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Mental Health and Addictions Education in the Emergency Department

Evidence-based guidance for including Trauma-Informed Care principles in practice and reducing stigma in health care.

Individuals who work in Emergency Departments (ED) are exposed to the worst days of their patient’s lives. In providing care to patients presenting with a range of reasons, staff are at higher risk for traumatic stress injuries. This section of learning will provide a variety of evidence-based resources to support you as a health care worker. Follow the link below to the Dynamic HealthTM skill Self Care: Mental Health and Addictions Education in the Emergency Department, where you will find a video of Health Care Ethicist Amanda Porter interviewing an ED nurse about her current journey with moral distress, self-care, trauma, secondary trauma, and more.

Definitions

Moral Injury or Moral Distress: is knowing the moral or “right” thing to do but experiencing limitations when acting in an ethical or moral way.1,2

Burnout: is a state of an individual that is described by physical and mental exhaustion and occurs when the person’s goals cannot be achieved. This leads to detachment and/or negative attitudes toward work and is usually associated with a perception of diminished professional efficacy. It is caused by low job satisfaction and leads to quitting the role/job. Professional burnout negatively affects both the health care staff members and their patients.1,5

Compassion Fatigue: is described as a condition where there is a gradual decrease in compassion over time and occurs when the person receiving care is not protected from pain or suffering. This results in the worker feeling guilt and distress. Compassion fatigue can develop in any caring relationship where there is a caring and empathetic relationship. Like burnout, this can cause mental, physical, and psychological exhaustion, however, it differs from burnout by its sudden onset. It also is a direct result of exposure to trauma experienced by other individuals, and thus is a synonym for secondary traumatic stress disorder. Compassion fatigue’s symptoms are associated with traumatic memories and can cause hyper-stimulation, avoidance, and burnout.1

Secondary Traumatic Stress (STS) and Secondary Traumatic Stress Disorder (STSD): are defined as the stress resulting from both seeking to help and helping individuals who have experienced traumatic events. This naturally happens with therapeutic interaction between health care workers and patients presenting for help.1

STSD is explained as a state of biological, psychological, and social burnout that is triggered by recalling long-term exposure to patient-related traumatic events. The exposure creates secondary stress that causes the health care worker to feel the inability to ease the pain and suffering of the patient.1

Vicarious Traumatization: is the outcome of health care workers empathizing with the traumatic events that patients experience. It is a compounding process that causes adverse changes in the health care worker’s ability to care for others and their views on the world.1 Simply put, it harms the mental health of those who are close to the patients, care for the patients, and listen to events that affect patients

 

If you recognize any of these attributes within yourself or a colleague, reach out for help. Nova Scotia Health’s Occupational Health Safety and Wellness page has access to many resources and processes to follow.

Occupational Health Safety and Wellness - Emotional Well-being (nshealth.ca)

Debriefing

Here are some resources to help guide and document your process.

Here are 2 infographics about debriefing:

Here is a document to post in your staff areas. These are things that health care workers should ask themselves before leaving their shift.

Confirmation of Completion

Once you have reviewed all the material, click the link below and select the name of the module and date of completion. Fill out the rest of the form and click on Submit. Save or print your certificate, if you have not received a certificate from a 3rd party.

 

Confirmation of completion

References

1. Compassion fatigue: The known and unknown - Journal of Psychiatric Nursing 

2. Moral Distress and the Importance of Psychiatric Ethics (psychiatryonline.org) 

3. Occupational Health Safety and Wellness - Emotional Well-being (nshealth.ca)

4. Resilience in Trauma-Exposed Work - Workbook.pdf (nshealth.ca)

5. Workplace Violence and Burnout Among Mental Health Workers | Psychiatric Services (psychiatryonline.org)