Operational Stress Injuries Research Articles

Operational Stress Injuries in Disaster Responders: A Framework for Supporting Mental Health in Climate Crisis.

The rising occurrence of natural disasters linked to climate change has drawn the attention of disaster response leaders to the significance of addressing operational stress injuries among disaster response personnel. We define and describe operational stress injuries in this workforce and explore theoretical frameworks that can inform the development of programs and interventions to mitigate these effects. We aim to establish a conceptual framework for understanding an operational stress injury by introducing a model specific to disaster responders. We also emphasize strategies that can be employed within a stress injury awareness framework to promote the mental well-being of those who respond to climate-related disasters.

Strengthening the military stoic tradition: enhancing resilience in military service members and public safety personnel through functional disconnection and reconnection.

This paper addresses operational stress injuries (OSIs) among military service members (SM) and public safety personnel (PSP) resulting from prolonged exposure to potentially psychologically traumatic events (PPTEs). While psychotherapeutic interventions for post-traumatic stress injuries (PTSIs) are well established, there is a significant gap in evidence-based mental health training programs addressing proactive mitigation of negative outcomes from PPTEs. Building on the Functional Disconnection/Functional Reconnection (FD/FR) model, we introduce FD/FR 2, emphasizing early identification and management of psychological risks. FD/FR 2 discusses the practice of emotional suppression, or "pseudo-stoicism," and its potential negative impact on mental health. By integrating authentic Stoic principles, FD/FR 2 offers practical exercises to enhance resilience and well-being, addressing a critical need in current training approaches for military SM and PSP.

Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis.

Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.

Workplace Reintegration Programs, Policies, and Procedures for Nurses Experiencing Operational Stress Injury: A Scoping Literature Review.

Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature. Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature. A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

The impacts of leadership behaviours on the mental well-being of public safety communicators

PurposePublic safety (communicators; e.g. 9-1-1, police, fire and ambulance call-takers and dispatchers), like many other public safety personnel (e.g. police, paramedics), (re)suffer operational stress injuries (OSIs) that are too often hidden and at a prevalence higher than the general population. Unfortunately, there are very little data for OSI rates in Canadian communicators. To the authors’ knowledge, this is the only pan-Canadian study focusing on organizational culture, and its potential influence on OSIs, within the communicator context.Design/methodology/approachThe authors conducted a 179-item online survey of Canadian communicators comprising 17 validated screenings for occupational stress injuries and symptoms and four open-ended questions relating to their agency's organizational culture. The authors thematically analysed participants' open-ended responses and their screening scores.FindingsA semi-grounded thematic approach revealed that managers and supervisors were significant contributors to negative perceptions (n = 165) of organizational culture, potentially resulting in or worsening existing OSIs. Specifically, leadership was viewed as ineffective, inconsistent, unsupportive, abusive and toxic, with limited understanding of communicator roles. Communicators described feeling devalued, particularly when leaders fail to recognize communicator OSIs, which can perpetuate stigma. Conversely, positive leaders (n = 24) were described as supportive, communicative and encouraging.Originality/valueThe findings suggest that while leadership behaviours are a key factor in employee well-being, it varies considerably across agencies, impacting treatment-seeking behaviours. The authors’ new understandings of leaders' roles in OSIs may help reduce the frequency and severity of communicator OSIs, helping ensure that emergency services are delivered to Canadians.

"Collapsing into Darkness": An Exploratory Qualitative Thematic Analysis of the Experience of Workplace Reintegration among Nurses with Operational Stress Injuries.

Nurses are engaged in an unpredictable and dynamic work environment where they are exposed to events that may cause or contribute to physical and/or psychological injuries. Operational stress injury (OSI) may lead to an extended time away from work or nurses leaving the profession altogether. A deliberate focus on the workplace reintegration phase of the mental health recovery process may lead to the increased retention of nurses in their profession. Prior to the creation and implementation of potential solutions to address workplace reintegration, it is imperative to explore the experiences and perceptions of nurses affected by OSI. This qualitative study aims to investigate the experiences and perceptions of nurses (N = 7) employed within a Canadian provincial healthcare system who have attempted workplace reintegration after being off of work with an OSI. Nurses were recruited via social media, unit emails, and word of mouth. Data were collected through recorded semi-structured interviews conducted over videoconferencing. Once transcribed, the data were thematically analyzed using an inductive approach. The resulting themes included (1) heroes to zeros, (2) changing the status quo, (3) connection is key, and (4) post-traumatic growth: advocacy and altruism. Study participants indicated both that nursing culture and a cumulation of events contributed to a need for a leave of absence from work and that a formalized process was desired by nurses to assist in returning to work. The development, implementation, and exploration of innovative policies, procedures, and initiatives to bridge the gap from clinical interventions to workplace reintegration are needed for nurses experiencing OSI. Further research is also needed regarding mental health impacts and appropriate resources to support nurses in their workplace reintegration process after experiencing psychological and/or physical injury.

