SHINE (Supporting Health in Negative Events) – CISM at Beacon Health Care from a systems & personal perspective
By: Kelley Kurtz, Beacan HCS, Manager of Risk Management, Huntington Beach, CA
Rev. Heather McDougall, BCC
Attempting to launch a new program of any type can be a challenge, especially in health care where things are always changing at light speed. Launching the critical incident stress management team at Beacon was challenging, but for different reasons. We were very lucky to have administration backing and a wealth of resources from the beginning. Because we were not creating something entirely new, developing a policy and structure was relatively simple, particularly when we had team members like Heather who had direct experience in implementation of a CISM team. The challenge came in changing the culture related to stressful events.
The concept of debriefing within the organization had been for years focused on process and finding error. Debriefing was synonymous with creating stress rather than relieving stress. Coupled with this issue was the natural tendency of care givers to deny their own stress. With most of the associates having a negative association with debriefing and wanting to present the “I can handle anything, no problem!” persona, we needed a sea change to make the program successful. This would start with getting the word out regarding what CISM is and what it isn’t. Having Heather’s direct experience with how CISM works was invaluable, as she can best describe herself.
It was one of those shifts that was anything but easy. I have those cases that are harder for me than some other cases. I am not only a staff chaplain at Beacon Health System and CISM steering committee member, but also a Mom to two college age girls. Pediatric cases resulting in the death of a child are always my most challenging cases because they often tug powerfully on my mommy and chaplain heart-strings. The mere fact that I am a mom helps me to connect with parents that have lost a child due suddenly or to chronic illness. I remember this shift involving a pediatric case. I heard the fire-fighter who serves as a first responder give the report leave the room, only to burst into tears. The team worked on this pediatric case diligently only to have it result in the sudden death of this precious child. I remember getting a glimpse of the amazing team, observing there was not a single person in the room that wasn’t doing everything they could to fight back tears. I learned that many of the staff had kids at home near the same age as this child. I fought back tears as we awaited to greet family and put them in the family room to be updated. I remember, wanting to support the firefighter, but knowing I couldn’t because I was right there in the mire with him. So, I made him promise he would seek out an individual defusing when he got back to the station. The trauma physician updated the parents and made arrangements for them to be with their elementary-school aged child. The trauma physician noted, “I think we are going to need CISM support. There was not a dry eye in the room. I think we should do it at the end of our shift before everyone goes home”. I called in the CISM team. I was grateful that I had some time to cry, receive support and explain to them what happened that evening. They began arranging and connecting with members of the team and ended up bringing all of us together to process, remind us of healthy coping skills and available support. Sometimes I am part of the team, but also sometimes I am part of the team being debriefed as part of my own self-care plan.
I know that every interdisciplinary team member called to support in cases like these are prone to compassion fatigue. Compassion Fatigue is stress from exposure to a traumatized individual. Compassion fatigue has been described as the convergence for secondary traumatic stress and cumulative burnt-out[i]. If I didn’t have a good self-care plan with participating in CISM debriefings; I could easily be experienced as angry, more irritable, and exhausted with less empathy and sympathy for others at work, at home and with friends.
Have you ever heard a family member share with you, “I don’t know how you do what you do every day?” Or maybe they share it as a confession given as a compliment for the way you walked alongside them during their unimaginable tragedy, “I couldn’t do what you do”. How is it we do what we do shift after shift? Participating in CISM, spending time near bodies of water and kayaking are all part of my personal self-care plan to help me continue to do what I do effectively. The seven phases in the Mitchell model, I have found useful in the parish setting when congregants get news of a difficult diagnosis. I have used some of these questions inclusive of: “what is the toughest part of all of this for you?” or “if you could change one thing, but not the outcome what would that be?” These questions help me to assess what is hardest for them, and additional possibilities for support. The ability to take what I refer to as “a pregnant pause” to process what it is we just experienced on an emotional level as a team helps me to continue to be an effective chaplain. It is how I am able to greet the grim realities of being a chaplain day-in and day-out. I believe it makes me a better chaplain, a better mom, a better colleague, friend, spouse and daughter.
I remember the day my oldest daughter wanted to do an EFE (Education for Employment) class to serve as a basic EMT for a southwest Michigan ambulance service, while taking a pre-med curriculum at a Michigan College. I would be lying to not admit I was afraid for her. She is young with so many years to experience the horrors of being a first responder. Ten years from now, would her outlook be more cynical and pessimistic? Would she be on the verge of compassion fatigue, cumulative burn-out or suffer with secondary vicarious trauma? We ended up making an agreement, that I would support her if she promised that if there was ever a case where a CISM or CISD was offered that she would participate as an act of her own self-care plan. Now CISM, is how both my daughter and I are able to continue to remain in the helping profession not just today, but hopefully for many years to come. I have seen how teams that take the pregnant pause become more effective, closer knit with a deeper synergy after having worked on a critical incident and being given CISM support. It gives the team permission to support and process emotionally with one another. I have heard staff name CISM teams as one way they feel like hospital leadership cares about on the job stress and supports them.
Our initial education approach included a presentation for management, creation of a program brochure and announcements via e-mail and other organizational social media. Our expectation and ask was that management would help promote and explain the program to associates. In hindsight, a more grassroots approach with associates from the beginning would likely have helped change the culture more quickly. We found that months into the program we were still struggling with direct line staff understanding the focus and benefits of debriefing. An event that occurred in the third month of our launch helped to turn the tide.
We had a very significant event that involved the tragic death of multiple children from the same family. Our ER staff and pediatric staff were involved in trying to save the children as well as interacting with family both before and after the deaths. For the debriefing, we involved both departments and even some of the first responders. The staff who participated clearly expressed the benefits they felt from the process and word of mouth spread to others. Momentum began to gather with this successful event as well as additional campaigns to reach staff via social media and safety huddles. Our initial system-wide team that included approximately 20 people was about to expand with training new members. Then Covid-19 happened.
As all of our worlds have upended, so has our SHINE program. We have shifted to providing one-to-one defusing and debriefing via telephone to adhere to social distancing guidelines. With the focus and stress related to the virus and these limitations, we have obviously experienced fewer referrals. However, we know this unfortunate climate is creating a great need for CISM on a broad scale. The next challenge for us will be adjusting to a new normal with all its fears, anxieties and disappointments brought on by the COVID pandemic. We are confident Beacon’s dynamic team is up to whatever challenges we face now and in the future.
[i] “Guidelines for Critical Incident & Stress Management”. American Association of Anthetists. c. April 2014.