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Verbal debriefing after a traumatic incident may interrupt the natural adaptive processes that help people to deal with such incidents. This article examines the effectiveness of written interventions to help people experiencing distress after trauma experienced at work. As an alternative to critical incident debriefing, the authors recommend a staff education programme in tandem with written disclosure.
key words
Occupational stress
Post-traumatic stress
These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.
NURSING STAFF are often involved in traumatic incidents. They may witness fatalities, major injuries or emergency medical procedures and their consequences. There is increasing evidence that witnessing such traumatic events can have negative consequences. Psychological symptoms include flashbacks, poor sleep, irritability and depression. Physical symptoms include hypertension (Hahn et al 1993). In some cases the psychological distress may warrant a diagnosis of post-traumatic stress disorder (PTSD).
Critical incident debriefing Some hospitals provide a critical incident debriefing service, where people are encouraged to talk about the traumatic experience. Such interventions have reduced the number of psychological problems, including PTSD, experienced after incidents. In the debriefing process, the person relives the traumatic event, usually prompted through a verbal question and answer format. This approach assumes that it is better to talk about and relive the event, than to repress and deny it. Debriefing generally requires a skilled therapist with specialist training.
However, evidence from clinical experience indicates that holding this critical incident debriefing close to the time of the trauma may be unwise. It is possible that debriefing may increase levels of psychological distress in the short term. The process of debriefing may also suggest to the person that the incident has the potential to become 'a problem' for them. Debriefing may interrupt perfectly adaptive processes that enable people to deal with incidents and move on with their lives. Perhaps they would cope well enough alone without debriefing.
Written disclosure How else can we help staff to cope when they are exposed to traumatic incidents? A recent development is a technique known as 'written disclosure' where the person writes about the event, usually over a number of days, instead of talking about it with a therapist.
Many medium-term...