How Do We Keep our Heads above Water? An Embedded Mixed-Methods Study Exploring Implementation of a Workplace Reintegration Program for Nurses Affected by Operational Stress Injury.

Nurses are exposed to potentially psychologically traumatic events which can lead to operational stress injuries (OSI). Workplace reintegration after an OSI can be challenging, especially with repeated exposure to potentially traumatic scenarios and workplace demands. A workplace reintegration program (RP) originally developed for police officers may be of benefit for nurses returning to work after an OSI. The purpose of this study is to investigate the perceived need for an RP for nurses, and its potential contextualization and implementation in the nursing context using an implementation science approach. This mixed-methods study collected data via questionnaires and focus groups from acute care nurses in Canada (N = 19). Data analysis was conducted using descriptive statistics, thematic analysis, and an organizational readiness assessment. Study participants indicated that formalized processes were rarely used to support nurses returning to work after time off due to mental health challenges. Themes included (1) "The Perfect Storm": the current state of return-to-work, (2) Integral Needs, and (3) A Break in the Clouds: hope for health. Exploration of innovative programs such as the RP may provide additional support to nurses affected by OSIs. Further research is needed regarding workplace reintegration for nurses, and contextualization and evaluation of the RP.

Stakeholder experiences of a public safety personnel work reintegration program

Public safety personnel (PSP) are at risk of experiencing operational stress injuries (OSIs). The functional impairments caused by OSIs can contribute to challenges with returning to pre-injury operational requirements. A Canadian municipal policing agency developed a peer-led workplace reintegration program (RP) to assist PSP in their workplace reintegration after an illness or injury. Although this RP has been used internationally, there is a paucity of research on this program and its implementation by PSP organizations. The perspectives of key stakeholders are important for capturing the current state of RPs and future directions for the advocacy, implementation, sustainability, and spread of the RP, and to set the stage for future research. The purpose of this study was to explore the experiences and perspectives of key stakeholders engaged in the creation, implementation, facilitation, and execution of RPs in Alberta, Canada. This will help identify strengths, barriers, facilitators, needs, processes, and attitudes associated with the RPs and direction for future research. A qualitative thematic analysis of focus groups (N=8) involving key stakeholders (N=30) from five PSP organizations with RPs was conducted using a community-engaged research approach as part of a larger mixed-methods study. Four key themes emerged from the participants: (1) Integral elements of success, (2) Integral needs, (3) Key areas of growth, and (4) Evolution of the Program. While RPs are highly regarded by the key stakeholders, it is essential that evidence-based research guide the evaluation, modification, implementation, spread, and scale of RPs globally.

A qualitative study of the capabilities of family members of veterans living with operational stress injuries

AbstractObjectiveThis qualitative study explores the experiences of 26 family members supporting Canadian Armed Forces veterans living with mental health problems including operational stress injuries (OSIs).BackgroundThe research focusing on military‐connected families emphasizes the impacts of service on the families. Little is known about how families impact military veterans, particularly those diagnosed with OSIs. This research addresses that gap by revealing the capabilities and demands characterizing their everyday lives.MethodSemistructured interviews with 26 individuals identifying as family members of Canadian Armed Forces (CAF) veterans and three focus groups (three participants in each group for a total of nine) with family members of CAF veterans released within the preceding 10 years were conducted. The veterans were living with broadly defined diagnosed and undiagnosed mental health problems including OSIs. Using the family adjustment and adaptation (FAAR) model as an organizational framework, demands and capabilities embodied within the everyday lives of the family members were revealed.ResultsMonitoring the well‐being of the veteran, managing daily life, accessing and mobilizing resources, and caregiving were discussed as capabilities by participants in this study. These capabilities buffer the demands associated with the veteran's mental health problems.ConclusionsResults of this study endorse recommendations for family‐centered program and service development, modeled on approaches that recognize the systemic and relational contexts instrumental in supporting positive outcomes for veterans with OSIs.ImplicationsFurther research exploring the complex, interdependent, and interactional role of families supporting veterans with OSIs is warranted.

