Incident Stress Research Articles

Pediatric Emergency Department Staff Preferences for a Critical Incident Stress Debriefing

IntroductionThere are significant and negative psychological effects that can occur in nursing staff caring for pediatric patients experiencing critical incidents. Debriefings can provide relief from the stressors caused by critical incidents. Adapting a pre-existing critical incident stress debriefing (CISD) process to ED staff is 1 way to provide staff debriefing. MethodsThis qualitative study used an emerging, descriptive design. Focus groups, (n = 3, total participant n = 19), consisting of pediatric emergency nurses and a nursing assistant, met for a minimum of 63 to a maximum of 83 minutes. Participants provided feedback on current debriefing strategies and suggestions for adapting a currently existing critical incident stress- debriefing process. Focus group questions included “Have you participated in a structured debriefing process? If so, tell us about it” and “What would you like to see in a structured debriefing process?” ResultsA theoretical orientation content analysis revealed 1 main theme—Clearing the Air and Finding Answers—and 6 subthemes: Current Debriefing Strategies; Positive Reinforcement; Constructive Critique; Clinical, Not Emotional; I’ve already moved on; and CISD Structure. DiscussionPediatric ED staff de-stress in a variety of ways, and a nonmandatory, formalized CISD process—open to staff involved and facilitated by an emergency nurse—could provide additional relief from stress. This debriefing process should include positive feedback and critiques to help improve care processes, information about mechanism of injury, and should occur before the end of shift or within 12 to 24 hours of the incident. Staff may deal with personal feelings outside of debriefing.

Shootings at Pittsburgh Synagogue Raise Anxiety Over More Hate Crimes

Shootings at Pittsburgh Synagogue Raise Anxiety Over More Hate Crimes

Comprehending Crisis Intervention among Helpers

Crisis applies when an individual experiences a trauma or tense situation that causes imbalance, disorganization and disorientation. Failure to oversee the crisis brings a negative impression to the whole self. This study involved 25 crisis helpers as respondents and all of them are registered counselors in Malaysia. Data are collected through semi structured interviews. The open questions in semi structured interview were used to identify information on 1. the meaning of crisis, 2. the process used to handle crisis intervention; 3. the model of crisis intervention used among helpers. Results showed that respondents’ comprehending of crisis were quite accurate and varied depending on situations experienced. They also had some brief ideas on how the process should be implemented to handle crisis cases. However, only nine out of 25 helpers specifically mentioned that they used models such as Roberts’s seven stages, Gilliland six steps, Kubler Ross, Critical Incident Stress Debriefing to handle crisis intervention cases. Meanwhile, 19 helpers used counseling theories such as Cognitive Behavioral Therapy (CBT), Reality Therapy (RT), Psychological First Aid (PFA) and basic attending counseling skills. This study indicates that helpers need more knowledge and training on crisis intervention. They also need to comprehend process to handle crisis intervention cases in appropriate and structured ways. Development of a crisis intervention model that suits Malaysia’s culture would be most preferable and later utilized as a guide for helpers and counselors in dealing with event of crisis.

Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews

Objectives(i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims,...

Effect of the debriefing and defusing in critical incidence stress care

Effect of the debriefing and defusing in critical incidence stress care

Active Shooter Training in the Emergency Department: A Safety Initiative

ProblemActive shooter incidents are becoming more common, and although they are still rare compared with other shooting sites, incidents have increased in health care facilities. Agencies such as the Federal Bureau of Investigation, The Joint Commission, and the Emergency Nurses Association have emphasized that an action plan and training are essential for hospital preparedness. MethodsPlanning an active shooter simulation for the emergency department was a complex project and involved collaboration between the hospital’s Emergency Management team, simulation staff, security, and ED leadership, which included the educators and clinical nurse specialist. Decisions were made related to appropriate location, equipment, and needs for the functional exercises. Scenarios also were developed with roles for the ED population and actors. ResultsA total of 204 staff members participated in the simulations between August and December of 2016. A survey was distributed to staff who attended the simulation. Ninety-two percent of staff felt more prepared to respond to an active shooter event and reported a 70% improvement in knowledge and preparation. Attendees reported their first response would be to flee the scene (66%), protect patients (15%), hide (7%), fight (6%), and call 911 (4%). Implications for PracticeThe active shooter education included a didactic portion, a pre- and postsurvey, and the simulation event. The presentation focused on statistics of active shooters, possible threats, and the concepts of RUN, HIDE, and FIGHT. A Critical Incident Stress Management team member was present to ensure the emotional and psychological health of the participants. The debriefing was a crucial part of the simulation experience so staff could talk about their experience and express their concerns.

