Tools and resources for healthcare providers through the critical incident stress management lens
Talk Tuesday - July 7, 2020



Presenter

Karen Burgess RPN BScPN BA 

Karen is a clinical nurse specialist in the Mental Health Program and the clinical director for the Critical Incident Stress Management (CISM) team at the Health Sciences Centre in Winnipeg.  She’s a registered psychiatric nurse who graduated from Brandon University with a Bachelor of Science in Psychiatric Nursing in 2002.  The most considerable portion of her career has been working as a nurse therapist with the Adult Eating Disorders Program at HSC. Other roles have included acute inpatient psych nursing, child and adolescent day hospital, consultation-liaison mental health nursing, and clinical nurse educator. 

She is midway through her graduate studies at Brandon University, where she is pursuing her Masters of Psychiatric Nursing.  Her clinical and research interests lie in critical incident stress and the variety of resources and interventions available to reduce the impact of critical incidents on health care providers.  As the clinical director of the CISM program at HSC, she is responsible for training CISM team members, overseeing the interventions and practices of the team, coordinating responses at HSC, providing guidance and mentorship to other teams, and providing education and presentations to a variety of clinical groups, units, and programs.

Summary

Karen Burgess, Director of the Critical Incident Stress Management (CISM) Team at Health Sciences Centre Winnipeg, joined us this evening to share the impact of COVID-19 through a CISM lens. She describes symptoms of critical incident stress and shares holistic approaches including psychological first aid to manage prolonged critical incident stress exposure and help health care providers. 

Karen started things off with this quote from Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others author Laura van Dernoot Lipsky, “We often assume that our very status as helpers grants us immunity from the suffering we witness. We are often wrong.” Nurses are very good at teaching and sharing strategies with patients and communities to support their coping, and sometimes less diligent in putting those same strategies to use in our own lives. 

It is important to differentiate between the patient safety definition of a critical incident and the CISM definition of a critical incident. Patient safety experts would define a critical incident in terms of harm to a patient whereas in the CISM world a critical incident is an unusual event that causes an extreme response and overwhelms people’s usual coping mechanisms either at the time or later. 

Karen reviewed Hans Selye’s Stress Theories & General Adaptation and described different types of stressful events nurses may be exposed to in our work and non-work lives such as cumulative stress, multiple incident stress, and prolonged incident stress. Then she shared symptoms of stress and a bit about the Crisis Intervention Theory underlying psychological first aid. The goals of psychological first aid are to create and sustain an environment of safety, calm, comfort, connectedness, self-empowerment and hope and to address basic needs and reduce psychological distress by providing a caring, comforting presence, and education on common stress reactions. To finish up her presentation Karen outlined some quick skills, shared some useful questions and tips for validating emotions and then recommended nurses familiarize ourselves with the Shared Health COVID-19 Mental Health resources page and in particular the printable pocket card.

 

Question and answer

1. Can you talk about the impact of excessive workload on nurses?

Any extra demand or extra workload will increase cumulative and maybe multiple incident stress, this is in addition to the pandemic permeating all parts of our lives and the other layers of stress that are always present. These sources of stress may result in the symptoms we talked about and will require more effort toward resetting and depending on the situation it may be appropriate to bring human resources into a workplace conversation.

2. Can you talk about vicarious trauma?

Vicarious trauma is when someone else experiences trauma that you witness and you experience a trauma reaction. This can result in similar symptoms to those of the primary victim of the trauma. This is what Laura van Dernoot Lipsky has called a trauma exposure response in her writing. There are elements of vicarious trauma in discussions about burnout too, though the definitions are different; the ideas of witnessing, hearing about and experiencing trauma and stress are shared.

3. Can you talk about trauma in healthcare, especially violence and aggression from patients?

This is one of the critical incidents the team is often contacted in order to provide support to staff for defusing or debriefing - that’s on a regular basis outside the pandemic. This has a very significant impact on nurses, there are multiple studies and reports that the risk for PTSD, depression and anxiety is higher in nursing and often because of the violence that’s experienced.

