An Exploration of the Experience of Critical Incident Stress Debriefing on Firefighters Within a Region of the New Zealand Fire Service

<p>This study originates from my practice experience working for the New Zealand Fire Service back in the late 1980's and early 1990's as an Occupational Health Nurse where I piloted a Critical Incident Stress Peer Support programme in the No.4 Region. My interest in the area began after attending a seminar on Critical Incident Stress Debriefing based on Mitchell's model of debriefing (1983). I had begun to recognise in my practice what I believed to be work-related stress but was a little uncertain about where this stress originated. After attending the seminar I began to understand that some of this stress was related to Critical Incident Stress (CIS) from firefighters exposure to critical incidents. This study explores four firefighters experience of Critical Incident Stress Debriefing (CISD) within a Region of the New Zealand Fire Service. It explores the application of CISD as one component of Critical Incident Stress Management (CISM), and the Nurse Researcher's philosophy of Clinical Nurse practice in relation to the application of CISD. The knowledge gained from the analysis of the data has the potential to influence professionals understanding of their experience and affect future practice and that of others working in the field of CISM. The aim of the study was to gain a greater indepth understanding of firefighters experience specifically in relation to their participation in a Critical Incident Stress Debriefing (CISD) following their exposure to a critical incident. Much of the literature that supported CISD appeared to offer a rather superficial understanding of the firefighters experience in relation to CISD. I chose to use narratives as the methodology, utilising four individual case studies as a method of social inquiry in order to explore the experience of CISD. The narratives were able to creatively capture the complexity and the dynamic practice of CISD. An overall pattern of the formalised process was uncovered through the participants' narratives. Eight dominant themes were highlighted from the narratives which included safe environment; ventilating the stress reaction; similar feelings; getting the whole picture; peer support; bonding and resolution. While these themes were common to all the participants, each participant had a particular theme/s which was unique to their experience. As a Nurse Researcher with dual practice interests in the area of nursing education and Critical Incident Stress Management (CISM), I am in a position to inform practice and service development. It is my belief that the knowledge gained from this study has the potential to be transferred to others working in the field of CISM. The study results are timely, practical and informative at a time of major change in the New Zealand Fire Service.</p>

An Exploration of the Experience of Critical Incident Stress Debriefing on Firefighters Within a Region of the New Zealand Fire Service

<p>This study originates from my practice experience working for the New Zealand Fire Service back in the late 1980's and early 1990's as an Occupational Health Nurse where I piloted a Critical Incident Stress Peer Support programme in the No.4 Region. My interest in the area began after attending a seminar on Critical Incident Stress Debriefing based on Mitchell's model of debriefing (1983). I had begun to recognise in my practice what I believed to be work-related stress but was a little uncertain about where this stress originated. After attending the seminar I began to understand that some of this stress was related to Critical Incident Stress (CIS) from firefighters exposure to critical incidents. This study explores four firefighters experience of Critical Incident Stress Debriefing (CISD) within a Region of the New Zealand Fire Service. It explores the application of CISD as one component of Critical Incident Stress Management (CISM), and the Nurse Researcher's philosophy of Clinical Nurse practice in relation to the application of CISD. The knowledge gained from the analysis of the data has the potential to influence professionals understanding of their experience and affect future practice and that of others working in the field of CISM. The aim of the study was to gain a greater indepth understanding of firefighters experience specifically in relation to their participation in a Critical Incident Stress Debriefing (CISD) following their exposure to a critical incident. Much of the literature that supported CISD appeared to offer a rather superficial understanding of the firefighters experience in relation to CISD. I chose to use narratives as the methodology, utilising four individual case studies as a method of social inquiry in order to explore the experience of CISD. The narratives were able to creatively capture the complexity and the dynamic practice of CISD. An overall pattern of the formalised process was uncovered through the participants' narratives. Eight dominant themes were highlighted from the narratives which included safe environment; ventilating the stress reaction; similar feelings; getting the whole picture; peer support; bonding and resolution. While these themes were common to all the participants, each participant had a particular theme/s which was unique to their experience. As a Nurse Researcher with dual practice interests in the area of nursing education and Critical Incident Stress Management (CISM), I am in a position to inform practice and service development. It is my belief that the knowledge gained from this study has the potential to be transferred to others working in the field of CISM. The study results are timely, practical and informative at a time of major change in the New Zealand Fire Service.</p>

Why Critical Incident Stress Management Teams Matter in Primary Care

ObjectiveCritical incident stress management (CISM) teams can be adapted in urban primary care clinics to address and process traumatic events in primary care. A guide for implementing the CISM team model within this setting is delineated.MethodsReview of existing literature and guide to implementation of CISM team in primary care.ResultsRespondents reported the team validated their reactions to the critical incident and were grateful for CISM presence.ConclusionDespite indications that vicarious traumatization, burnout, and compassion fatigue are rising (Bodenheimer & Sinsky, 2014; Coles et al., 2013; Woolhouse et al., 2012), there is little information about efforts to address this. Operating and emergency rooms and intensive care units utilize CISM (Maloney 2012; Powers, 2015); however, it's overlooked in primary care (Blacklock, 2012; Naish et al., 2002).

