Debriefing-An reinforcement into your organization’s trauma informed principles

A traumatic event is one that poses a significant threat to life or mental stability. It can happen not just to the service users but also to the service providers especially those working in mental health inpatient settings.

Why debriefing is important?

Recently while working on an acute inpatient floor setting, a fight broke out in the milieu among the clients causing blood all over the hallways.  The unit was a bit short staffed and it took us a while to finally separate the clients.

A few days after, there was another episode where a client went on a destruction rampage,  throwing off furniture, boxing and kicking whoever came his way and running around in every direction possible.

In both the instances, minimal damage was done and the situation was ultimately brought under control.  What was not under control were my emotions.  I spent the nights on both occasions, tossing and turning, replaying the incidents over my head imagining different more catastrophic outcomes each time.

Has it ever happened to you?

Do you see the same stressful situations playing out again and again?

If you have sincerely answered ‘YES’, to the above questions, perhaps you and I have both missed one very important step in crisis control, that is debriefing.

What is debriefing?

Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma exposure. Debriefing allows those involved with the incident to process the event and reflect on its impact.

Debriefing gives us a closer look into the patterns that led to the traumatic event.  This helps the organization to investigate any repeated patterns and implement remedial measures which can further strengthen the team’s or the individual’s responses to similar situations in the future.    When we as a team get together to debrief following a traumatic event; we share ideas, feelings and emotions; we offer support and encouragement to one another; and express trust and confidence in our team members. Most often than not, it provides a closure to the overwhelming emotions the event might have caused.  It not only helps build stronger teams but also resilience among individual members.   

When is debriefing effective?

Research has shown that debriefing done the sooner the better the results.  However, to be effective, it should be done within 72 hours of the incident to mitigate any long term effects in the individuals concerned.

What happens when a debriefing is ignored or forgotten?

Absenteeism and decreased productivity among the staff members, a sense of dissatisfaction, and a high turn over among staff are common if individuals are not empowered with coping and management skills following the critical incident.

–Secondary Post Traumatic Stress

Secondary trauma or care giver trauma after a disturbing episode is often manifested in a number of stress-related symptoms such as exhaustion, sleep disturbance, loss of appetite, headaches and lack of concentration at work.

 Different people react differently to triggers; for some of the people, trauma could also mean restlessness, fatigue, frustration, fear, guilt, blame, grief, moodiness, sleep disturbance, eating disturbance, muscle tremors or “ticks,” reactive depression, nightmares, profuse sweating episodes, heart palpitations, vomiting, diarrhea, hyper-vigilance, paranoia, phobic reaction and problems with concentration or anxiety.

Serious reactions to stressors or trauma may also include shock, denial, anger, rage, sadness, confusion, terror, shame, humiliation, grief, sorrow, and even suicidal or homicidal ideations.

Furthermore, disengagement of nurses in patient care or over involvement is also seen as a nurse’s response to care giver trauma.

Although some of these symptoms may be overt and easily detected, often times there are instances when certain symptoms gradually surface and become part of crisis reactions in the future.

Who should be debriefed?

1. Patients should ideally be debriefed following a restraint/seclusion episode and given a chance to describe their version of the events following the episode.  Both the aggressor and the victim should be allowed to relate their version of the event to help better understand the clients underlying triggers and their coping skills.  That’s when we bring the best practices from trauma informed care to clinical practice.

Speaking from experience, during a routine patient tracking, I once saw a client hold one of his peers in a chokehold near the unit visitor’s room.  I calmly asked him to let go but he wouldn’t comply.   I called for help and had the patient placed in the ERC.  After all the essentials were completed, I went back to the aggressor to talk to him about what happened.  He told me his version of the story and I was left speechless.   He told me that all he wanted to do was to prevent the other person from eloping.  Turns out; the other client had visitors and was happily going to visit with them (the visitors room is near the exit door) when this client thought he was eloping with them and caught him.  Although the incident could have led to dangerous outcomes, the client’s intent was clear.  This knowledge will definitely help treatment teams implement better treatment plans

• Staff members involved in the incident should be debriefed following a difficult or a traumatic episode.

How to debrief?

Never underestimate the importance of having a quiet space, away from the place where the incident has taken place, to conduct or receive debriefing or support. It is also important that the debriefing be facilitated by a trained person and conducted among the peers or colleagues who were involved in the incident.