You may have been involved in a traumatic incident at work which was highly stressful. It is normal to have a whole host of feelings following a traumatic incident. Your reaction may be worse if:
- you have stresses in your life
- you have experienced previous trauma
- you doubt your contribution
- you feel unsupported in your role
Critical incidents have the potential to cause psychological trauma for any member of the team involved, in fact most will have experienced past traumas which they continue to carry with them, and these increase our vulnerability.
Studies have shown that by allowing staff the time and opportunity to process these incidents we can hopefully reduce their impact and longevity.
Staff wellbeing is fundamental to patient safety which is why we have introduced the ‘Check Out’ campaign.
What is Check out?
The Check Out initiative aims to improve awareness of the psychological impact of trauma on staff to encourage people to access support if needed and to normalise conversation about our reactions to the stressful incidents we experience.
It’s time to ‘Check out’
After every incident where any staff member feels that the team may have experienced stress, we should take a few minutes to ‘Check out’ before staff return to their duties.
This need not and can not take more than a few minutes or the process will not occur. Ongoing patient care is of course essential and therefore on some occasions, eg. Patient being rushed to CT, the ‘Check out’ may need to be separated into different fractions of the original team but should still be conducted and prioritised.
Staff should ‘Check out’ using the memory aid AEIOU
- A – Acknowledge the Stressful Nature of the Incident
- E – Explain the facts of what has just happened
- I – Inform staff of the common symptoms of an Acute Stress Reaction which they may experience in the next few days
- O – Overview of coping strategies and awareness of avoidance behaviour
- U – YOU are Important – therefore please access support if you need to.
AEIOU explained
A – Acknowledge the Stressful Nature of the Incident
It is important to recognise that with experience we develop resilience and that whilst I may not find a particular case stressful, there are inevitably staff present who will. This is often the least-responsible person present, who may never have seen this before.
E – Explain the facts of what has just happened
In recognition of the point above, if members of the team do not fully understand decisions being made by the senior team members, they are more likely to struggle when reflecting on the case.
We do not always have all the information regarding what has caused a patient to collapse at the time, and hence clinical and process learning from the case needs to be explored later. At the time staff only need a brief summary of the facts that are known. This does not need to be a long explanation and is arguably not the right time to delve into clinical or system failings.
I – Inform staff of the common symptoms of an Acute Stress Reaction which they may experience in the next few days.
At the time of a stressful incident the majority of individuals will experience a flight, fight or freeze response. In healthcare we train to use this adrenaline surge to act and we simulate emergency scenarios to help staff to function well during times of stress.
Emotionally we are often numb at the time and utilise our past training and experience to autopilot through these situations. The Acute Stress reaction usually follows later, either the same day or in the days that follow. During this time it is common for people to ruminate over the event. This can include experiencing intrusive thoughts or dreams and can lead to sleep disturbance with trouble falling asleep and waking early thinking of the stressful incident. Common emotional consequences include feeling more irritable or tearful.
It is human nature to avoid situations where stress has occurred, and this can lead to avoidance behaviour to reduce the risk of further exposure. Physical symptoms can include sweating, palpitations and hyperarousal where one expects further stresses. This is all a normal part of processing being involved in a stressful incident but can leave one feeling very tired. When tired, we are more likely to make mistakes and so acknowledging this in ourselves and asking our team to support during this time is really important.
O – Overview of coping strategies and awareness of avoidance behaviour
It is sometimes tempting to use drugs or alcohol to facilitate relaxation. Staff must be warned of the dangers of this and encouraged to be self-aware in terms of utilising substances to manage their emotions.
U – YOU are Important – therefore please access support if you need to
Staff should be signposted to the Check out webpage on Staffnet to explore support options and choose the most appropriate one for them. Encourage staff to talk about anything that has caused them to feel upset or stressed. Clearly the case must remain confidential, but staff are allowed to talk about the things they experience at work. This can be with friends or family, but all could benefit from identifying a Critical Friend who is someone who understands your role and who you trust to listen and support you.
Staff can always speak to a senior colleague or your local ‘check out’ champion. Often by talking it through with a colleague who works with you, can help to validate you reactions and may enable you to better process any concerns you have about the case. You can also access more formal independent support through Occupational Health or agencies including Sussex Staff In Mind.
Check out Champion
‘Check out’ champions are members of your team who have volunteered to provide a listening ear to members of their team to discuss difficult cases. A ‘Check out’ champion helps to promote and demonstrate this initiative within their own departments and to analyse and address barriers to the ‘Check Out’ taking place.
Become a ‘Check Out’ Champion
We continue to recruit interested and motivated staff members across the Trust. If you are interested in becoming a ‘Check out’ Champion please contact [email protected]. Ideally the ‘Check out’ Champions will include representatives from all disciplines within the team and will include clinical and non-clinical staff members.
Additional support services
- Download the support leaflet: Psychological support for staff following a traumatic incident
- Counselling and psychotherapy available through the Staff Psychological Support Service
- The Chaplaincy Team are available to listen
- Mental Wellbeing resources (e-Books, Webinars and more)
- Citizens advice: 01243 784231
- Samaritans: 116 123
- NHS: 111
Qudos
Qudos is a recognition scheme developed by a consultant working at UHSussex that’s designed to make it easy to say thank you to a colleague.
It embraces a culture of positivity, kindness, gratitude and learning from excellence. In fact, it’s from the Learning from Excellence initiative that the idea was created. It focuses on what we’re doing well at UHSussex and in a way that others can learn from.
More information about Qudos and how to send one…