CHCMGT005 Facilitate WorkplaceDebriefing and Support ProcessesAssessment Task 2: RoleplayInstructions:Read the scenario below. It is 9am on Tuesday 5 December. You work for a large community ...

It is 9am on Tuesday 5

December.

You work for a large community

services organisation – Finding Solutions (FS).

Beverly, a manager in the

Community-based Addiction Interventions Team, has called and asked you to

facilitate a debriefing session following an incident that occurred yesterday.

The incident occurred in a

different department to your own – Beverly wants you to conduct the debrief

because you do not know any of the staff members concerned. It is felt that

staff will feel more confident to discuss incidents with people who they do

not know.

You have been briefed on the

incident by the manager of the area (they did not witness the

incident).

The incident occurred on Monday

4 December at approximately 3.30pm.

John and Anna were running a

group support meeting for people seeking help with drug addiction. The

program is run in the community as part of FS’s community-based addiction

treatment services.

One of the clients had a

seizure during the session and stopped breathing. Anna performed CPR while

John called 000.

Jessica was working in the

reception area nearby. She helped move the other clients to another

room.

The paramedics worked on the

client for some time, but he was pronounced dead on arrival to

hospital.

Part A: Plan and prepare for

the debriefing session

SAMPLE

CRITICAL INCIDENT PLANNING POLICY

Rationale and Aims:

Critical Incidents may have a

severe emotional and/or physical impact upon people. During a Critical

Incident, a coordinated, systematic response is required to restore stability

and to create a sense of safety and security for all involved.

The key aim of this Policy is to

assist the Organisation in preparing to respond to a Critical Incident.

Accordingly, the procedures, flowcharts, checklists and guidelines provided

in this Policy and attachments are designed to assist in the planning and implementation

of an inclusive response to manage any critical incident effectively and to

restore a sense of safety and security to the staff and clients.

Definitions:

ACritical Incidentis

defined as a physical event, a series of events or psychological trauma which

has severe immediate impact and likely long-term effects on the individuals

involved. These may include, but are not limited to:

§the death, suicide or

disappearance of a client or staff member;

§the destruction of

part or the whole of the facility;

§major vandalism;

§acts of terrorism;

§extremely damaging

media attention;

§a sexual assault;

§a natural or other

major disaster in the community such as fire, flood, epidemic;

§enforced closure of

the facility.

Critical Incident Team

is the group of personnel established to manage a Critical

Incident. This should include those with appropriate expertise as well as

others who have personal qualities appropriate to crisis management. One

member of the Management Team will lead the Critical Incident Team.

Commitments:

We make the following commitments:

1.to

demonstrate a commitment to the principles of best practice with regards to

the management of critical incidents across our organisation;

2.to

ensure that our duty of care for staff and clients is fulfilled to the best

of our ability and in keeping with legislative responsibilities;

3.to

provide an environment of support in which stability and a sense of safety

can be restored at the earliest possible time following a critical incident;

4.to

minimising short and long term disruption to services

5.to

care for both the physical and emotional well-being of staff, clients and

families.

Major Strategies for Implementation

of Aims:

1.Regular,

planned professional development of staff in the areas of prevention,

preparation and response to critical incidents.

2.Regular

liaison with local community services and service providers to develop and

monitor strategies for use of alternate facilities/resources if required and

the communication of information when required.

3.At

the time of a critical incident, implementation of a Critical Incident Plan

for:

a)Immediate

action

b)Additional

action

c)Follow-up

– monitoring, support, evaluation

d)Staff

and client Education

e)Restoration

of Wellbeing

Organisation:

Management Team (CEO or HR Manager)

is responsible for:

§overseeing the

coordination of any critical incident response

§establishing and

leading theCritical Incident Team

§developing and

implementing aCritical Incident Plan

§liaising with the Media,

CEO, Police, Families

Managers

are responsible for:

§professional

development of Staff for prevention, preparation and response to critical

incidents

§monitoring of staff

needs throughout a critical incident response

§determining the level

of counselling/other support required from external authorities

§setting up and

staffing recovery room

§liaising with relevant

external support agencies

Supervisors

are responsible for:

§monitoring of

individual staff and clients

§implementation of

actions as required by the Critical Incident Team

§referring staff and

clients to support services

Resources:

The nature of critical incidents is

such that resources cannot always be provided in anticipation of events. For

this reason, the Management Team will use its discretion to provide adequate

resources – both physical and personnel – to meet the needs of specific

situations.

Response to Critical Incident

a)Immediate response

1.The Management team

assesses the risk to staff, clients and others and takes action to make them

safe from further harm.

2.Where there is a risk of

further harm or other life or property the assistance of emergency services

must be requested immediately.

