Psychological First Aid can help managers provide early support to staff affected by occupational violence and aggression (OVA).
Most experts in post-traumatic mental health recommend Psychological First Aid (PFA) to provide early practical and emotional support to people who have experienced a very stressful or traumatic event.
This approach seeks to reduce initial distress, address basic needs (for example, comfort, information, practical and emotional needs), promote adaptive coping (for example, assist with problem-solving), and encourage engagement with existing social supports and professional services.
While there is no set formula for providing PFA to a person following a very stressful or traumatic experience, the person should be supported in using strategies and resources that suit them and that are readily available.
Research indicates that structured psychological interventions such as psychological debriefing (which encourages individuals to recount the traumatic event and their responses in some detail) should not be offered on a routine basis. Psychological debriefing as an early intervention after trauma is not effective in preventing later mental health problems, and may be counterproductive for some people.
Ask yourself: 'Am I best placed to speak with affected staff?' For example, you may have been directly affected by the incident or the person needing support may feel more comfortable with another manager. Consider who else may be able to provide support to staff.
You can be guided by the following five principles of PFA: sense of safety, calming, self-efficacy, connectedness, and hope.
Promoting a sense of safety is particularly relevant to providing initial assistance following an incident of OVA.
- Respect the person's privacy and talk somewhere private, away from the scene of the incident.
- Prevent exposure to additional stressful experiences. For example, don't ask a person to continue to look after a patient who has just assaulted them.
- Be concrete and realistic – avoid vague and potentially inaccurate reassurances. For example, you might say 'The situation is under control and we're safe here,' rather than 'I think we'll all be OK now'.
- Provide practical assistance to meet the person's basic needs – for example, food, comfort, transport, and contact with loved ones.
- Repeat information as often as necessary – particularly to an acutely distressed person – to help them understand the information provided.
- Demonstrate support by reminding the person that it's not OK that this has happened to them.
Contact with staff in the hours and days following an incident of OVA provides an opportunity for you to help calm them and address any anxiety or other emotions that can undermine confidence and active coping.
- Reassure the person that short-term distress is understandable given the circumstances.
- Encourage them to get enough rest and exercise, and to eat a healthy diet.
- Encourage them to use slow breathing or other simple calming strategies to manage their anxiety.
- Promote the benefits of enjoyable and relaxing activities, and encourage the person to limit unhelpful coping strategies like excessive substance use.
Self-efficacy is the belief in one's ability to influence important aspects of one's life. Following an incident of OVA, a person may feel overwhelmed and experience difficulty in prioritising needs. For example, they may be concerned about caring for their patients, completing an incident form, or how they will be perceived by work colleagues.
- Highlight aspects of the situation that the person has some control over.
- Explore experiences from their past when they successfully coped with a stressful situation.
- Encourage them to actively address problems and try to solve one problem at a time.
- Help them to temporarily lower their expectations of themselves.
Support from family, friends and colleagues is a strong protective factor and can enhance a person's recovery following a very stressful or traumatic experience. There are different forms of social support – for example, emotional support, material and physical assistance, and a sense of belonging – and people can derive benefit from receiving such support and connecting with others.
- Explain the known benefits of social support.
- Encourage the person to spend time with family and friends.
- Suggest that they may find talking to others helpful and to do so when they feel ready.
- Direct and refer them to appropriate .
In the days and weeks following an incident of OVA some people might feel pessimistic and defeated by their recent experience, and may have trouble seeing a positive work future for themselves. You can promote hope about the person making a successful recovery.
- Tell the person that most people recover, given time, by using helpful coping strategies and the support of others.
- Reassure them that distressing psychological reactions are short-lived for most people.
- Confirm that the incident is being investigated and that practical actions and strategies will be implemented, making a future incident or potential re-occurence less likely to occur.
Reviewed 15 July 2018