C:\WINNT\Profiles\leslie\LOCALS~1\Temp\coping after serious incident (Jan 06).DOC

COPING AFTER A SERIOUS INCIDENT: A GUIDE FOR HEALTH CARE STAFF

SERIOUS INCIDENTS can include any event where there may be an actual or potential threat to people’s well-being and safety. These incidents can range from major disasters and accidents, which may affect many people at once, to smaller incidents that might prove distressing for more personal reasons. In either situation, it is entirely natural for people to experience powerful physical and emotional reactions.

THIS BOOKLET has been prepared to help you understand some of the common reactions that you, your colleagues and others involved in the incident may experience. It also outlines some of the actions that can be taken to reduce the risk of longer term effects.

HOW YOU CAN BE AFFECTED PHYSICALLY

Often after a serious incident people notice changes in how they feel physically. This can occur with or without emotional changes. These changes may occur very soon after the event, but might also develop many months later. Some of the common signs are:

Tiredness and exhaustion

  • Serious incidents place intense and prolonged pressure on your body. This does not necessarily stop when the event is over. Your body may continue to be physically and emotionally over-aroused. This might lead to tiredness at first, and later, exhaustion.
  • Despite feeling tired people often describe difficulties sleeping.

Muscle Tension

  • The strain can show itself in muscle tension in different parts of the body. This can be accompanied by symptoms ranging from general stiffness and tension to specific localised pains, headaches, choking sensations in the throat and chest and dizziness.

Re-experiencing the event

  • The impact of an event may be so significant that it is re-experienced long after it actually occurred. Flashbacks and dreams are common. It is also usual to re-experience the feelings that surfaced during or after the event.
  • Sometimes too, you may start to feel as if the original event is about to happen again.
  • This can be distressing and frightening. If it happens, be assured it is not at all unusual and will fade.

Other physical reactions

  • These may include palpitations of the heart, excessive sweating, mild tremors that may develop into periodic shaking, stomach pains and problems of digestion.

When experiencing uncomfortable physical reactions, such as difficulties sleeping, it is tempting to seek medical treatment such as sleeping tablets. Although this can help for a short period it is not advisable to get into the habit of taking medication for symptoms directly associated with such events.

Normal reactions to out of the ordinary events

HOW YOU CAN BE AFFECTED EMOTIONALLY

In addition to the physical reactions, people may notice signs of emotional strain. Some of the normal feelings are:

Sadness
  • for deaths, injuries and losses of every kind.
Fear
  • of "breaking down" or "losing control".
  • of damage to oneself and those we love.
  • of being left alone, of having to leave loved ones.
  • of similar events happening again.
Anger
  • at what has happened, at whoever caused it or allowed it to happen.
  • at the injustice and senselessness of it all.
  • at the shame and indignities.
  • at the lack of proper understanding by others.
  • at the inefficiencies.
  • WHY ME?
  • being provoked by seemingly trivial events.
  • other people may comment on the way you have changed since the event.
Guilt
  • for being better off than others.
  • regrets for things not done.
Helpless
  • crises show up human powerlessness, as well as strength.
  • finding that no matter how hard you have worked you feel unable to do enough.
Longing
  • for all that has gone.
  • to have been more involved and helpful.
Shame
  • for having been exposed as helpless, "emotional" and needing others.
  • for not having reacted as one would have wished.
Wound up
  • your body feeling in continuous turmoil, difficulty resting, sleeping, having peace of mind.
  • being more forgetful, reduced ability to concentrate.
  • being on a high, difficulty returning to normal activities.
Memories
  • of feelings, of loss or love for other people in your life who have been injured or died.

Feeling as though nothing will ever be quite the same again.

Remember!

Some people may experience more feelings than others. These feelings are part of the natural healing process, which helps people come to terms with the stressful event.

The way nature works is by healing through allowing these feelings to come out. Distress and physical discomfort may find an outlet in crying - this is not unusual. For relief it is better to express feelings than to hold back tears.

