Delivering psychological first aid in LTC

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Elizabeth Leis Newman
Elizabeth Leis Newman

For all of our discussions about emergency preparedness, there's a crucial component missing: how long-term care staff should talk to residents after a traumatic event.

A session at LeadingAge's annual convention titled, “Psychological First Aid: Response and Recovery to Traumatic Events” by University of South Florida associate professor Lisa Brown, Ph.D., explained both how issues of traumatic stress should be handled, and how long-term care residents have unusual challenges.

While there are problems that can affect anyone — hurricanes, earthquakes, death of a loved one, or even assault — Brown pointed out that the death of a roommate, a change in staff assignments, a change in health status or change in the length of stay, can all leave a resident in need of psychological first aid.

How much traumatic stress can develop can depend on a number of factors, such as timing, frequency and perception. For example, a weather event can be perceived as an act of nature and less scary to some than a terrorist attack.

That can be compounded when a well-meaning employee can say something such as, “At least he went quietly,” or, “I know how you feel.”

“There are people who say well-intentioned things but make it worse,” Brown explained. “Understanding what not to say becomes critical.”

A person doesn't have to be directly impacted to experience stress, Brown revealed. In a study conducted after the Sept. 11 terrorist attacks, a study at a nursing home found that even those with cognitive impairment became stressed because of the televisions constantly running news coverage of the event. The key was an emotionally charged event combined with “repetitive opportunities to learn.”

That “becomes encoded for people with moderate dementia,” she said. The lesson is to turn the television off after the original news is conveyed.

Other advice is to have a “lunch and learn” or training session with certified nursing assistants on communication with residents related to trauma.

“CNAs don't get trained in how to talk to residents,” Brown noted.

To be fair, there is ample training on politeness and respect. But that's a different can of worms than allowing a resident to express his or her feelings. It's also not uncommon for that resident to feel more comfortable talking to a maintenance person or CNA rather than a registered nurse, she noted.

“You need to give people tools,” she said. For example, in addition to what not to say, it should be taught that it's okay to say, “I am sorry that this has happened to you,” and to allow time to listen, and to maintain eye contact. Another appropriate tool is to help normalize the reaction, such as, “I have heard this has happened to other people,” or, “You are not alone.”

On the “don't “ list: Don't doubt, don't inquire about details, don't make statements that imply holding the person responsible, she said.

“Negative interactions trump all, and it's words,” she said.

The main takeaway for providers, Brown told McKnight's, is to spend time investing in how to help staff communicate on topics that can be tough.

“If you haven't had training, it's hard to be effective, and to know what is helpful and what isn't helpful. Just sitting down and having that conversation can cause a tremendous ripple effect.”

Elizabeth Leis Newman is Senior Editor at McKnight's. Follow her @TigerELN.
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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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