Brief mindfulness training for Canadian public safety personnel well-being

The body of research demonstrating the psychological and physiological benefits of mindfulness-based interventions (MBIs) is robust and spans decades, yet its adaptation for a population at significantly higher-than-average risk of negative health outcomes, operational stress injuries, moral injury, and burnout is in its infancy. Failing to address these risks has costs not just for the well-being of public safety professionals (PSPs), but for their families, their agencies, and their communities. Public safety work requires a high standard of ethical decision-making and compassionate contact with the communities served. The public safety oversight of agency, government, and training institutes must prepare its professionals to deliver exemplary levels of service as well as establish trauma-competent training and support frameworks that are evidence-based to protect PSP well-being. Remedying historically ineffective training with evidence-based models not only addresses the complexity of operational stress injuries (OSIs) but also the needs of social justice reform. Canada’s contribution to the body of research using evidence-based MBIs for PSP well-being is scarce. This literature review informs leaders, policymakers, change agents, and researchers not only of the need for such critical research in Canada, but of its current state and important considerations for its design. The efficacy of MBI is discussed, evaluating recent quantitative, qualitative, and mixed-methods studies towards charting a brief MBI (bMBI) logistically deliverable, attentive to the PSP cultural context needs and barriers, and which facilitates sustainable skill-building in attention, awareness, and compassion.

A Post-Traumatic Growth Perspective on PTSD: Implications for Those Who Have Served and Their Partners

Research emphasizing the negative psychosocial impacts of service-related post-traumatic stress disorder (PTSD) for military members, veterans, and their families is well established. Post-traumatic growth (PTG), positive psychological change resulting from managing adverse life events and situations, is an alternate outcome considered in research focusing on the impacts of serious illness and other life-altering circumstances on families. Little is known, however, about the processes that create and sustain PTG within military and veteran family systems. This paper will review conceptualizations of PTG and consider its relevance as a construct for analysis of outcomes related to the experiences of partners of military members and veterans living with PTSD and other operational stress injuries.

Workplace Reintegration Facilitator Training Program for Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: Pre-Post Pilot Cohort Study.

BackgroundPublic safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated.ObjectiveThe purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators.MethodsThis pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession.ResultsStatistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge.ConclusionsAlthough results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP.

Use of the Operational Stress Injury Social Support (OSISS) Program in a Nationally Representative Sample of Canadian Active Duty Military Personnel

IntroductionRecent research evidence indicates increased mental health needs among Canadian Armed Forces (CAF) personnel. Research evidence also indicates that a portion of CAF personnel with mental health needs do not seek professional mental health care or significantly delay initiating treatment. The current study was designed to examine individual correlates of use for a paraprofessional peer support program available to CAF personnel, veterans, and their families (i.e., Operational Stress Injury Social Support [OSISS]). Methods: Participants included 6,700 CAF Regular members. Prevalence estimates were computed for all variables of interest and hierarchical logistic regression analyses served to identify correlates of OSISS use. Results: The results indicate that meeting criteria for posttraumatic stress disorder had the strongest association with OSISS use (OR = 22.31 [95% CI = 13.36-37.28]), but only a small number of CAF personnel (1.2%) seek help from OSISS. Discussion: Results suggest that OSISS use was limited and tended to occur in conjunction with professional mental health service use. Efforts could be engaged to emphasize the availability of peer support as a resource for all operational stress injuries and to increase the reach of peer support programs for military personnel.

Exploration of Trauma-Oriented Retreats: Quantitative Changes in Mental Health Measures for Canadian Military Members, Veterans and Royal Canadian Mounted Police with Posttraumatic Stress Disorder and Moral Injury

Background: Military members, veterans, and public safety personnel have been noted to have a higher risk of exposure to potentially traumatic events and potentially morally injurious events resulting in operational stress injuries (OSI) such as posttraumatic stress disorder (PTSD) and moral injury (MI). Treatments that can quickly and effectively address these conditions are desperately needed. The purpose of this research was to identify the impact of participation in a non-evidence-based trauma-oriented retreat for the above populations experiencing PTSD and MI. Methods: This study was an embedded mixed-methods longitudinal study with parallel repeated quantitative measures designed to evaluate outcomes at 1, 3, 6, and 12 months after completion of the retreat. Results: Analysis showed a statistically significant reduction in self-reported symptoms of PTSD, anxiety, stress, depression, MI, anger, and emotional dysregulation pre/post-retreat, and an increase in resilience. Self-reported longitudinal results did not see a change in symptom scores, with participants continuing to maintain their clinical diagnoses post-retreat. Conclusions: The results from this study illustrate that trauma-oriented retreats may be a complementary treatment modality for OSI-related conditions but should not be seen as a first-line treatment option. Program evaluation, determination of the evidence-based nature of retreats, and standardization are yet needed.

