A critical-incident stress debriefing program for hospital-based health care personnel.

Abstract

Although occupational stress exists in all work situations, the intensity and emotional demands of the health care environment and patient care service delivery in often life-threatening situations place exceptionally high performance expectations and stress on health care providers. Stress associated with dramatic, emotionally overwhelming situations, known as critical incidents, can overcome professionals' normal coping mechanisms, particularly following the injury or death of colleagues, loss of life after extraordinary and prolonged professional interventions, actual or potential threats to professionals' well-being, or emotionally charged crises such as sudden and pediatric deaths (Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). The effects of critical-incidents stress on health care professionals can pose potentially life-threatening hazards to patients, families, or other staff who rely on the competent delivery of timely, complex, and safe interventions (Graham, 1981; Neale, 1991; Patrick, 1981; Robinson, 1986; Spitzer & Neely, 1992). Symptomatology associated with excessive acute or sustained stress may include cognitive impairments such as diminished memory, decision-making capacity, and attention span; emotional reactions of increased anger, irritability, guilt, fear, paranoia, and depression; and physical problems ranging from fatigue, dizziness, migrane headaches, and high blood pressure to diabetes and cancer. Self-destructive and antisocial behavior may also be triggered (Everly, 1990; Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). Professional intervention that addresses occupational stress of hospital personnel becomes crucial to safeguard quality patient care; to maintain employee health; and to reduce organizational costs associated with malpractice litigation, employee turnover, and use of employee health care benefits because of work-related illnesses or injuries. Such concern has contributed to expanded use of employee assistance programs and other supportive interventions (Blair, 1985; Howard & Szczerbacki, 1988; Kunkler & Whittick, 1991; Matheson, 1990; McCue & Sachs, 1991; Mitchell & Bray, 1990). Hospital-based social work departments have offered employee counseling, stress management education, and team development training (National Society for Hospital Social Work Directors, 1987; Spitzer, 1985). Notwithstanding the important contribution of social work in responding to work-related stress among health care professionals, limited evidence suggests the use of critical-incident stress (CISDs) as an intervention option in health care settings. This article reviews the individual and institutional effects of critical-incident stress on health care delivery and use of stress education, defusings, and debriefings as effective interventions with health care personnel. The successful efforts of a social work department using these techniques in a major university hospital system are presented as a model for replication in similar settings. CRITICAL STRESS INTERVENTION Substantial evidence exists that stress management programs can ameliorate psychological and behavioral factors that are adversely affected by excessive stress (Everly & Smith, 1987). During the past 15 years, the Mitchell model of CISD has proved to be an effective stress management intervention with emergency professionals (Mitchell, 1985, 1986a; Mitchell & Bray, 1990; Spitzer & Neely, 1992). Nearly 300 CISD teams exist in the United States, offering intervention to fire, paramedic, police, and other emergency first-responder personnel (American Critical Incident Stress Foundation, 1992). CISD teams of specially trained mental health and peer support professionals use defusings and to provide ventilation of feelings, emotional reassurance, education regarding stress awareness and reduction techniques, consultation, and referral assistance to distressed personnel (Mitchell, 1982, 1983, 1986a; Mitchell & Bray, 1990). …