Download - Stress and Debriefing
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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
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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
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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
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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
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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
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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
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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
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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
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STRESS REACTIONS (EMOTIONAL)ShockAngerDisbeliefGuiltTerrorSadnessDepressionFear
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STRESS REACTIONS (BEHAVIORAL)Social WithdrawalAlienationHypervigilanceExcessive change in communication or interactionsIrritability and agitationMaladaptive coping responses, such as drinking excessively or
using other mind-altering substances
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STRESS REACTIONS (BIOLOGICAL)Sleep disturbancesAppetite disturbancesTremblingGI DisturbancesNightmaresHyperarousalAutonomic nervous system arousalStartle response
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STRESS REACTIONS (COGNITIVE)Decreased concentrationConfusionIntrusive thoughtsSelf-blameDecreased self-confidence and self-esteemFlashbacksForgetfulnessUpsetting dreams and images
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CISD TEAMSTypically consist of mental health professional and non-mental
health professionalsInterventions offered within 2-7 days post trauma
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DEBRIEFINGSIs NOT psychotherapyIs an opportunity to process the experiences and put them into
perspectiveParticipation is voluntary
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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
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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
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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
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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
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SYMPTOM PHASETransition from an emotional level to a mind cognitive level
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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
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RE-ENTRYDebriefing comes to a closeReassurance is providedGather closing statements about the processMake appropriate referrals and follow ups
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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