First Aid for our
Hearts and Minds
Lisa Zaoutis, MD, FAAP, FHM
Allison Ballantine, MD, FAAP, FHM
Anne Fallon, MD
Disclosure
 None
 Nada
 Nil
 Zippo
 Zilch
 Bupkis
 Background
 Introduction
 Peer Support Session
Overview
1. Safety & Security
2. Ventilated & Validate
3. Predict & Prepare
 Mock Sessions
 Model one, try some
 Sharing from other institutions
Q&A
 Our staff does amazing work every day
 Occasionally…
Event
Why?
QI and
Safety
Risk Mngmt
Emotional
Support
System to provide emotional support to staff
after an especially difficult work-related event
 Timely
What?
 Peers
 Trained
 Help staff understand effects of trauma
 Support natural resilience
 Individual
 Group
Goal
 Reduce isolation, burnout, dissatisfaction
 Demonstrate institution’s concern for staff wellbeing
ESE
Supervisor or
Team Member
Notices Distress
Supervisor Sets
Up Time and
Place
How?
Peer
Support
Session
Peer
Support
Rep
First 8 hours
First 48 hours
Peer
Responders
Scheduled
 Not psychotherapy or group therapy
What it isn’t
 Not a QI investigation
 Not a legal inquiry
Act 1: S&S (Safety and Security)
The Peer
Support
Session
Act 2: V&V (Ventilate and Validate)
Act 3: P&P (Predict and Prepare)
Safety and Security
Set the tone:
 Take a deep breath, pause, look around the group.
Safety and
Security
 Thank everyone for joining you.
 Your voice is gentle and warm
 Your body is S.O.L.E.R.
S.O.L.E.R
S = Sit squarely
Safety and
Security
O = Open posture
L = Lean in
E = Eye contact
R = Relax (Soften)
 Introductions
 Explain why you’re there
Safety and
Security
 Explanation of session purpose
 Ground rules, confidentiality
Ventilate and Validate
 Allow/encourage discussion
 Affirm thoughts, feelings, questions
 Gently point out commonalities and themes.
Ventilate and
Validate
 Plenty of pauses
 after asking a question
 before responding
 Be an active listener (lots of nonverbals)
 Ask for “thoughts”, but listen for feelings
Ventilate and
Validate
 Use clarifying questions and statements, but use
them sparingly
 Try not to judge
 avoid expressions of approval or disapproval
 Try not to talk too much
 Resist the need to frame the responses too much
 Step in when things go off track
Ventilate and
Validate
 Try not to interview
 Try not to rescue
 your empathetic understanding is more valuable than
you realize
Expressions of Extreme Guilt or Shame
 Play back without agreeing
Ventilate and
Validate
 Validate the feelings without validating the facts.
 “Real but not True”:
 The feelings are real whether or not the facts are correct
 Try not to talk someone out of the facts to make them
feel better.
Play back without agreeing:
Are you feeling like
you should have
done more?
Ventilate and
Validate
It sounds like
you expect a lot
from yourself.
So you feel bad
about how you
handled this?
Validate feelings not facts:
I can only imagine
how difficult it
would be to see it
that way.
Ventilate and
Validate
Oh. Is that
how you’re
feeling?”
That’s quite a
heavy burden
to carry.
Is it hard to walk around
with those
thoughts/feelings?
AVOID:
Ventilate and
Validate

“You shouldn’t feel that way because…”

”Don’t be so hard on yourself…”

“It wasn’t your fault.”

”At least…”

“You’re such a good nurse/doc/RT/pharmacist…”
Blaming
 Diffuse the blame
Ventilate and
Validate
 Name the “anger” (…or fear) in the blaming
It’s hard to imagine
that anyone meant
for this to happen.
Is that frustrating?
Ventilate and
Validate
We may not have all
the facts yet.
Does it shake
your confidence
in the system?
It could make a
person angry,
couldn’t it?
Predict and Prepare
 Dealing with a trauma is a process
Predict and
Prepare
•
•
•
•
Wide range of reactions to an extraordinary event
You’re not crazy
Variable but predictable
Gets better with time and support
 Some folks are minimally impacted
 Some folks are significantly impacted
Common Reactions
Predict and
Prepare
• Self-blame, self-doubt
• Sadness
• Anger
• Anxiety
• Irritability
• Emotional numbness
• Perseverative thoughts (replaying the tape)
• Difficulty concentrating
• Changes in sleep, eating, or activity level
Timing
Predict and
Prepare
• Immediate or delayed reaction
• Comes and goes
• Morphs over time
• Expected/unexpected triggers
• General trend: improving over time
• Duration… weeks to months
Explain how to help oneself
 Know that you are resilient
• Be gentle and understanding,
Predict and
Prepare
• Give yourself extra time, support
• Make it easier on yourself
• where you can
• when you can
• for the time being
Positive ways of coping
Predict and
Prepare
 Talking to others
 Getting needed information
 Getting adequate rest, nutrition, exercise…
 Engaging in enjoyable activities
 Normal or lightened schedule
 Soothing activities
Negative ways of coping
Predict and
Prepare
 Drugs, alcohol
 Excessive isolation
 Activity level too high/low
 Over- or under-eating
 Risky or dangerous behavior
 Uncontrolled or misdirected anger
Options for additional support
 Your colleagues, family, friends
Predict and
Prepare
 Hospital support group
 Clergy
 EAP or mental health services
Closing comments
Predict and
Prepare

Take good care of yourself

Take good care of each other
•
•
•

Surveillance
Check in: “how ya doin’?”
Offer an ear or other resources
Our compassion grows through this process
• For ourselves
• For others
QUESTIONS?
COMMENTS?