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 Teamis 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

Managersare 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

Supervisorsare 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:

–timeframes for
interventions

–the responsibilities of those
involved

–the methodsfor
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 different
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 XXXXXXXXXXImplementation and evaluation of a
practical intervention programme for dealing with violence towards health
care workers. Journal of Advanced Nursing. Vol 31, issue 3, pages XXXXXXXXXX

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 XXXXXXXXXXManagement 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 XXXXXXXXXXFramework
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

Duringthe 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.