NUMERICAL SIMULATION OF STRESS WAVE PROPAGATION IN SAP CONCRETE

The SAP (Super Absorbent Polymers) concrete is a new kind of concrete materials with uniformly distributed spherical pores with diameter of millimetre-size. The study on propagation characteristics of SAP concrete is important to give a full comprehending of its dynamic mechanical properties.Based on the ABAQUS platform, the numerical model to simulate the propagation of stress wave in SAP concrete was established by introducing the function of dynamic compressive strength increment DIF-fc,r caused by strain-rate effect of the material itself and strain rate into the expanded Drucker-Prager model. Totally six kinds of triangle stress wave have been investigated, and the transmitted stress wave for each triangle incident stress wave through different pressure bars has been analysed. Based on the numerical calculation, the laws of attenuation and dispersion effect on stress waves in the SAP concrete with evenly distributed millimetre-size spherical pores inside have been analysed.

MP08: A novel measure to capture transactional stress in paramedic services

Introduction: In the past few years, there has been an increase in awareness of the challenge of managing work related stress in EMS. Extant research has liked different types of chronic and critical incident stress to stress reactions like posttraumatic stress. However, there is no tool to capture the transactional stresses which are associated with the day to day provision of service (e.g., dealing with offload delays or mandatory overtime) and interacting with allied professions (e.g., emergency department staff) or allied agencies (e.g., law enforcement). The purpose of this study was to develop and validate a measure which captured transactional stresses in paramedics Methods: An online survey was conducted with ten Canadian Paramedic Services with a 40.5% response rate (n= 717). Factor analysis was used to identify variation in responses related to the latent factor of transactional stress. The scale was validated using both exploratory and confirmatory factor analyses. Results: The sample of transactional stress questions was split to allow for multiple analyses (EFA n=360/ CFA n=357). In the exploratory factor analysis, principal axis factoring with an oblique rotation revealed a two-factor, twelve item solution, (KMO=.832, x2=1440.19, df=66, p<.001). Confirmatory factor analysis also endorsed a two factor, 12 item solution, (x2 =130.39, df=51, p<.001, CFI=.95, TLI= .93, RMSEA= .07, SRMR= .06). Results supported two groups of six-item factors that captured transactional stress in the provision of service. The factors, clearly aligned with transactional stress issues internal to the ambulance and transactional stress relationships external to the ambulance. Both subscales demonstrated good internal reliability (= .843/ =.768) and were correlated (p.01) with a convergent validity measure. Conclusion: This study successfully validated a two-factor scale which captures stress associated with the day to day provision of EMS and the interaction with allied professions. The development of this measure of transactional stresses further expands the potential that paramedics, Paramedic Services, employers, and prehospital physicians may understand the dynamics that influence provider health and safety. As a result, there may be greater opportunities to intervene holistically to improve paramedic health and well-being.

Suicide Prevention in U.S. Law Enforcement Agencies: a National Survey of Current Practices

Increasing attention is being paid to suicide among law enforcement officers, and how the agencies that employ these officers could prevent such deaths. This study presents the results of a national survey of U.S. law enforcement agencies’ strategies for preventing officer suicide. We invited 177 agencies from across the United States to be interviewed, and 110 agreed to participate in qualitative interviews. Agencies were grouped into one of four categories based on the services they offered. Agencies offered minimal (a municipal employee assistance program), basic (mental health, critical incident response procedures, and training), proactive (in-house mental health care, embedded chaplains, substance misuse programs, peer support, screening, or health and wellness programs), and integrated services (integration of services into day-to-day operations). The results indicate that many U.S. law enforcement agencies are engaged in efforts to promote officer wellness and prevent suicide. Officers’ perceptions of confidentiality may inhibit the use of in-house or contracted mental health services, while a weak or inconclusive evidence-base raises questions about common approaches like peer support or critical incident stress debriefing.

