William Jacobowitz, EdD, RN.
Associate Professor, College of Nursing and Public Health, Adelphi University, Garden City, NY.
Mr. Jacobowitz has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
For staff on inpatient psychiatric units, the rate of posttraumatic stress disorder (PTSD) is around 9%, which is two to three times higher than the national prevalence rate of 3%–5%. Rates are higher if you work with forensic patients or if you’re a nurse. Nearly all (96%) psychiatric nurses have been directly or indirectly exposed to a critical event, and over half have been physically assaulted by a patient (Hilton NZ et al, Psychiatr Serv 2020;71(3):221–227).
Typical manifestations of workplace PTSD include disengagement from patient care, frequent absenteeism, and a tendency to self-isolate. Over half of workers who meet PTSD criteria also meet criteria for depression or anxiety (Seto MC et al, Can J Psychiatry 2020;65(8):577–583).
How can we mitigate our risk of developing PTSD after a traumatic event? Debriefing sessions help, especially if they take place soon after the event—within 10 hours. Be careful, however, as a single debriefing can be retraumatizing if it is not followed with individual counseling, which staff can seek through their workplace’s employee assistance program.
Here are some additional tips to help you decrease your chances of developing PTSD after workplace trauma:
Try to carry on with your usual work activities—in effect, you’ll be practicing exposure therapy, a common psychological intervention in treating PTSD.
Talk to people and spend time with others.
Practice mindfulness—which includes muscle relaxation, meditation, and frequent self-assessment of stress level.
Make as many daily decisions as possible, even about minor things—like what to make for dinner—as they will give you a feeling of control over your life.
Understand that you might experience recurring thoughts, dreams, or flashbacks; they are normal and will decrease over time.
Here are some ways that you can help co-workers who have been exposed to trauma:
Offer them assistance and a listening ear even if they have not asked for help.
Don’t pressure them to recount the incident if they don’t want to. Respect their privacy.
Don’t tell them they are “lucky it wasn’t worse.” Instead, affirm that you are sorry such an event has occurred, and you want to understand and help them (Mitchell JT. Critical Incident Stress Management (CISM): Group Crisis Intervention, 4th ed. Ellicott City, MD: International Critical Incident Stress Foundation; 2006).
Also, consider scheduling routine monthly staff meetings, as they help reduce the risk of PTSD by enhancing employee cohesion and providing opportunities to express concerns and receive support (Jacobowitz W, Issues Ment Health Nurs 2013;34(11):787–795).
CHPR Verdict: Many of us experience or witness traumatic incidents on inpatient psychiatric units, so it’s no surprise that rates of PTSD are high. Practical tips can help reduce the risk, but be careful about debriefing sessions as they can be retraumatizing if not done correctly.