3.Arrange medical treatment

as soon as possible if necessary, and provide immediate appropriate personal

support, and other assistance reasonably required.

4.Identify the full name of

those involved in the critical incident, if possible.

5.Contact the CEO who will

advise on the need for further action.

6.The Management team is to

make notes of key facts of the incident at first available opportunity.

7.This phase is completed

when those involved are safe from further harm, in receipt of necessary

immediate support and services, and in a stable care environment.

b)Secondary response

1.The Management team is to

identify other interested parties who may need to be notified or may be

affected by the incident and advise the CEO who will advise on an appropriate

communication and support response.

2.Sensitivity to the wishes

of those involved in terms of contact and notifying others must receive high

priority where it does not conflict with statutory obligations.

3.The Management team is to

arrange access to counsellors and/or pastoral care for clients and staff

affected, as required

4.The Management team is to

establish an information point for clients, family and others who have a

legitimate interest in the matter.

5.The CEO in conjunction

with the management team, is to make all necessary arrangements depending on

the situation (eg extra security, alternate accommodation, funeral

arrangements etc.)

6.The CEO will be responsible

for all media contact to provide a briefing about the incident if required

7.The CEO and Management

team will develop a concise Incident Recovery Plan with objectives, actions,

responsibilities and timelines.

8.The Management team will

make a full written report of the incident and response.

9.This phase is complete

when all affected parties have been notified and support services have been

mobilised as required, necessary practical arrangements made, and an Incident

Recovery Plan (IRP) developed and implemented.

c)Follow up response

1.Continue implementation of

the IRP until any further response is assessed as unnecessary.

2.Review the implications of

the incident for ongoing services and determine the need for alternative

accommodations and implement a support plan if required.

3.Update critical incident

reports regularly until the response period is completed.

4.Review the incident and

identify implications for future responses. Develop plans and amend policy if

necessary to prevent a recurrence of the incident or any shortcomings in the

response.

d)Critical Incident Reporting

1.The Manager managing the

critical incident is required to establish the facts and keep detailed

records.

2.These records must be kept

on the staff/client’s file marked confidential.

3.These records may be used

in the case of coronial enquiry, media interest and police.

Evaluation:

This policy shall be evaluated against the aims in the month following

a critical incident response or at least every two years by the CEO in

consultation with the Management Team and OHS Committee (Reps) if present.

BEST PRACTICE GUIDELINES

POST ASSAULT

Employers have a duty of

care towards employees to ensure that they are not harmed in any way by work

activity. If violent incidents occur the effects should be minimised.

Long-term effects may

include reduced morale, impaired performance, absenteeism, increased sick

leave and the psychological trauma suffered by the people involved in the

incident. The employer should have:

§documented

procedures for prevention and early intervention strategies, as soon as an

assault or the potential for an assault is identified

§procedures

in place to be followed for an effective immediate response that controls and

diffuses the situation

§access to a

debriefing session if required

§a

rehabilitation assessment that considers:

–
time
frames for

interventions

–the responsibilities of those

involved

–
the methods
for

assessing needs

§A process to

ensure that referrals are made to the relevant service providers for the appropriate

treatment

Procedures for responding to incidents

§Describe the circumstances in which the procedures should

be followed;

§Describe the role of the individual members of staff

§Nominate an individual to co-ordinate response action

§
Allocate a safe place to retreat to

§
Control media access to those involved

§
Provide communication with families and arrange transport home

§Give clear guidance on reporting procedures

§Indicate follow up actions, including staff debriefing

and counselling as appropriate

§
Consider referral to employee assistance programmes to provide

psychological first aid support.

Be aware of diff
er
ent

people's reaction to a stressful situation. These may include: feelings of

anger, frustration, anxiety, guilt, embarrassment and of being "out of

control". They may respond inappropriately and have physical symptoms

such as vomiting. Longer term, they may suffer with sleeplessness, "reliving

the event", and a fear of returning to work. These reactions should be

recognised and managed quickly after the episode to reduce the risk of

psychological harm.

Reporting

§Employee details

§Location of incident

§Date, day and time

§Details of the assailant

§What the employee was doing at the time of the incident

§The circumstances of the assault

§Details of the outcome: i.e. injuries received, time off

work, property damage

§Information about any remedial action

Medical Treatment

§When a

caregiver reports being assaulted and/or injured in the course of his or her

work, the employer should assess the injury, provide first aid treatment if

required, and facilitate any short- or long-term medical treatment that is

necessary.

