Policy briefing

Helping nurses to ‘defuse’ after difficult situations

The RCN has issued guidance on how to discuss and reflect on challenging incidents at work

The RCN has issued guidance on how to discuss and reflect on challenging incidents

Nurses meeting to discuss and reflect following a difficult situation
Picture: iStock

Essential information

Making time for nursing teams to reflect on challenging or difficult situations and ‘defuse’ can support their psychological well-being and enhance their self-care and management, according to the RCN.

It can help to sustain a workforce, improve communication and reinforce teamwork. It allows teams to share successes and positive experiences.

What’s new

Advice on responding after challenging situations and when staff should meet to reflect on them is the subject of new guidance from the RCN.

The leaflet, Time and Space: Enabling Defusing Activities, sets out the benefits of giving nursing staff the chance to react to and reflect on the incident or event and gives advice on how this review should be structured.

It sets out advice on regular catch-ups before, during and after shifts, and a more detailed discussion after particularly busy or difficult shifts.

The leaflet is part of the RCN’s new package of mindfulness tools. These tools are intended to help nurses and other staff in all clinical settings focus on the present, protect themselves, reduce stress and improve patient care.

When it comes to defusing difficult situations, the nurse in charge should assume responsibility and explain the importance of honest and open communication and reflection, encouraging the team to connect regularly.

They should plan an agreed time that the whole team can get together mid-shift and briefly check that original task allocations are working and manageable, re-evaluate this if necessary and raise any concerns. The nurse in charge should bring the team together again at the end of the shift.

Following more challenging shifts, the RCN says that the nurse in charge should acknowledge it has been difficult, thank everyone for their efforts and allow strong views to be expressed.

It is an opportunity to reassure staff that what they are feeling is normal, and to give them a sense of proportion, perspective and control over what has happened. If physical restraint has been used, it is a chance to check the physical well-being of staff.

Implications for nurses

Advice for defusing sessions after difficult situations:

  • Keep it fairly brief.
  • Ask how everyone has been feeling during the shift and how they are feeling now.
  • If any strong feelings or opinions are expressed, just let this happen. Do not feel that you have to rationalise these opinions or come up with an answer. The simple message should be, ‘it’s okay to have feelings and it’s okay to express them’.
  • Ask staff if they have any important points or observations they want to make about anything that has happened during the shift or any problems, for instance, racial abuse, threats, issues with procedures or equipment. Do not try and solve these issues at this point. Where necessary, encourage staff to raise these issues at the weekly staff meeting/clinical supervision.
  • Try to give staff a sense of proportion, perspective and control over what has been happening during the shift.
  • Emphasise areas of good practice and thank staff.

 

Expert comment

Ann NormanAnn Norman, RCN professional lead for criminal justice and learning disability nursing

‘This is an important issue for all nursing and other clinical staff, wherever they work, because we are all working under enormous pressure in these challenging times, with limited resources.

'Nurses are always dealing with challenging situations as we cope with the greater complexity of conditions that our patients present with, whether that’s poor mental health, physical health or substance misuse.

'We need to stay resilient to safeguard those we are caring for. That’s not always easy. While we need to pay attention to ourselves, how we are thinking, how we act and behave, we also need our managers and employers to invest in our care, support, health and well-being.

'Nurses need to know to look after themselves first. Don’t be afraid to ask for support.’

 

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