After the Emergency: Self-Care for nurses after adverse events

Emergency Preparedness

June is National Safety Month – and this week’s focus is Emergency Preparedness.
Did you know that a survey of 3,000 employees in a variety of fields conducted by the American Heart Association found that over 50% of workers were not trained in first aid and CPR? However, 90% said that they would be willing to learn if their employer offered training. Nurses can play an important role in educating businesses and organizations on the importance of CPR training for its employees. Read the full article on the National Safety Council’s website.
Another aspect of Emergency Preparedness week involves ensuring you are prepared for natural disasters. In Michigan, the summer months can bring severe weather - such as tornados, floods, excessive heat and lightning storms. View The National Safety Council’s article on ensuring your workplace is prepared for a tornado. Nurses are known for being informed, organized and prepared in emergency situations – so natural disasters should be no different. Having a disaster plan is an important step in ensuring your family and workplace are safe. Set aside time this week to check out this article from Ready.gov on creating an emergency plan.

Self-Care

An equally important, but often overlooked, aspect of Emergency Preparedness is self-care during and after a traumatic event or emergency. There is no doubt that as nursing students and future nurses, we will be exposed to high-stress and emotional situations throughout our careers. It is important to have a plan to cope with these events to mitigate burnout, compassion fatigue, secondary traumatic stress, depression, anxiety and other mental health disorders.

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Tips for coping with traumatic events:

• Practice being aware of your emotions: In a systematic review of emergency nurses, those with lower emotional awareness showed higher compassion fatigue. ¹ Meditation, prayer, self-reflection and conversing with a trusted friend are just a few ways to increase your emotional awareness.
• Learn to recognize the signs:
  • ​Burnout is defined as, “distress experienced by employees related to job expectations and working conditions.” ² Symptoms include exhaustion; distancing oneself (emotionally and cognitively) from the job/patients; cynicism – questioning whether your job is worthwhile; inefficacy – feeling as though you are not producing your desired results or feeling your job expectations are not being met.
  • Compassion fatigue is defined as, “weariness experienced by health care providers repeatedly exposed to seriously ill, traumatized, suffering, and dying patients.” ² Symptoms include, “a reduced capacity for empathy, intrusive thoughts, apathy, depression, lessened enthusiasm, desensitization, diminished ability, irritability, feeling overwhelmed, hypervigilance, emotional disturbances, and disordered thinking.” ²
  • Secondary Traumatic Stress Disorder is defined as, “the reactions of health care providers who experience a traumatic event vicariously by caring for seriously ill and dying patients.” ² Symptoms include, “difficulty sleeping, intrusive thoughts about patients, irritability, fore-shortened future, and diminished activity levels.” ²
• Participate in debriefing after adverse events: formal debriefs facilitated by a social worker or APRN may help prevent STSD. If your workplace does not hold debriefing sessions, informal conversations with coworkers may provide similar relief and support. ²
• Nurture positive coworker relationships: In a study of 128 trauma nurses, those with weaker coworker relationships reported greater compassion fatigue. They also reported utilizing strong social support networks to reduce burn-out. ³
• Draw from family support: Spending time with family and accepting their support is a commonly reported self-care strategy to decrease the stress of traumatic events at work.
• Avoid spreading yourself too thin: In one study, nurses working longer shifts and a greater number of hours each week exhibited increased burnout and compassion fatigue. ³ Another study emphasized the importance of setting clear boundaries for yourself, and not feeling guilty when turning down overtime or extended shifts. It is important to know your limits and when to say, “No!” ⁴
• Engage in hobbies: In a study of 128 trauma nurses, nurses with fewer hobbies reported higher compassion fatigue. ³ Another article also stressed the importance of participating in nonwork activities to provide distance from the work environment as a way to promote healthy coping. ²
• Get back to the basics: it may seem simple, but getting adequate sleep, exercising, and eating healthy are key strategies to prevent burnout. ⁵
• Know your resources: seek professional counseling/treatment and support groups.
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Hotline: 1-800-985-5990 or text TalkWithUs to 66746; website

 
Articles:​
1. Killian KD. “Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors.” Traumatology. 2008;14(2):32–44.
2. Melvin, CS. "Historical Review in Understanding Burnout, Professional Compassion Fatigue, and Secondary Traumatic Stress Disorder From a Hospice and Palliative Nursing Perspective." Journal of Hospice & Palliative Nursing 17, no. 1 (February 2015): 66-72. doi:10.1097/njh.0000000000000126.
3. Hinderer, Katherine A., Kathryn T. Vonrueden, Erika Friedmann, Karen A. Mcquillan, Rebecca Gilmore, Betsy Kramer, and Mary Murray. "Burnout, Compassion Fatigue, Compassion Satisfaction, and Secondary Traumatic Stress in Trauma Nurses." Journal of Trauma Nursing 21, no. 4 (July/August 2014): 160-69. doi:10.1097/jtn.0000000000000055.
4. Showalter S. Compassion fatigue: what is it? Why does it matter? Recognizing the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue, and strengthen the professional already suffering from the effects. Am J Hosp Palliat Med. 2010; 27(4): 239–242.
5. Swetz K, Harrington S, Matsuyama R, Shanafelt T, Lyckholm L. Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment. J Palliat Med. 2009; 12(9): 773–777. doi:0.1089/jpm.2009.0050.