The impact of COVID-19 on the workplace wellbeing of police services in Australia

ABSTRACT Workplace wellbeing is a fast-developing subject in employment relations. This qualitative study examined the workplace wellbeing of police during COVID-19. There has been a significant critique of the narrow focus only on individual resilience and stress as the cause of workers’ poor mental health and wellbeing. Research into frontline workers’ mental health and wellbeing has mainly focused on the cumulative effect of trauma and operational stress injuries on individual resilience, with insufficient consideration of the impact of organisational culture, systemic and environmental factors. Drawing on a survey of 665 police professionals from all states and territories in Australia, this research investigated individual, the nature of work, organisational and environmental factors that negatively impacted worker wellbeing during the pandemic. The paper concludes that incorporating the full range of factors related to workplace wellbeing would inform an improved, holistic approach to maintaining and enhancing employee wellness. Understanding the influence of these factors during COVID-19 has implications for employment relations theory and the practical management of frontline emergency service workers’ workplace wellbeing generally and in times of crisis and disruption.

Evaluation of Before Operational Stress: A Program to Support Mental Health and Proactive Psychological Protection in Public Safety Personnel.

Public safety personnel (PSP; e.g., communications officials, corrections workers, firefighters, paramedics, and police officers) are at risk of developing mental health problems due to experiencing potentially psychologically traumatic events during their career. Research examining evidence-based treatments for psychological injuries resulting from operational duties (also known as operational stress injuries) has not yielded robust results that would indicate ongoing interventions as the best solution for managing PSP mental health injuries; as such, proactive psychological interventions designed to bolster resilience are being considered potentially beneficial for mitigating the impact of occupational stress on PSP. Despite the growing popularity of resilience programs, most are delivered in a single session after an event deemed particularly problematic with no follow-up. Longer interventions may better support sustained resiliency, mitigate the impact of operational stress, and increase positive PSP workplace outcomes. The current article introduces the Before Operational Stress (BOS) program, which was designed for delivery early in a PSP career to enhance self-awareness and healthy relationships. The year-long program is derived from cognitive behavior therapy and group therapeutic techniques to meet program objectives. The current BOS program evaluation demonstrated small, statistically significant improvements in symptoms of PTSD, quality of life, stigma, and perceived social support from baseline (Time 1) to 6 months (Time 4). There were also non-significant improvements observed in symptoms of depression, anxiety, stress, alcohol use, as well as in emotional regulation and resilience. Qualitative results indicated participants positively perceived the BOS program, with participants reporting specific improvements in self-awareness, avoidant behaviors, and relationships with family and colleagues. The BOS program content (e.g., functional disconnection and functional reconnection) and processes (e.g., psychoeducation within a supportive learning structure; mutually empowering group interactions) appear unique relative to other PSP resilience programs, with promising initial results in support of PSP mental health. Recommendations for future research and program development are provided.

Peers supporting reintegration after occupational stress injuries: A qualitative analysis of a workplace reintegration facilitator training program developed by municipal police for public safety personnel

Public safety personnel (PSP) are at increased risk of developing operational stress injuries. Peer-led reintegration programs (RPs) for PSP, evidence-based research is lacking. This study explored the experiences of PSP participating in a Reintegration Program Facilitator Training (RPFT) program. Participant ( n = 57) responses were collected from surveys, satisfaction and knowledge questionnaires, and a World Cafe. Four themes emerged: (1) traits of an ideal RF; (2) holistic/complementary workplace reintegration approach; (3) necessary features of the reintegration program; and (4) culture-specific considerations. While RPs hold promise, it is essential that evidence-based research be used to guide RPFT and RP spread and sustainability.

Reimagined connection: New possibilities for virtual mental health support for children and youth of public safety personnel affected by operational stress injuries

LAY SUMMARY Young people in public safety personnel (PSP)-connected families are affected by the distinctive stress related to having a parent with mental health issues, including operational stress injuries (OSIs) and the existing strain connected to the COVID-19 pandemic. This increased vulnerability makes it important to be innovative in opportunities for prevention in the PSP community. After reviewing available resources aimed at helping young people affected by a parental OSI, the authors uncovered a gap in prevention and intervention programs accessible to all Canadian PSP families. A new virtual six-week program offered to Canadian young people in military and PSP families affected by an OSI creates potential for developing resilience. The online platform opens access to young people who may be isolated from joining a traditional face-to-face mental health support program with peers. The virtual program aims to empower young people in their knowledge of mental health and enable them to learn about the complex nature of parental OSIs, such as posttraumatic stress disorder. More research on this program is needed to ensure interventions created for this target population are effective in the Canadian context and meet the unique needs of PSP-connected young people.

Equine-Assisted Therapy as Complementary Practices in the Treatment of Operational Stress Injuries of Canadian Armed Forces Veterans

Equine-Assisted Therapy as Complementary Practices in the Treatment of Operational Stress Injuries of Canadian Armed Forces Veterans

Impressions of a Veteran recovering from operational stress injuries during the COVID-19 pandemic

Impressions of a Veteran recovering from operational stress injuries during the COVID-19 pandemic