§Provision

needs to be made for employees to be able to summon help quickly

§Plans/arrangements

may be necessary with local medical care facilities for urgent consultations

in cases of injuries

§A treatment

plan or provider network should be established in advance, not only to deal

with any physical injuries but also to provide a treatment plan for any

psychological or mental health issues that might arise from a workplace

incident

Debriefing

§Sharing personal experience with others to diffuse the

impact of abuse

§Helping those who have been affected understand and come

to terms with the event

§Re-assurance and support

§Getting people to focus on the facts and give information

§Explaining subsequent help available

Counselling

1.Face to face contact -

preferably short term of between 5-8 sessions

2.Response to traumatic

incidents:

§Defusing and debriefing

-helping staff

to come to terms with what has happened

-offering

re-assurance and support

-getting people

to focus on the facts and give information

-explain the

subsequent help an available

§Post Trauma counselling

-For staff who

need more intensive support or when symptoms persist over a long period

3.Integration of cognitive

strategies into the decision making process

4.Links to outside services.

Arrangements need to be made for staff to have access to external advice

where the full range of services is not available in-house. Written protocols

for these services should cover accessibility

Management support

§Taking control of situation, informing others and dealing

with victims and other staff

§Producing organisational and administrative policies

aimed at minimising the impact of traumatic events which cover areas such as

post incident support, provision of leave, costs, legal issues, etc.

§Provision of information to families and the media,

expressions of gratitude to staff and investigatory procedures

§Provide a structured feedback program with workplace

staff incorporating better awareness of risk situations for violence, how

potentially dangerous situations could be avoided and review strategies in

dealing with aggressive patients

Rehabilitation

Best practice

rehabilitation policies, procedures and responsibilities include:

§Early

intervention

§A strong

management commitment to rehabilitation including the provision of safe

modified duties during the recovery phase

§The early

development of rehabilitation plans in face-to-face interviews with the

injured employee

§A supportive

and consultative workplace culture for injured employees, including the

provision and support for modified work and reduced hours of work in the

short term

§Consideration

of training and vocational needs

§Workers should be supported during the entire period of

rehabilitation, allowed all necessary time to recover but also encouraged to

return to work

§The sooner the victim can return to work, the easier it

would be for him/her to rejoin the workplace as the worker may have missed

out on the current information needed for effective job performance

§Workers should not be subjected to too much stress at

first and flexibility in the form of part time work, a different assignment

&/or support of a co-worker can allow the person to recover their

self-confidence

§It is important that, when they return to work, they feel

safe in their environment both from physical and psychological violence

§the feedback

into hazard management of issues arising out of the rehabilitation process

References

Arnetz, J & Arnetz, B. (2000) Implementation and evaluation of a

practical intervention programme for dealing with violence towards health

care workers. Journal of Advanced Nursing. Vol 31, issue 3, pages 668-680

NZ Ministry of Business, Innovation & Employment. Managing the

risk of Workplace Violence to Healthcare and Community Service Providers (
www.osh.dol.govt.nz
)

Richards, J. (2003). Management of workplace violence victims.

Available from:

http://www.who.int/violence_injury_prevention/violence/interpersonal/en/WVmanagementvictimspaper.




pdf

International Labour Office/International Council of Nurses &

World

Health Organization/Public Services International. (2003). Framework

guidelines for addressing workplace violence in the health sector. Available

from:

http://www.who.int/violence_injury_prevention/violence/interpersonal/en/WVguidelinesEN.pdf

Your assessor will be looking to see that you can:

Plan and prepare debriefing in line with standards and procedures

For example, by scheduling a time; finding out the facts that are

available about the incident; finding out who was involved in the incident

and their roles and responsibilities

Schedule debriefing at an appropriate time following the incident

Understand the limitations of your role and responsibilities

Maintain and describe professional boundaries.

Part B: Conduct the debriefing sessions

Your assessor will be looking to see that you can:

Prepare for the debriefing session as per workplace standards and

procedures

For example, by arranging the room appropriately; by bringing notes,

etc

Conduct the debriefing in a safe environment

For example, by ensuring WHS issues are addressed; it is a private and

confidential environment; the area is comfortable and non-threatening, etc.

Use appropriate debriefing techniques to:

§open the meeting and explain the reason for the

debriefing

§explain the rules of confidentiality, non-judgment and

freedom to talk

§encourage open and honest conversation

§invite staff to each give their account of the incident

and clarify as required

§invite group members to put forth their thoughts and

ideas (both at the time of the incident and upon reflection)

§focus on the facts

§review staff reactions and stress symptoms

Use appropriate questioning to encourage staff members to explore and

acknowledge their concerns

For example, use of open and probing questioning; consideration of

body language and cues; active listening, etc

Discuss any issues that arise during the session that are relevant to

the incident and attempt to find solutions

For example, was John really incompetent? Anna seems to think he did

well; the length of time the ambulance took to arrive was only 10 minutes,

but it seemed much longer; the phone and the changes in client behaviour are

valid issues.