Connecting the dots between breast cancer, obesity and alcohol consumption in middle-aged women: ecological and case control studies

BackgroundBreast cancer (BC) incidence in Australian women aged 45 to 64 years (‘middle-aged’) has tripled in the past 50 years, along with increasing alcohol consumption and obesity in middle-age women. Alcohol and obesity have been individually associated with BC but little is known about how these factors might interact. Chronic psychological stress has been associated with, but not causally linked to, BC. Here, alcohol could represent the ‘missing link’ – reflecting self-medication. Using an exploratory cross-sectional design, we investigated inter-correlations of alcohol intake and overweight/obesity and their association with BC incidence in middle-aged women. We also explored the role of stress and various lifestyle factors in these relationships.MethodsWe analysed population data on BC incidence, alcohol consumption, overweight/obesity, and psychological stress. A case control study was conducted using an online survey. Cases (n = 80) were diagnosed with BC and controls (n = 235) were women in the same age range with no BC history. Participants reported lifestyle data (including alcohol consumption, weight history) over consecutive 10-year life periods. Data were analysed using a range of bivariate and multivariate techniques including correlation matrices, multivariate binomial regressions and multilevel logistic regression.ResultsEcological inter-correlations were found between BC and alcohol consumption and between BC and obesity but not between other variables in the matrix. Strong pairwise correlations were found between stress and alcohol and between stress and obesity.BMI tended to be higher in cases relative to controls across reported life history. Alcohol consumption was not associated with case-control status. Few correlations were found between lifestyle factors and stress, although smoking and alcohol consumption were correlated in some periods. Obesity occurring during the ages of 31 to 40 years emerged as an independent predictor of BC (OR 3.5 95% CI: 1.3–9.4).ConclusionsThis study provides ecological evidence correlating obesity and alcohol consumption with BC incidence. Case-control findings suggest lifetime BMI may be important with particular risk associated with obesity prior to 40 years of age. Stress was ecologically linked to alcohol and obesity but not to BC incidence and was differentially correlated with alcohol and smoking among cases and controls. Our findings support prevention efforts targeting weight in women below 40 years of age and, potentially, lifelong alcohol consumption to reduce BC risk in middle-aged women.

A versatile split Hopkinson pressure bar using electromagnetic loading

This paper presents a novel electromagnetic split Hopkinson pressure bar (ESHPB), which employs the electromagnetic energy conversion technique of LC circuit to generate directly the incident stress pulse.Such a versatile technique can generate easily compressive as well as tensile incident pulses. The duration and amplitude of the incident pulse could be controlled by adjusting the capacitance and charging voltage in the LC circuit. Therefore, compressive or tensile high strain-rate tests can easily be performed using the present apparatus by simply choosing the compression bars or tension bars.The primitive shape of generated stress pulse is a half-sine function, which is well suited for testing brittle materials and soft rubber-like materials in order to reach a rather constant strain rate. Meanwhile, for the tests of metals, a pulse shaper can be used to reach a rather classical trapezoidal pulse similar to that of the classical pressure bar tests. Furthermore, it is also possible to modify the stress pulse by shaping the discharge current using a specially designed active coil array and a sequential switch.Finally, a number of different materials were tested in compression and tension using this electromagnetic split Hopkinson bar system. The same materials were also tested using the traditional split Hopkinson bars. It turns out that the results obtained by the present device are consistent with those by the traditional split Hopkinson bars.Compared with traditional pulse generation techniques by the impact of a projectile or by a sudden release of a pre-stressed section, the proposed electromagnetic energy conversion technique can be accurately triggered within several microseconds. It is, therefore, a good candidate to supply the symmetrical and synchronous loads in bidirectional or biaxial split Hopkinson bar systems in the future.

Revisiting the Compassion Fatigue, Burnout, Compassion Satisfaction, and Resilience Connection Among CISM Responders

Previous research by Burnett and Wahl found that resilience moderately mediated the association between compassion fatigue (CF) and burnout (BO) among trauma responders. No studies have attempted to replicate and verify the research results of Burnett and Wahl. This study examined whether similar patterns of resilience, CF, BO, and compassion satisfaction (CS) would be found among a convenience sample of disaster behavioral health (DBH) responders ( N = 70) attending an annual Critical Incident Stress Management training conference in Michigan. Measures included the 30-item Professional Quality of Life Scale, the 14-Item Resilience Scale, the Response to Stressful Events Scale, and a demographic questionnaire. Similar to the Burnett and Wahl’s study, resilience was found to have a significant negative correlation between CF and BO. Mediation analysis similarly found that resilience moderately mediated the relationship between CF and BO among both resilience measures.

