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Ann MacLochlainn is the Mental Health Nurse Consultant at St. Vincent's Hospital Sydney and the director of the Peer Support Program. Kathleen Ryan is a Nurse Educator in the Department of Nursing Inservice Education, St. Vincent's Hospital Sydney and the Peer Support Program coordinator. |
Peer support as a model of psychological support is examined from its inception in the public service industry through its expansion to emergency service and more recently to St. Vincent's Hospital, Sydney. Peer Support Programs aim to reduce stress resulting from critical incidents and cumulative stress and accelerate the return of workers to normal personal and professional functioning. This is achieved by colleagues who have completed specific training providing support for their peers. The Division of Nursing at St. Vincent's Hospital, Sydney has introduced a peer support program as a method of offering staff support and facilitating stress management.
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Nursing is a stressful and demanding profession and without the utilisation of appropriate interventions to deal with stress, many nurses 'burn out'. Unfortunately, as a result of stress, valuable people have left the profession while others have remained and become less effective in their professional and personal lives. Psychological support for nurses is not always provided in the most effective way, if provided at all. Peer Support Programs are effective, and since their inception in the public service organisations, have spread to emergency service workers and health care workers. In 1994 the Division of Nursing at St. Vincent's Hospital, Sydney, established a Peer Support Program.
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According to Robinson (1990: 1) Peer Support was first introduced into public service organisations in Chicago in 1955 and established in this period to deal with employees with alcohol problems. Since this time, emergency services have been at the vanguard of development, and in 1981, the Los Angeles Police Department was the first police department to implement such a program. In Australia, peer support programs were also initially developed in the emergency services, especially the ambulance and fire brigade services. In 1988, a peer support program was established in the NSW ambulance service and the NSW police department in 1990 (Robinson 1990: 1).
It is well established in industry that management has an obligation to protect the health, safety and welfare of its employees. In many instances, this obligation is now legislation, and standards must be met in order to protect workers. We have seen the introduction of protective clothing, eyewear, masks and earmuffs (Robinson, 1990: 2).
The introduction of such measures has also been evident in the nursing profession. The physical wellbeing of the employee is of great concern to management, and major steps have been taken to ensure its protection. For most industries and organisations, there has been no formal system of psychological support for employees until the introduction of peer support programs in the late eighties and early nineties.
The essence and basic philosophy of a peer support program is that people who have completed a specific education program assist fellow workers to cope with on-the-job problems.
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Workplace peer support is not a new idea. Informally, workers have offered assistance to colleagues during traumatic and stressful times. Unfortunately, in some cases, the support provided caused more problems than it solved (Tunnecliffe & Roy, 1993: 21). The concept of formal peer support is new and exciting. Peer support utilises the experiences and skills of fellow workers to provide support and reassurance in times of distress. Psychological support for staff is provided, that is both reactive to staff distress and proactive in promoting psychological health and early detection of problems. Support is provided by fellow workers who have the same or similar experiences. As Robinson (1990: 2) states, 'Experiencing a common circumstance or being in a common predicament can be a powerful component of healing'. In this way, peers are highly accepted by fellow workers, and the use of peers is less stigmatising than other formal support. Effective use of workers by utilising the special skills of the employees is cost effective and contributes to increased job satisfaction for staff who have the opportunity to use and extend their skills (MacLochlainn & Ryan, 1994).
Peer support programs provide workers with the opportunity to confidentially 'talk out' any problems with specially trained coworkers (Robinson, 1990: 3).
As a society-oriented people, we need other people to relate to and to communicate with. Without this part of our existence, most of us would be unable to deal with the mounting stresses we are subjected to at work and at home. (Goliszek, 1987, cited by Tunnelcliffe & Roy, 1993: 9).
Peer support also promotes cohesiveness, by placing emphasis on staff providing support and solving their own problems. The introduction of peer support programs has been reported to increase staff morale, reduce sick leave and increase satisfaction with management (Robertson & Murdoch, 1992: 2).
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The very nature of nursing is stressful. Nurses are constantly faced with sickness, suffering and death, requiring them to deal with the physical and psychosocial needs of both the patient and their loved ones. In addition, nurses are also expected to function in the dynamic hospital environment coping with constant change. The exposure to these everyday stressors results in cumulative stress and nurses may also experience a critical incident. A critical incident is any situation faced by staff, that causes them to experience unusually strong, emotional reactions that have the potential to interfere with their ability to function, either at the scene or later. Critical incident stress is a normal reaction to an abnormal situation or event (Paton, 1992: 2).