Provide information and advice to help participants to identify and

understand the level of risk to their emotional well-being and to manage

their symptoms

Identify staff members who need additional support and refer them to

suitable services

For example, EAP counselling services; a GP to obtain time off work,

treatment for depression or anxiety; John and Jessica both have feelings of

doubt and self-worth. John in particular is demonstrating signs of stress;

Jessica thinks she doesn’t want to work here anymore.

John

During the incident:

You were in charge of the group therapy session. You noticed that the

client (Yasser) was looking unwell, but you presumed he was drug affected and

you didn’t say anything to him.

Yasser was looking hot and sweaty and was not joining in with the

session. You were really annoyed with him for coming to the session stoned.

When Yasser had the seizure, you didn’t know what to do – even though

you have been in this job for 10 years and you do first aid training each

year.

You felt frozen to the spot. You saw Anna doing CPR, and she yelled at

you to call the ambulance.

All the other clients were yelling and carrying on in a panic.

Eventually you snapped out of it and went to reception to get the

mobile phone. [There are no phones taken into sessions as they tend to be

stolen by clients.]

Jessica was working in reception – you yelled at her to get the

clients out of the room while you called 000.

The 000 operator asked a million questions – you just wanted an

ambulance to get there as soon as possible. Anna was still doing CPR

like crazy.

The operator asked if Yasser was breathing. You kept saying ‘No, just

get the ambulance here!’

The ambulance took forever. They came in and took over, but Yasser

never recovered.

After the incident:

You haven’t eaten since the incident and you have barley slept. You

keep seeing Yasser’s eyes looking at you, just before he had the

seizure.

During the debriefing:

You don’t want to talk about what happened – you feel ashamed that it

wasn’t you doing the CPR and that you didn’t deal with the situation

well.

You don’t want to participate in debriefing because you think it is a

waste of time.

You wish you had asked Yasser if he was okay.

You need to start the session as uncooperative. Talk as little as

possible.

During the meeting you need to act distracted.

Sigh often.

Get up and pace around the room.

As the student/debriefer starts to open you up, you need to contribute

more to the discussion.

In the end you pour it all out. You have two major issues:

§There

have been a lot of incidents with these community groups lately. With

different drugs on the market, clients are becoming more violent, volatile

and hostile. You don’t think management is listening when you say more staff

and security arrangements are required.

§The

second issue is that there is no phone or duress alarm available in the therapy

session room.

Anna

During the incident:

You were working with John at the group therapy session. You hadn’t

noticed anything wrong until Yasser started to fit.

It was horrible to watch as his body was thrown all over the place.

Then he just flopped. He wasn’t breathing and you couldn’t get a pulse.

You called for John to come and help you, but you saw he was busy

trying to calm down the other clients. You realised that you would need to do

CPR – you had just done your refresher training.

You shouted at John to call the ambulance – you also said that Jessica

might be able to help John with the other clients.

The CPR seemed to go on forever. You remember John shouting at the

person on the phone to make the ambulance hurry.

Finally the ambulance came and you handed over to the paramedics. They

tried to resuscitate Yasser but unfortunately they couldn’t.

After the incident:

You are coping well. You think that you, John and Jessica did

everything you could. You worked well together, each of you taking a role. It

was sad that Yasser died, but it wasn’t for your lack of trying!

During the debriefing:

You should be cooperative, friendly and bubbly through the whole

meeting.

You agree with the issues John has (see above).

Jennifer

During


the incident:

You have only working here for a few days. You are just learning about

the work that is done. Your role is to take bookings and to file

paperwork.

You are 18.

When the incident occurred, you felt like all hell had broken loose.

John came running out to reception shouting something, but you couldn’t

understand him – then he reached over the counter and grabbed the

phone.

You gathered he was ringing 000 but had no idea why.

John told you to get the clients out of the room and then raced back

with the phone.

You went into the room and asked all the clients to come with you, but

had no idea what you were supposed to do with them. You sat them down in

reception and went back and asked Anna and John what you were supposed to do

now.

They were both so busy they didn’t notice you, so you thought you had

better go back to reception. Two of the clients were getting angry with each

other.

After 10 minutes [you had looked at the clock when John came to get

the phone – it was 3.30pm] the ambulance turned up [it was 3.41pm by this

time]. The clients had all gone home.

You took the paramedics into the room and they took over from Anna.

You were the only one who knew that the ambulance arrived within 10

minutes.

After the incident:

You went home because you didn’t know what else to do. You didn’t know

until the next day that the client had died. No one said much to you –

probably because you are so new to the workplace.

During the debriefing:

Your main issue is not knowing what to do.

You wonder if you caused the client to die because you took too long

to understand what John wanted.

You don’t think you are suffering from stress, but you don’t think

this type of job or workplace is for you.

You don’t intend to go back to work. It is a pity because now you will

have to sell your new car.