Typically, the reactions start to diminish within a week before fading away altogether over a longer period of time. If they do not, it is important that you take the initiative and talk to someone about it.

RELATIONSHIPS

You may develop new and different relationships. You might also notice strains in existing relationships. The good feelings in giving and receiving might be replaced by conflict.

Stresses and strains previously taken as being part of life can appear unbearable. A tendency to withdraw from close contact with friends and work colleagues can happen, leading to additional problems. Relationship difficulties of long standing may get worse along with a growing sense that "nobody can possibly understand what I'm going through".

This is a major obstacle to seeking help. Don't forget other people are your main source of comfort at a time of crisis.

THINGS THAT HELP YOU COPE
Numbness
  • This is a natural response to serious incidents that can be helpful in the short term as it gives a chance for what has happened to sink in and it protects people from feeling overwhelmed. The event may seem unreal, like a dream, something that has not really happened. Other people may misunderstand numbness and wrongly see it as either as "being strong" or "uncaring".
Activity
  • Keep active. Being involved in helping may give some relief. However, doing too much over a prolonged period of time can be detrimental, even if it seems helps at the time.
Reality
  • Make sure you know what did happen rather than relying on what you think has happened.
Going over the event
  • Allowing yourself more time to think about the incident, not pushing it to the back of your mind.

Support

  • It is a relief to receive other people's physical and emotional support. Try not to reject it. Sharing with others who have similar experiences feels good. Barriers can break down and closer relationships may develop.

Privacy

  • In order to deal with feelings, both at work and at home, you will find it necessary at times to be alone, or just with family and close friends.

Activity and numbness (blocking of feelings) may be over used and delay your healing.

Remember!

Often there is the expectation that you should be able to cope. This may make it hard for you to share your experiences with others, particularly if you are feeling that there are things you should have done but did not. It is important that all staff trust each other enough to be able to support each other both during and after the event.

SOME DO'S AND DON'TS

  • DON'T bottle up your feelings DO express your emotions.
  • DON'T avoid talking about what happened. DO take every opportunity to go over the experience. DO allow yourself to be part of a group of people who care.
  • DON'T let embarrassment make it difficult to give others the chance to talk.
  • DON'T expect memories to go away - the feelings will stay with you for a long time to come.
  • DO take time out to sleep, rest, think and be with your close family and friends.
  • DO express your needs clearly and honestly to family, friends and work colleagues.
  • DO try to keep your lives as normal as possible after the incident.

Remember!

Mistakes are bound to be more common after events of this kind. You need to be especially careful at work, around the home and when driving.

WHEN TO SEEK FURTHER HELP

As mentioned earlier, reactions to serious incidents usually fade as time passes. Some events, however, are extremely distressing or may go on for a long time or have special meaning. If this is the case you may require further help. You should consider this if:

  1. Your feelings continue to be overwhelming.
  1. You can find no relief from tension, confusion, or experience a sense of emptiness or exhaustion.
  1. If after a month you still feel completely numb and if you have to keep active in order not to feel upset.
  1. If you continue to have nightmares or cannot sleep.
  1. If you have no one at work or at home with whom to discuss your feelings yet you feel the need to do so.
  1. If your relationships are suffering badly or people keep commenting on how much you have changed.
  1. If you find yourself prone to accidents or mistakes.
  1. If your work suffers.
  1. If you find your smoking, eating and drinking habits changing for the worse.
  1. If you find yourself relying more on medication.
  1. If you find yourself getting uncontrollably angry.
  1. If you as a helper are feeling "burnt out".
  1. If you and your colleagues have tried to get things back to normal, but are finding this difficult.

WHERE TO SEEK FURTHER HELP

The employee wellbeing service offers confidential brief structured counselling interventions. Contact no. for confidential answering service 02929744133. State your name and a contact number clearly. Normally you will be contacted within five working days.

Representatives from Staff Side, Trade Unions and/or your Professional Organisation or the Chaplaincy may also be able to help – contact via switchboard.

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