As a psychiatric nurse working within a major city, I handle a diverse array of patients. Each of the patients has unique needs and presents a specific personality. My work is to care for the patients and to help them recover more holistically. I have had several challenging encounters that have contributed to my growth and development in the profession. Other than growth, challenging encounters have also inflected me with stress. By far, the most memorable of such encounters was an incident involving a violent patient who could not take his drugs. Such stressful events present nurses with an opportunity to exercise stress management techniques to recover fully. One of the common techniques employed is attending debriefing sessions. The debriefing sessions minimizes the stress of the traumatic event on the nurse and help them perform the better when it reoccurs (Mulvogue, Ryan & Cesare, 2019) . Through traumatic personal experiences, one can appreciate how the nursing profession can inflict stress on the nurse. However, one also appreciates the mechanism that has been put in place to help the professionals overcome the stress.
Stressful Events
One day, I was part of a team that received a male psychiatric patient when he was brought in to the facility. He would not let the nurses inject him with tranquilizers by resisting immensely. In the course of his resistance, he injured one orderly by punching his jaw. My colleague tried talking to the patient in an attempt to soothe him, but the patient got agitated. When the patient tried to grab the colleague, three of us decided to tackle him and hold him down for a tranquilizing injection. We may have applied too much force because the patient was knocked off his feet and hit his head on the wall of the reception area. Consequently, he went into a coma for nearly a week. Despite the high impact on the wall, were not aware of the impact of the fall and nearly tranquilized him until he lost consciousness.
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Effect of the Case on my Work
To this day, the events of that day still hang on my mind, especially whenever new admissions are made. As a psychiatric nurse, much of our work involves dealing with reluctant and sometimes violent patients. As such, whenever I am called upon to handle any admissions, I endeavor to ensure the process is as smooth and non-violent as possible. I have often told my younger colleagues to be careful when tackling patients and only do so where no other option exists. The experience still affects me, especially when I have to tranquilize or restrain a patient. On the other hand, the incident also helped me to appreciate that some activities at the workplace induce stress to the workers. However, there are established mechanisms for dealing with induced stress. Therefore, whenever such incidents happen, one should not let the trauma affect their work. Instead, they should seek counseling and draw lessons that enable one to perform better in similar events that may occur.
Overcoming the Stress of the Event
The team of four that had handled the patient was called in for a debriefing session by the head nurse in an attempt to overcome the stress of that event. At the meeting, each nurse was required to narrate the events that led the patient into a coma. Once the investigation into the incident was done, we were assigned a workplace counselor. The counseling was intended to relieve us of the psychological effect of the event. The therapist offered us a number of exercises that would help us overcome the event. For one, each of us was required to internalize the fact that despite the patient ending up in a comma, the whole process of handling the violent patient was part of our work. Secondly, the therapist also asked us to talk to the family of the patient, and later on with the patient himself. Talking to the family and the patient was intended to clear any rift us and make the patient and his family realize that the handling was in the best interest of the patient's wellbeing. Therefore, the comma was an accident. The therapist also asked us to keep in mind that accidents happen in the course of duty. However, the therapist was keen to advise us on taking greater caution when handling violent patients in the future. Finally, each of us was encouraged to share with others whenever the stress of the event started affecting our work. The counseling sessions proved helpful. They alleviated the guilt that had started demotivating me at work. It also encouraged us to share our experiences with colleagues. The sharing helps us draw strength from each other and remember the lessons we learned from the incident.
Debriefing Sessions
Debriefing involves the sharing of information after the occurrence of a significant event with the aim of preventing posttraumatic stress disorder. The information shared in the debriefing process presents the facts of the event, and the experiences of the members of a given team can be reviewed. An example of a team in a debriefing session is the four nurses and one orderly in the case narrated above. Debriefing sessions are conducted to process events and are thus necessary for a number of ways. As Schmidt and Haglund (2017) note, one of the importance of the debriefing sessions is to help individuals confront the situation after traumatic events. In our scenario, the debriefing sessions helped us accept the erroneous handling of the patient. Secondly, debriefs are useful in establishing shortfalls in a given process. The identified shortfalls are fundaments in guiding the design of a more effective solution to the problems at hand. Finally, debriefings are helpful in focusing on the future and the present rather than the past. Thus, as Hart, Brannan, and De Chasnay (2014) suggests, debriefing sessions help individuals cope with events sharing an experience with trained professionals such as the workplace counselor assigned to my team after the incident and fellow colleagues.