Postoperative delirium incidence and oxidative stress in laparoscopic surgery

Postoperative delirium is a common complication of all types of surgery, especially in elderly patients (2). Overproduction of free oxygen radicals and decrease of organism defense mechanisms is believed to be involved in multiorgan failure, especially in the brain (4). It is important to determinate the susceptibility, incidence and preventive measures for postoperative delirium (8). Our objective was to identify an oxidative stress indicator that predicts the appearance of postoperative delirium in patients that undergoes laparoscopic renal or gynecological surgery for malignant diseases and the possible correlations between certain anesthetic drugs and postoperative delirium occurrence. This study included 29 patients that were treated for localized kidney or uterine cancer by trans peritoneal laparoscopic radical surgery procedures (nephrectomy or hysterectomy) between 2014 and 2016. They were randomized in two groups: the sevoflurane group (n=14 patients) and propofol group (n=15 patients). Blood samples were collected before anesthesia induction, at the end of surgery and at 24 h after surgery and the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Postoperative delirium was assessed using Confusion Assessment Method for the ICU (CAM-ICU). All patients with delirium from both groups developed the condition on the first postoperative day. In the sevoflurane group, postoperative delirium has observed in 6/14 patients (42%) and in the propofol group, 5/15 patients (33%) have developed the same postoperative syndrome. There was a significant increase of malondialdehyde levels in the delirium group compared to the non-delirium group in patients, sevoflurane and propofol, at the end of surgery. (p<0.05) There were statistical difference between delirium group and non-delirium group in both sevoflurane and propofol patients, regarding superoxide dismutase levels before anesthesia induction (p<0.05). Postoperative delirium incidence can be predicted by preoperative superoxide dismutase levels assessment in patients that undergoes laparoscopic urologic or gynecological surgery for malignant diseases.

The effects of innovative silicon applications on growth and powdery mildew control in soilless-grown cucumber (Cucumis sativus L.) and zucchini (Cucurbita pepo L.)

Silicon (Si) is one of the most beneficial microelements for several plants, in mediating the growth regulation in horticultural species. This research evaluated the effects of innovative Si-applications on. soilless-grown Cucumis sativus L. and Cucurbita pepo L. Crop growth, powdery mildew incidence and abiotic stress resistance were evaluated. Two experiments were carried out in a nonheated glasshouse on benches. Two new Si treatments (Si–Nanosponge complex, and one experimental fertilizer) were compared with the traditional K2SiO3. Topas® EC 10 was used as control fungicide treatment. Biometric parameters, and incidence and severity of powdery mildew were measured. Cucumis sativus plants showed a severe powdery mildew infection, and no significant effect of the Si treatments was found. Cucurbita pepo plants were initially grown under lower disease pressure conditions, and the positive effect of Si treatments was found. The innovative use of Si–Nanosponge complex and the new experimental fertilizer can be considered a good alternative to traditional compounds for plant growth stimulation.

Numerical simulations of mechanical and ignition-deflagration responses for PBXs under low-to-medium-level velocity impact loading

An effective computational model is required to accurately predict the dynamic responses in accidental initiations of explosives. The present work uses a series of two-dimensional mechanical-chemical simulations performed via a hydrodynamic-code, DREXH-2D, to efficiently describe the mechanical and ignition-deflagration responses of cased cylindrical polymer-bonded explosives (PBXs) undergoing a low-to-medium-level impact (70–350m/s) in longitudinal direction. The ignition response was predicted based on an ignition criterion of effective plastic work. Slow burning and its growth to deflagration were described through a pressure-dependent reaction rate equation. The extreme value of effective plastic work was found to be useful to determine the ignition threshold velocity for PBXs. For low-level velocity impact, the incident stress wave reflection from lateral surfaces contributed to the formation of ignition regions. After the ignition, the deflagration was induced in the medium-level impact, and its violence was related to the shock strength. However, the low-strength stress wave only induced reaction at local regions, and sequent burning was no longer sensitive to the strength of incident wave. The predicted pressure and temperature results of PBXs were consistent with the medium-level impact tests performed by China Academy of Engineering Physics.

Weak shock loadings induce potential hot spots formation around an intergranular pore

The weak shock loading plays the leading role in the unexpected explosion accidents of condensed-phase explosives. Under the weak shock loading conditions, the shear localization is the main factor affecting the formation of hot spots. When a planar stress wave crosses over a pore in the polymeric binder of the polymer bonded explosive (called intergranular pore), the shear localization comes out around the pore, which may induce potential hot spots formation in the polymeric binder and cause the chemical reaction of the nearby energetic crystal granules. In the present work, a novel experiment system consisting of time-resolved shadowgraph and laser-driven compressions was used to record the interactions between the planar stress wave and the intergranular pore. Then, a two-dimensional numerical simulation was performed to calculate the shear localization and the temperature rise around the intergranular pore. The simulation results were in good agreement with the experiments. Finally, the locations of the potential hot spots were determined, and the variations of the locations with the impulse width of incident stress wave were discussed.

