The forum was opened today by Kevin Gournay, Emeritus Professor of psychiatric nursing at the Institute of Psychiatry in Kings College London. Professor Gournay has over 30 years of experience as a chartered psychologist and registered nurse, particularly in assessing and treating PTSD as a CBT therapist and treating doctors and other health professionals presenting with mental health problems.
Professor Gournay spoke to us about the traumatic experiences inherent in working within the health workforce. He explained that despite theoretical education about how to deal with these situations, health professionals often feel unprepared when confronted with traumatic experiences.
He explained that an issue with the de-institutionalisation movement is the transition of people from inpatient hospitals to the criminal justice system and prisons. He also believes that inpatient services are more traumatising for health professionals compared with several decades ago. In particular, patients have little to do in these environments and the level of violence is higher. Professor Gournay also spoke of the breakdown of hierarchical structures in services. On one hand, this has resulted in more autonomy for professionals, yet on the other hand, there is less of a support system available for health professionals. He also explained that changes in the attitude of the general public towards health professionals may contribute to trauma within the workplace. He explained that, compared with several decades ago, there is less respect for health professionals within the workplace and gave the example of paramedics in Manchester now wearing stab-proof vests.
Professor Gournay also shared with us a list of experiences in the workplace that commonly lead to issues with trauma. These include: sudden assault, witnessing or proximity to acts of suicide and self-harm, treating and caring for victims of crime/accident/war-related incidents, and being involved in control and restraint methods (due to the trauma this causes for clients). Professor Gournay also cited lack of supervision and support for health workers as an issue to be resolved, along with staff burnout due to high case loads and working with populations who don’t improve.
Professor Gournay spoke of the various types of trauma in the workplace. In terms of physical trauma, deaths are rare. However, fractures, cuts and bruises, and whiplash-type injuries from restraining patients are common. He emphasises that the consequences of physical assaults can be pervasive, including to psychological difficulties, impairments in mobility and function and dependence on analgesic medications and alcohol. In terms of psychological and emotional trauma, health care professionals may experience transient trauma in which the person faces emotional upheaval which resolves very quickly. Acute trauma involves significant episodes of trauma involving more symptoms which take longer to resolve (with or without treatment). The final category of psychological trauma, chronic trauma, involves trauma symptoms experienced over a long period of time. If the symptoms are at a low-level, the trauma symptoms can go undetected and the person may remain within the workforce while their quality of life and work is greatly impaired.
Professor Gournay also spoke to us about research on trauma in the workforce, explaining that there is a paucity of studies and the results of the research are generally inconclusive. He spoke about some myths that exist about trauma in the workplace and how research is important in debunking these misconceptions. For instance, he explained that people tend to believe that doctors and nurses have higher rates of suicide than the general population. However, a study conducted at Griffith University found that doctors and nurses have similar or lower rates of suicide than the general population. However, medical doctors and nurses seek psychiatric treatment more than other professionals.
Research has also been used to identify the issues of trauma existing within the workforce. A Monash University study conducted in 2013 found that 43% of nurses met criteria for psychiatric disorder with 18% meeting criteria for PTSD (compared to lifetime prevalence of 10% PTSD in Australia).
Research is also essential in uncovering the factors involved in trauma and burnout, as well as offering strategies to resolve this. The Clayburn Stress Study (1995) investigated the factors involved in stress amongst nurses. The nurses reported that the top five things they found stressful within the workplace were: not having services to refer to, dealing with long waiting lists, dealing with suicidal patients on one’s own, not having time for study and personal improvement and trying to maintain a high quality of work within a demanding environment. Further, a 2007 study found that the quality of management support within the workforce seems critical in stress-management. In particular, adequate staffing and availability of clinical supervision are essential.
Finally, Professor Gournay spoke of implications of staff trauma and burnout for consumers. Specifically, these issues can impact continuity of care and impair staff empathy for clients. This results in less than optimum skill delivery, and an overall reduction in the quality of therapeutic environment.
J Adv Nurs. 1995 Aug;22(2):347-58. The Claybury Community Psychiatric Nurse Stress Study: is it more stressful to work in hospital or the community? Fagin L, Brown D, Bartlett H, Leary J, Carson J.