At my workplace, debriefing sessions occur regularly. The sessions are often meant to help individuals to overcome traumatic events they might have been encountered. Also, the debriefing sessions are meant to reduce the likelihood of future reoccurrence. Ordinarily, the debriefing sessions are carried out in the presence of, and with the contribution from multiple parties. First, there is a human resource representative who represents the employee involved. Then there is a managerial level employee who represents the organization at the sessions. Further, there has to be the person conducting the debriefing – often a senior employee or a trained workplace counselor. In some cases, debriefing sessions are also attended by representatives from the legal department of the institution. During debriefing sessions, the meetings are led by the person tasked with debriefing, such as a senior employee or a trained counselor (Morrison & Joy, 2016). Other debriefing sessions are also led by managerial level employees, although they are not common because they risk being biased. The sessions normally take place in conference rooms or boardrooms within the institution. Though, other instances take place in the offices depending on the time constraints and number of participants.
Importance of Debriefing Sessions in Nursing Practice
At my workplace, debriefing sessions are carried out with the aim of reducing stress among the nursing community in three approaches. It helps the participants of a traumatic event appreciate what went right and what when wrong in the event. Additionally, the whole population can draw lessons from the particular event and device ways that prevent future reoccurrence. As Schmidt and Haglund (2017) affirm, debriefing sessions are intended to alleviate stress in individuals by sharing events of their trauma. The sessions are, however, conducted by a trained professional for the participants to derive optimal effect. The sessions equip participants of the traumatic event with the capacity and techniques of confronting their emotions. They also help the participants appreciate the good that came out of the event. The appreciation of the good in the traumatic event emphasizes the fact that the occurrence was in line with the desired outcome only that it had shortfalls. As such, the participants can prepare themselves on delivering a more accurate outcome whenever the situation reappears (Hart, Brannan and De Chasnay, 2014). Finally, debriefings are helpful in focusing on the future and the present rather than the past. The approach reduces quilt and fault finding. Thus, as Morrison and Joy (2016) indicate, debriefing sessions could help nurses to cope with the stressful events that they encounter in the line of duty.
Conclusion
I handle a diverse array of patients in my work as a psychiatric nurse, each with unique needs and personalities. In the course of admission, my colleague had tried talking to a patient to soothe him, but the patient tried to grab her, and three of us tackled him. The patient was knocked off his feet, hit his head on the walls, and went in a coma for nearly a week. The patient’s comma was traumatic to me and still affects my work, especially whenever new admissions are made. As a way of trying to overcome the stress of that event, the head nurse in the presence of a workplace counselor called in the team of four that had encountered the trauma for a debriefing session. The debriefing involved the sharing of information on the occurrences of the significant event. The shared information enabled the team to appreciate the events that were successful, such as containing the patient. It also highlighted the committed mistakes that included sending the patient to a comma. Finally, it helped us design a means of dealing with the situation better when it reoccurs. In addition to the three benefits above, the debriefings helped us focus on the future and the present rather than the past. A number of debriefing sessions take place on a regular basis at my workplace. They are conducted in the presence of a human resource representative, a managerial level employee, a trained person conducting the debriefing, and a workplace counselor. Such sessions are carried out with the main aim of reducing stress among nursing employees who occasionally experience traumatic events.
References
Hart, P. L., Brannan, J. D., & De Chesnay, M. (2014). Resilience in Nurses: An Integrative Review. Journal of Nursing Management , 22 (6), 720-734.
Morrison, L. E., & Joy, J. P. (2016). Secondary Traumatic Stress in the Emergency Department. Journal of Advanced Nursing , 72 (11), 2894-2906.
Mulvogue, J., Ryan, C., & Cesare, P. (2019). Nurse simulation facilitator experiences learning open dialogue techniques to encourage self-reflection in debriefing. Nurse Education Today , 79 , 142-146. doi: 10.1016/j.nedt.2019.05.021
Schmidt, M., & Haglund, K. (2017). Debrief in Emergency Departments to Improve Compassion Fatigue and Promote Resiliency. Journal of Trauma Nursing , 24 (5), 317-322.
