Implementing an ED Critical Incident Stress Management Team

• Published in: Journal of emergency nursing Vol. 42; no. 6; pp. 474 - 480
• Main Authors: Wuthnow, Julia, Elwell, Sean, Quillen, Joann McDaniels, Ciancaglione, Nicole
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Acute stress disorder; Aftermath; Alcoholism; Anxiety; Anxiety-Depression; Caregiving; Child; Community mental health services; Crisis intervention; Crisis Intervention - methods; Crisis Intervention - organization & administration; Critical incident stress; Critical incidents; Death & dying; Dysfunction; Emergency Nursing - methods; Emergency Service, Hospital; Emergency services; Families & family life; Grief; Homeostasis; Humans; Intervention; Liability insurance; Mental health; Nurses; Nursing; Panic attacks; Pediatric Nursing - methods; Pediatrics; Personality disorders; Post traumatic stress disorder; Prevention programs; Proximity; Psychological distress; Psychological trauma; Secondary prevention; Somatoform disorders; Stress; Stress management; Stress, Psychological - therapy; United States > US
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2016.04.008

Research suggests that the death of a child ranks high among the situations that cause nurses distress, and when left unresolved, this stress can result in acute or long-term dysfunction.1 Given that our team works at a full-service pediatric hospital that is an American College of Surgeons verified level I pediatric trauma center and a state designated level I pediatric emergency department, where we treat approximately 50,000 children a year, we are accustomed to caring for high-acuity pediatric patients and the psychological consequences of caring for them. Crisis intervention is defined as the provision of emergency psychological care to help these persons return to an adaptive level of functioning and to prevent or mitigate the potential negative impact of psychological trauma.2 Crisis intervention procedures have evolved from the studies of grieving conducted by Erich Lindemann in the aftermath of a major nightclub conflagration, from the military writings of Kardiner and Spiegel2 on the 3 basic principles in crisis work (immediacy of interventions, proximity to the occurrence of the event, and the expectancy that the person affected will return to adequate functioning), and Gerald Caplan's emphasis on community mental health programs that emphasize primary and secondary prevention. [...]in sum, intervention should be the natural corollary of the nature of the given problem. [...]behavioral manifestations can include social withdrawal, listlessness, substance abuse, and aggressive behaviors.5 CIS that is not addressed may lead to the eventual development of acute stress disorder, posttraumatic stress disorder, generalized anxiety disorder, panic, major depression, dysthymia, alcoholism, somatoform disorders, and personality disorders.