Dr Gillian Moore Groarke: Professional help paramount for frontline staff once crisis ends
The pandemic will exert a heavy toll on frontline workers, who will struggle to regain a sense of normality in their personal and professional lives, writes
Yesterday I spoke with one of my patients who is a frontline worker. She emphasised to me that it was not now she needed to talk to me but in the coming weeks and months ahead, when she and her staff would need a clear debriefing.
As we spoke, I could sense the fear in her voice. It brought me back a number of years when I trained with Jeffrey Mitchell in critical incident stress debriefing (CISD).
CISD is a specific technique designed to help people who have been exposed to a traumatic event and as a result have physical and psychological symptomology. No doubt those working on the frontline during this current pandemic of Covid-19 will struggle to regain a sense of normality and safety in their workplace and personal lives.
The events of the past number of weeks have had a life-changing effect on every individual throughout this island, young and old. As I went for a walk, I could not but overhear the terror in a young nurse’s telephone conversation as she described her night duty experience on a ward with Covid-19 patients.
One of my closest friends told me of the disappointment of staff following the arrival of sub-standard personal protective equipment.
As a psychologist, I have worked with several patients who have experienced a variety of different traumatic experiences. I am only too aware of the duration of effects that people experience. In truth, many patients are left with residual symptoms over their lifetimes.
Professional help will be paramount for our frontline workers once thispandemic comes to an end.
Debriefing should occur shortly after the traumatic event to increase the methods effectiveness.
Between 24 to 72 hours is normally considered the crucial time frame. However, if we look at the timeline of the virus in other parts of the world, the trauma for our frontline workers is likely to go on for a very long time.
They will require prompt treatment as symptoms and reactions spring to thesurface. It is important to emphasise that, in essence, it is never too late to seek psychological support, even if the trauma occurred a long time ago.
A critical incident is when somebody experiences trauma following a catastrophic event. A pandemic such as Covid-19 falls into this category of trauma that will no doubt profoundly change and disrupt an individual’s physical or psychological functioning, especially those working on the frontline in the many hospitals and nursing homes throughout Ireland.
Such workers are likely to experience both short term and long-term emotions, symptoms, and reactions. Once the need for help is recognised by all,including our Government, such help can and will lead to healing and restored hope for the future of our health system.
Without it, we will inevitably see a greater rate of absenteeism and our staff suffering from post-traumatic stress and adjustment disorder.
Such stress debriefing allows the trauma survivor to safely reflect on what they experienced in their workplaces and it secures a bridge away from the traumatic event to a new walkway towards healing and recovery in both physical and mental health.
It will no doubt empower the survivor by allowing them to have a voice and bring closure to the kaleidoscope of emotions and physical reactions each and every healthcare worker can expect to experience. I acknowledge that many healthcare workers have enormous resilience but, cumulatively, this pandemic will take its toll on so many who put their lives at risk every day.
Debriefing will allow for a restored sense of security and positive well-being. The myriad of emotions that first appear are our predominant responses of fear and anger. Many people will experience a strong sense of avoidance, hyper-vigilance, intrusive thoughts, to name but a few. The most common physical symptoms we can expect many frontline workers to experience are fitful and disturbed sleep patterns, nightmares, flashbacks, associative memories, panic attacks, nausea, and diarrhoea.
For many, especially young medical and nursing personnel, we can expect their reactions to appear immediately. For others with more prolonged clinical experience, we are more likely to see delayed reactions. This usually occurs when they are physically removed from the hospital or other work environment where they are exposed to the trauma.
Some will turn to substance or alcohol abuse as a means of coping, all in an attempt to repress the trauma. One of the biggest red flags for our healthservice moving forward is that if our workers’ mental health is not properly cared for, we can expect a high increase in the rate of absenteeism from work.
Debriefing can be carried out individually or in a group setting. The group sessions are helpful in realising that you are not losing your mind or you are not alone with how you feel. With the group, the trained facilitator helps the participant to take ownership and understand their emotional reactions. Equally, it is within a group setting that one’s responses are often validated. Group support provides stress management skills which you can apply in the longer term.
Suffice to say that CISD is not intended to replace individual or group therapy that might be provided through referral to your employment assistance program. However, the number of sessions offered by most employers only take into account brief solution-focussed therapy and moving forward the HSE would be wise to offer some additional sessions given the unprecedented experience of the pandemic.
CISD is not intended to be the only treatment available and it is necessary for duty of care to inform trauma survivors of other sources of help available. After CISD, survivors are better placed to return to their normal life at home and at work with a significant reduction in their overall ratings of stress.
Without debriefing our frontline staff are more at risk in the future from a psychological perspective. Used in conjunction with psychological therapy, it paves a road towards recovery. Ideally it should occur at the end of every shift and such demobilisation of trauma taking hold is minimised and allows our workers to discuss their individual and collective concerns and draw up a plan for ongoing support to be put in place.
Debriefing is a powerful process and provides for a structured voluntary discussion. The aim is to attempt to put an abnormal event such as this pandemic into perspective for every individual that chooses to be part of our frontline staff. As US president Richard Nixon said: “The easiest period in a crisis situation is actually the battle itself, the most dangerous period is the aftermath.”
