Crisis and Critical Stress Crisis and Critical Stress ManagementManagement

Spiritual Care Champions 2010-2011Spiritual Care Champions 2010-2011

November 10, 2010November 10, 2010

Tim Serban, Vice PresidentTim Serban, Vice PresidentMission Integration & Spiritual CareMission Integration & Spiritual Care

Providence Regional Medical Center Everett, WAProvidence Regional Medical Center Everett, WA

““Heal Thyself” ?Heal Thyself” ?

“ Until we recognize that we are in need of healing ourselves and recognize in the weakness of our patients, a weakness not unlike our own, we will never be very good healers.”

Ethicist /Theologian Daniel Sulmassy, OFM

Learning Objectives for Learning Objectives for Spiritual Care ChampionsSpiritual Care Champions

1. Define a Critical Incident & Grief Event

2. Understand typical Interventions of Critical Incident

3. Who to include in a Critical Incident Stress Debriefing?

4. Supporting staff in Grief?

5. Basic Principles of “Self Care” in ongoing disasters.

What is a Critical What is a Critical IncidentIncident

• Any event that overwhelms the senses and dramatically affects one’s ability to cope.

• Any experience of a traumatic nature which renders a person stunned, disoriented, helpless or even with a feeling of loss of control.

GriefGrief

A multidimensional response to loss; particularly here we are referring to the death or loss of a person with which a bond was formed.

Critical Incident ExamplesCritical Incident Examples

• Sudden unexpected shooting of a patient in the ICU

• Hostage situation in the Emergency Room with gunman and S.W.A.T team involved.

• Traumatic death of a child at the hands of their parent

• Armed-robbery of our pharmacy

Hopkins Shooting Makes Caregivers Aware of Stresses, Vulnerability AP 9-20-2010

U.S. Man charged for ER Nurse Manager Murder (Sydney, Australia) May 20, 2010

POLICE have charged an American man with the murder of Sydney Australia nurse three weeks after she was found lying in a pool of blood on the doorstep of her home.

Detectives interviewed a registered nurse, three times after the murder and spent two days last week forensically investigating his apartment in Lane Cove.

AP - Family of Slain RN Grieves

Types of IncidentsTypes of Incidents

• Violence in the Workplace

• The Sudden Death of a Co-worker on-site

• The Traumatic Death of a Co-worker on-site

• The Injury or Death of a Child in E.R.

The Injury or Death of a ChildThe Injury or Death of a Child

• “In a survey, healthcare providers were asked what were the 10 worst things about the job? Without exception the top two responses were the injury of a child and the death of a child.”

Cordiero 1995

Patient Safety and Staff Patient Safety and Staff RecoveryRecovery

• How soon is the CISM response initiated?

• How does CISM impact staff recovery?

• What kind of follow-up is offered?

• How is the CISM program connected with EAP?

• How does the CISM team interface with Risk Management?

CISM IsCISM Is

• An Emotional Debriefing designed to mitigate the effects of the critical or traumatic incident thus reducing the chance of Post Traumatic Stress Reactions.

• Is a chance to speak about my reaction to this event.

• Is confidential and safe. • Is effective when used properly

Role of the Chaplain in Role of the Chaplain in Grief EventsGrief Events

• A grief event requires a coordinated and focused response often led by the Chaplain. However, a debriefing is not used in such situations.

• Grief events require honoring the life of the person through rituals, events and gatherings that chaplains are often key to supporting those involved

Grief Event - ExamplesGrief Event - Examples

• Anticipated Death of a long-term employee

• Sudden unexpected death of an employee at home

• Shooting of a co-worker at home or outside of the work environment

• Auto-Accident death of a co-worker and family outside the area

Complicated GriefComplicated Grief

• Complicated grief is the grief of individuals and situations that may not be easily acknowledged by society

• Still-birth• SIDS death• Conflicted family and patient diagnosis • Murder/Suicide• Parents/Children of Death Row inmate

Proximity of those Proximity of those exposed to the eventexposed to the event

• Who witnessed the event?

• Who needs to be included in the critical incident stress debriefing

• Who have we forgotten? (Lab, RT, housekeeping, MD, admitting, chaplain, cath lab, Security, interns, volunteer, MSW, EMT, M.E.)

• Who should not be included? (NOK)

Action-Planning before Action-Planning before and Event Occursand Event Occurs

• What are our current resources?

• Does our EAP include CISM?

• Who in our organization has been trained in CISM interventions?

• How can we partner with Social Work and Mental Health professionals now to plan ahead?

Plan a TrainingPlan a Training

• The International Critical Incident Stress Foundation ICISF.org provides training sites around the world

• Consider having key staff trained in CISM techniques (2-3 days)

• Explore Psychological First Aid training with the American Red Cross designed for the general public

Planning Immediately Planning Immediately After a Critical IncidentAfter a Critical Incident

“Necessity is the mother of invention”

• Unfortunately we may only think about fixing the problem after an event occurs.

• So think now, who is a key leader that you can target soon after an event occurs?

What to do now?What to do now?

• Create a quick and easy handout for patients and staff alike about the “Emotional Aftershocks” we can expect following a critical incident or disaster.

• Have enough handouts on hand and provide one to each employee impacted before they leave their shift.

Quick & Easy HandoutQuick & Easy Handout

Plan to be OverwhelmedPlan to be Overwhelmed

Like a critical incident, when a larger disaster occurs, often chaplains feel unprepared for what to do, due to the nature of a the event.

Hurricane KatrinaHurricane Katrina Field HospitalsField Hospitals

Airport Hospital Airport Hospital Disaster Triage Disaster Triage

Existing Hospitals Existing Hospitals

Photo Courtesy of FL-3 DMAT

Photos Courtesy of Hurricane Katrina.com

Temporary Hospital Temporary Hospital Hurricane Katrina Hurricane Katrina

•(Photo Courtesy LSU, NIH)

Pete Maravich Assembly Center

Louisiana State University (LSU)

Baton Rouge, Louisiana

Plan to be OverwhelmedPlan to be Overwhelmed

• Start Slow

• Plan Ahead

• Remember Self-Care

• The Basics: Eat, Sleep and Breathe

• Review the Disaster Spiritual Wisdom Sayings

Disaster Spiritual Care Disaster Spiritual Care Wisdom SayingsWisdom Sayings

1. “No one who witnesses a disaster is untouched by it”

2. “Draw the lines before you jump or you will end up in an overwhelming sea of need”

3. “People don’t care how much you know until they know how much you care”

Disaster Spiritual Care Disaster Spiritual Care Wisdom SayingsWisdom Sayings

4. “The best initial spiritual assessment is “How You Doin?”

5. Finally, “Let them Pound on God’s Chest, the Creator of the Universe can take our anger.”

The only thing tougher than planning for The only thing tougher than planning for disasters is explaining why you didn’t...disasters is explaining why you didn’t...

Questions, Comments, Interests?

ResourcesResources

• Handout for Survivors of a Disaster (Tim Serban)

• Disaster Spiritual Care – (Ashley, W. & Roberts, S. (2008) Skylight Paths, Woodstock, Vermont)

• The R.E.D. Guide to Recovery –www.theredguidetorecovery.com (Scott,S. (2010) Dewitt Publishing, San Diego, CA)

• Caregiver’s Grief Guide Handout– Faith & Fear Factors© (Serban, T, 2004)

• International Critical Incident Stress Foundation Ellicott City, Maryland www.ICISF.org

• American Red Cross – www.redcross.org