The cumulative stress and critical incidents that health care workers endure is well documented in the present media, with headlines of 'The Hidden Health Hazard' (Sweet, 1995: 12). Sweet (1995: 12) also reports '...doctors and nurses are dead on their feet' and the use of drugs, alcohol and suicide is alarmingly high among these professions. Health care workers perceive themselves as helpers, not victims; therefore, they do not seek help often.
As the Division of Nursing at St. Vincent's Hospital recognises the most valuable resource in the organisation is its personnel, they have endorsed the introduction of the Peer Support Program.
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There are several models of psychological support established in organisations.
Robinson (1990: 2) reports there is much to be gained from the dual system of peer supporters and mental health professionals. Peers offer psychological support for colleagues, while mental health professionals provide education for peers and critical incident stress debriefing for groups or individuals.
St. Vincent's Hospital is in the fortunate position of having the peer support program developed with involvement of mental health professionals. The Mental Health Nurse Consultant is the director of the program and the Liaison Psychiatrist assists with workshops, debriefings and continuing education for peer supporters. The program also has support and input from the Social Work Department.
Peer supporters have come from various levels of nurses, including Assistant Directors of Nursing, Nursing Unit Managers, Clinical Nurse Educators and Specialists, Registered Nurses and Enrolled Nurses. Ideally peer supporters are nominated by the staff and are not self-appointed or management-appointed. The peer supporter must have a good rapport with fellow colleagues and be sensitive to the needs of others. Willingness to learn is also an essential attribute for peers.
At St. Vincent's Hospital, peer supporters attend a two-day workshop that enables the participant to develop the skills necessary to function as a peer support person. The workshop gives peers the opportunity to recognise potential or aggressive situations, manifestations of stress and develop appropriate interventions to cope with these situations. The main objective of the peer support person is to provide assistance to fellow workers who have either work-related or personal problems associated with a critical incident and/or cumulative stress. It is made clear that peers are not qualified, nor have the skills to provide formal counselling. Peers will link workers in need to appropriate specialist care (MacLochlainn & Ryan, 1994). In addition, the workshop also provides the peers with information on how to access the specialist care and arrange debriefing sessions for staff.
There have been four workshops conducted with a further two workshops planned for 1995. As of December 1994, sixty-four members of the Nursing Division have completed a workshop and are functioning as peer supporters in the hospital.
The wellbeing of peer supporters is also very important. Support is provided for peers with regular meetings, newsletters and contact with the program director, coordinator, other mental health care workers and fellow peers who provide support and advice.
Evaluation of the program will take place on a continuous basis. Peer supporters complete monthly activity sheets indicating the number and types of peer support activities undertaken. In addition to the activity sheets, debriefing records will be maintained. The number and type of reported incidents and debriefings prior to the introduction of the program will be compared to current records and trends.
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The Peer Support Program is complemented by a debriefing program.
Debriefing refers to the process whereby people who experience a traumatic event are encouraged to discuss the event, including their reactions and feelings, in a supportive, accepting environment.
The aim of debriefing is to assist recovery in normal people experiencing normal reactions to abnormal events. Debriefing can be conducted individually, although it is frequently carried out with a group to reinforce the normality of the individual's reactions and to facilitate the provision of support from group members (MacLochlainn, Ryan & O'Mara, 1994).
Debriefing sessions are generally conducted within 24-72 hours after the traumatic event and should not be confused with operational debriefings in which procedures, results, reports etc. are discussed, although these may be the focus of some discussion in stress debriefing sessions. Education on various stress-related symptoms is usually included (Sorrell, 1993).
The debriefing of stressful incidents includes recognition of threats to the individual's feeling of mastery, efficacy and competence as well as personal meanings and vulnerabilities. Discussion of these issues is an important part of the debriefing process (MacLochlainn et al., 1994). Peer supporters receive input on the debriefing process and its benefits, together with information on the sort of situations for which debriefing would usually be helpful. This enables peer supporters to utilise the debriefing program for the benefit of their peers.
Educational sessions on debriefing are conducted for peer supporters and others who wish to become debriefers, or who would like to learn more about debriefing.
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Peer Support has been shown to be an effective method of psychological support for staff. The Division of Nursing at St. Vincent's Hospital, Sydney has introduced a program to assist nurses to effectively cope with cumulative stress and critical incident stress. The program has been received enthusiastically by all levels of the Division of Nursing.
Evaluation of the two day workshops has been very positive, as has feedback regarding the implementation of the program. The effectiveness of the program will continue to be evaluated.
Stress, unfortunately, is the norm in health care today and it is vital to have effective stress management programs implemented. It is anticipated that the introduction of the peer support program will facilitate a change in the culture of nursing, so that staff will become more aware of how effective peer to peer support can be in coping with a stressful environment.
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