress symptomsRemind participants about normalcy of their reactions to an

abnomral situation and the need to talk to each other rather than isolating

RE-ENTRYDebriefing comes to a closeReassurance is providedGather closing statements about the processMake appropriate referrals and follow ups

ACTIVATIONAnyone can request a debriefingThere are teams throughout the county, including both

hospitalsContact a member of the management team if you feel a

debriefing is in orderEvents are not isolated to violence, they can be anything that

overwhelms the staff