Post-Incident Team Analysis
In the aftermath of a violent incident, there is an opportunity to examine the incident with the goal of identifying vulnerabilities in protocols and procedures that, if corrected, might have prevented the incident from occurring. Just as important is to recognize and reaffirm those procedures that worked to contain the incident.
Following immediate crisis care and support of injured staff, at next team conference or a special meeting, schedule at least a half hour for discussion and analysis of the event, covering the following:
- The power dynamics from perspective of the patient and the injured nurse;
- The de-escalation tactics and crisis intervention strategies used;
- The role of hospital management and security;
- The nurses' perspectives of administrative support and follow-up care;
- What the team as a whole can learn from this incident about prevention and how it was handled, without blaming the victim.
Violence and Crisis Expert
About Critical Incident Stress Debriefing
Critical Incident Stress Debriefing (CISD) is a process intended to prevent or limit the development of post-traumatic stress in people exposed to critical incidents. In CISD, professionally conducted debriefings attempt to help people cope with, and recover from an incident's aftereffects. CISD purportedly enables participants to understand that they are not alone in their reactions to a distressing event, and provides them with an opportunity to discuss their thoughts and feelings in a controlled, safe environment.
Importantly, a Cochrane Review of 11 clinical trials found no evidence that debriefing reduced general psychological morbidity, depression, or anxiety. In one trial at one year follow-up there was a significantly increased risk of PTSD in those who received debriefing. The Cochrane team recommended that compulsory debriefing of victims of trauma should cease (Rose, Bisson, & Wessely, 2001).
While the debate over CISD continues, psychotherapists and victimology experts know about the potential damage of eliciting expression of deep psychological trauma prematurely or without appropriate follow-up and support.