Application and Integration of Psychological First Aid in First Responder Organizations

First responders are exposed to many potentially traumatic events throughout their careers. Given the risk of adverse mental and physical health outcomes secondary to frequent trauma exposure, access to culturally-sensitive, evidence-informed early intervention is paramount. Critical Incident Stress Management (CISM) and components therein (e.g., Critical Incident Stress Debriefing, peer support) represent the most commonly utilized early interventions within first responder organizations. Limited research has evaluated these models, and evaluation of early interventions presents many challenges due to characteristics of first responder cultures and organizational demands and constraints. Psychological First Aid (PFA) is a widely endorsed and promising evidence-informed early intervention model grounded in research on trauma recovery and resilience. This chapter examines the theoretical underpinnings and core actions of PFA and describes the potentially diverse applications of PFA within first responder organizations and concludes by discussing recommendations and future directions.

45 Helping the Helpers: Peer Critical Incident Stress Management for NICU Health Care Providers to Improve Resilience, Burnout and Patient Safety

Introduction/Background Health care providers in neonatal intensive care units (NICU) experience critical or distressing events that can overwhelm their usual coping skills and lead to significant stress. Ineffective support for health care providers dealing with critical incidents can lead to poor unit resilience, staff burnout and compromised patient care behaviours. A formalized peer program and process to address critical workplace incidents and support care providers, “Critical Incident Stress Management (CISM)” is used in many first responder professions. While there is growing interest in implementing peer CISM teams in critical care units, there is a lack of research describing the impact of CISM in NICU. Objectives This study examined the effect of implementing a multidisciplinary NICU health care provider peer CISM team on resilience, burnout, and team/safety culture in a tertiary NICU. Design/Methods Multidisciplinary team members were peer selected and formally CISM trained. Change management strategies were employed to introduce CISM to the NICU. All health care providers were invited to complete an anonymous online or paper survey before and 1 year after NICU CISM team implementation. The survey contained validated measures of resilience, burnout, and team/safety culture that were analyzed pre and post intervention. Results The response rate pre-intervention was 66% (114/172 staff) and 32% post (60/186 staff). Stress recognition significantly improved as fewer staff reported being less effective at work when feeling stressed post incident (74% vs 61%, pre and post CISM respectively, p&lt;0.05) (Table 1). Fewer staff reported feeling burned out from their work (41% vs 31%, p=0.4), trending towards improved resilience (Table 1). Communication in the NICU significantly improved as staff indicated debriefing methods met their needs (38% vs 57%, p&lt;0.05) and felt comfortable speaking up about safety concerns (66% vs 78%) (Table 1). Post-intervention, despite feelings of increased workload indicated by a significant decrease in agreement that “NICU staff levels were sufficient for patient load” (54% vs 33%, p&lt;0.001), a majority of staff reported a supportive environment in the NICU (59% vs 77%, p=0.08) (Table 1). Work culture significantly improved as staff felt rewarded and recognized for improving quality (13% vs 31%, p&lt;0.05) (Table 1). Conclusion Implementation of a peer CISM team led to improved NICU care provider resilience, stress recognition, and team culture, all of which can mitigate the effects of increased patient load. Findings from this research and knowledge gained from the CISM implementation process should be shared with other health care environments.

Volunteer firefighters: A qualitative exploration of critical incidents and applied coping skills

Volunteer firefighters have limited up-to-date training and awareness in applied coping skills and trauma informed practice (TIP). Critical Incident Stress Management (CISM) has been a standard of practice within emergency services — including fire rescue services — for decades in Northern British Columbia. With new developments in TIP, I suggest we can further improve volunteer firefighters’ wellness by exploring specific coping strategies. The purpose of this endeavour was to interview volunteer firefighters, explore their experiences, and better understand their coping styles and approaches to managing stress related to the work. In the exploration of critical incident coping skills, a qualitative methodology and thematic analysis was applied. This study adds to the current literature on work-related coping, and hopefully increases awareness of best practices for psychological safety and wellness of volunteer firefighters in Northern British Columbia.

Application and Integration of Psychological First Aid in First Responder Organizations

First responders are exposed to many potentially traumatic events throughout their careers. Given the risk of adverse mental and physical health outcomes secondary to frequent trauma exposure, access to culturally-sensitive, evidence-informed early intervention is paramount. Critical Incident Stress Management (CISM) and components therein (e.g., Critical Incident Stress Debriefing, peer support) represent the most commonly utilized early interventions within first responder organizations. Limited research has evaluated these models, and evaluation of early interventions presents many challenges due to characteristics of first responder cultures and organizational demands and constraints. Psychological First Aid (PFA) is a widely endorsed and promising evidence-informed early intervention model grounded in research on trauma recovery and resilience. This chapter examines the theoretical underpinnings and core actions of PFA and describes the potentially diverse applications of PFA within first responder organizations and concludes by discussing recommendations and future directions.

Critical Incident Stress Management

This chapter provides a clear overview of a peer support program for first responders. The field of Critical Incident Stress Management (CISM) was specifically developed to prepare emergency services personnel to psychologically manage significant traumatic events and to recover from the impact of psychological trauma. CISM services are based in the theoretical foundations of crisis intervention and CISM uses the lessons learned from the 150-year history of worldwide crisis intervention services. This chapter presents a history of crisis intervention that helps the reader to understand the core principles of crisis support. It then focuses on the numerous techniques that are incorporated into the Critical Incident Stress Management field. It summarizes key peer support procedures and practices. The chapter also describes the resiliency and the “AS IF” models that aid in the application of crisis intervention services. The chapter concludes with a summary of the evidence that supports CISM services.