4. Can you talk about coping with COVID at work? Like counselling for coworkers and patients.

  • For colleagues that would be psychological first aid at work and we’re working on getting trained boots on the ground to support that. There need to be trained health care workers dispersed throughout the province and there are trainers out there working on offering classes.
  • What we do for patients is to continue to support them and validate the fear of the experience and offer the same care and compassion that we always have.

 

5. Can you give some ideas for how not to bring work stress home?

Sometimes having a transition ritual helps. One colleague made a point to take off their watch leaving work - that watch was mentally linked to timed events like vital signs, medications, and strict work schedules, taking it off signalled to them that their own time was their own and not managed. Consider what is a thing that we do to reset our bodies or mind like a period of deep breathing when you get in your car, while you drive home or before you get out of your car when you get home. We teach kids to do this with a bedtime routine and these transition rituals can be helpful for everyone looking to make the most of the time we have.

6. How can we deal with other people’s negativity especially when trying not to have nursing students see that type of environment?

Negativity is a stress reaction and nurses jobs are stressful. It may seem kind to shield a student from that but it might be more useful for them to have you acknowledge it and then you can have a conversation about navigating it and coping skills including not internalizing other people's stress.

7. Can you suggest some techniques to destress?

  • The techniques that have really robust empirical evidence are things like deep breathing, stretching… it’s important to know yourself and what helps you destress. Think about what movie gets you laughing every time you watch it, or is there a way of moving your body that you know makes you feel better after every time.
  • Have a look at the printable pocket card on the Shared Health website for more ideas (linked above in the summary).

 

8. Can you give us some conflict resolution tips?

One big shift is being curious in conflict. Often we or the other party has decided that something needs to be done, or not done. We can be curious and explore what’s going on for both of us and not need to make a big decision in the middle. Pressing pause is an important skill, it’s okay to take a break and reflect before regrouping and moving forward.

9. How can we access psychological first aid?

In Winnipeg you can connect with Sandi Mitchell. Otherwise training will be fanned out from the provincial table.

10. Can you comment on Manitoba’s healthcare response to the COVID pandemic? We are fortunate to have a low number of cases and deaths compared to the rest of the world, is the stress still high and similar to harder hit regions?

  • There is literature around public health disasters, particularly SARS. The geographical areas that had the most stress reactions and most difficult outcomes re: depression and anxiety were places that were hardest hit like Toronto. Even within hard hit areas it depended where in the health system a person worked with clinical areas like critical care and emergency demonstrating more stress reactions and higher rates of difficult outcomes.
  • In our province because we don’t have a lot of cases right now this is an opportunity to fortify our practices - this pandemic isn’t over and will continue to underlie the decisions we make now and the plans we make for the future. We can still engage in catastrophic thinking so we need to be resetting our minds and bodies now with these practices so we can have them ready.

 

11. Are there any counsellors or psychologists who are specializing in this area?

There is the provincially offered AbilitiCBT which is psychologically based. You could look at the Manitoba Psychology Society to see if anyone is specializing. Psychologists and counsellors may also rely on traditional methods like CBT. The Anxiety Disorders Association of Manitoba has a phone line specifically for people with COVID-19 anxiety. Can check the Shared Health COVID-19 Mental Wellness page. Dr. Maxine Holmqvist, a psychologist, shared two Talk Tuesday presentations in April, they are a great place to look too.

Resources

Click on the titles below to access the resources.  

Shared Health
Resources are constantly being added and updated on Shared Health -  see the section: Mental Health resources for health-care workers and the public.

Blue Cross Employee Assistance Program ‘Connect Now’for Shared Health
Click above or call 204-786-8880 or toll free 1-800-590-5553.

Doctor’s Manitoba and MD Care
(available to physicians and their families)
Click above or call 204-480-1310 for intake.