The role of religious coping on problematic alcohol consumption by police officers

Problematic alcohol consumption by police officers is well documented in the literature. It also shows that critical incident stress is correlated with this behavior. A separate body of research indicates that religious coping exerts a moderate protective effect on various types of problematic behavior, including problematic alcohol consumption. We merge these literatures in an effort to determine if religious coping reduces problematic alcohol consumption by police officers and whether it mitigates the positive relationship between critical incident stress and problematic drinking. Data from the Police Stress and Domestic Violence in Police Families in Baltimore, Maryland, 1997–1999 are analyzed to examine these propositions (n = 1004). Results indicate that police officers with higher levels of religious coping were in fact less likely to report problematic alcohol consumption. However, religious coping did not mitigate the positive relationship between critical incident stress and problematic alcohol consumption. The implications of our findings and suggestions for future research are discussed.

Cumulative Stress Debriefings: Support for Clinicians and Nurse Leaders

Clinicians and nurse leaders in all organizations, from large medical centers to critical access community hospitals, are exposed to situations that are traumatic. We call these critical incidents, and they are distinguished by the fact that the immediate and/or delayed stress of these exposures can impact ability to function and overall wellness. 1 Maloney C Critical incident stress debriefing and pediatric nurses: an approach to support the work environment and mitigate negative consequences. Pediatr Nurs. 2012; 38: 110-113 PubMed Google Scholar Clinicians and nurse leaders in all organizations, from large medical centers to critical access community hospitals, are exposed to situations that are traumatic. We call these critical incidents, and they are distinguished by the fact that the immediate and/or delayed stress of these exposures can impact ability to function and overall wellness. 1 Maloney C Critical incident stress debriefing and pediatric nurses: an approach to support the work environment and mitigate negative consequences. Pediatr Nurs. 2012; 38: 110-113 PubMed Google Scholar

Comorbid diseases as risk factors for incident posttraumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4)

Nature disasters and terrorist attacks have occurred globally in recent years. Posttraumatic stress disorder (PTSD) has gained increasing attention, but its incidence and comorbidities in the general population are different from those inside the disaster areas. The present study estimated incident PTSD and comorbid diseases for over a decade in a cohort from a community-based integrated screening program. Factors associated with the incidence of PTSD were analyzed using Cox regression models. PTSD incidence was estimated as 81 per 105 person-years. Incidence was higher in females than in males and one-year increments in age lowered the risk for PTSD by 3%. Adjusting for other factors, cardiovascular heart disease (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI): 1.03–2.04), bipolar disorder (aHR = 1.86, 95% CI: 1.07–3.24) and major depressive disorder (aHR = 7.03, 95% CI: 5.02–9.85) all significantly increased 45%, 86% and 603%, respectively, the risk of developing PTSD. The low rate of people with incident PTSD receiving treatment in this community health screening population implies there is room for improvement in terms of early detection and intervention. Clinical preventive efforts may be made for patients seeking general medical help, especially those with cardiovascular disorders or mood disorders.

Constant Strain Rate Uniaxial Compression of Green Sandstone during SHPB Tests Driven by Pendulum Hammer

During the Split-Hopkinson pressure bar (SHPB) tests driven by pendulum hammer, employing a proper special shape striker is an effective way to obtain dynamic stress equilibrium condition and to get constant strain rate of the rock specimen. To find the proper special shape striker, a striker with a cambered surface was introduced and eight geometrically different hammers were designed to analyze the effect of hammer geometry on the waveform of excited incident stress waves. Based on experiments and simulations, parameter effects, including the cambered hammer curvature radius and hammer diameter, length, and impact velocity, on the incident wave shape were examined. These parametric studies provided guidelines for achieving constant strain rates in rock specimens during SHPB tests. The use of different diameter hammers was noted for shaping stress-time curves to follow the stress-strain behavior of green sandstone. Finally, to examine the applicability of using hammer geometry for shaping incident waves to achieve constant strain rate, SHPB tests on green sandstone specimens were conducted. The results demonstrated that a constant strain rate (100 s−1) lasting for 70 μs was achieved with the 8# hammer (3.7 kg; curvature radius, diameter, and length of 100, 70, and 126.3 mm, resp.). In addition, dynamic experiments on green sandstone were carried out under various strain rates and the results showed that the initial tangential modulus was almost unaffected by strain rate. The strain at peak stress tended to increase with rising strain rate and the dynamic strength of green sandstone showed an apparent rate dependency.