Peer support systems:
A consistent finding in the literature is that staff mostly want the support of peers after adverse events, including PSIs. Through shared experiences and immediacy, peer-based support can help to normalise the complex feelings experienced after an incident.
Finney, R. E., Johnson, M. J., & Sviggum, M. H. (2021). Implementation of a Second Victim Peer Support Program in a Large Anesthesia Department. AANA journal, 89(3), 235-244.
Edrees, H., Connors, C., Paine, L., Norvell, M., Taylor, H., & Wu, A. W. (2016). Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ open, 6(9), e011708.
Post-incident debriefing:
In healthcare, team debriefs are frequently used to learn from clinical events, drawing upon approaches such as REFLECT (Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasise key points, Communicate clearly, Transform the future). ‘Psychological debriefing’(PD) or ‘Critical Incident Stress Debriefing’ (CISD) is a different approach, facilitated by two trained debriefers/psychologists, between 48 and 72 hours after the incident. PD/CISD emerged in the 1980s, designed as a group intervention for emergency services personnel exposed to potentially traumatic events; occupational hazards inherent in their job. In this sense, CISD/PD is an occupational health tool of community support and cohesion, rather than a ‘treatment’ to prevent or treat PTSD (Richins et al., 2020): “CISD employs the active mechanisms of early intervention, verbal expression, cathartic ventilation, group support, health education, and assessment for follow-up” (Everly, Flannery & Eyler, 2002, p.173).
The use of PD/CISD on a one-to-one, personal basis and/or as an intervention to prevent or treat PTSD is contraindicated: a Cochrane Review (Rose et al., 2002; updated 2010) found no evidence for the effectiveness of individual-participant, single-session debriefing in preventing PTSD after traumatic incidents, and found some suggestion that it may increase the risk of depression and PTSD. NICE (2018) recommend that psychologically focused debriefing is not offered for the prevention or treatment of PTSD.
However, when used as part of a comprehensive program of organisational support, incorporated into working practice and conducted appropriately by trained facilitators to evidence-based criteria, PD/CISD has been reported to be an effective tool (Everly, Flannery, & Eyler, 2002; Richins et al., 2020):
- CISD/PD receives positive feedback from participants: e.g. according to UK scoping review of 50 studies, emergency responder employees consistently express satisfaction and appreciation from being able to discuss their experiences (Richins et al., 2020).
- PD/CISD appears to support natural coping processes and may reduce problematic coping behaviours: when peer group processes are mobilised through CISD/PD, natural recovery without additional intervention (e.g. occupational health) is found to be more likely (Richins et al., 2020). In a randomised controlled trial, firefighters’ participation in CISD was associated with significantly less alcohol use and greater quality of life post-intervention – although there was no significant effect on post-traumatic stress or psychological distress (Tuckey & Scott, 2014).
Three necessary conditions have been identified for effective early interventions (including CIDS/PD): (1) they are supported by senior leadership teams; (2) they are attuned to unique organisational cultures; (3) they draw upon existing peer support systems and social cohesion in teams (Richins et al., 2020, p.8).
Everly, G. S., Flannery, R. B., & Eyler, V. A. (2002). Critical incident stress management (CISM): A statistical review of the literature. Psychiatric Quarterly, 73(3), 171-182.
Harrison, R., & Wu, A. (2017). Critical incident stress debriefing after adverse patient safety events. The American journal of managed care, 23(5), 310-312.
Kolbe, M., Schmutz, S., Seelandt, J. C., Eppich, W. J., & Schmutz, J. B. (2021). Team debriefings in healthcare: aligning intention and impact. bmj, 374.
NICE (2018a). Post-Traumatic Stress Disorder: Evidence Reviews For Psychological.
Richins, M. T., Gauntlett, L., Tehrani, N., Hesketh, I., Weston, D., Carter, H., & Amlôt, R. (2020). Early post-trauma interventions in organizations: a scoping review. Frontiers in psychology, 1176.
Rose, S. C., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane database of systematic reviews, (2).
Tamrakar, T., Murphy, J., & Elklit, A. (2019). Was Psychological Debriefing Dismissed Too Quickly?. Crisis, Stress, and Human Resilience: An International Journal, 1(3), 146-155.
Tuckey, M. R., & Scott, J. E. (2014). Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial. Anxiety, Stress & Coping, 27(1), 38-54.