Ep 5: How do we better prepare and support student nurses for critical incidents? A conversation with Tiffany Hood

Posted

October 16, 2022

Show Notes —

Tiffany Hood is an Associate Professor of nursing at Weber State University in Ogden, Utah. She has a highly varied nursing background and in the latter stages of her career has focused more on research. In this episode we talk about her research examining student nurses’ responses to critical incidents at work, to better understand their psychological reactions and help guide more effective preparation and post-event support.

We discuss:

  • The kinds of critical incidents student nurses may be exposed to at work (e.g. death, violence, severe injury and disability).
  • How there is currently a lack of adequate preparation for student nurses to inform them of the realities of what they may witness.
  • How many student nurses enter training with unrealistic expectations about critical events due to popular culture such as what is seen on TV or movies.
  • Why providing student nurses with a space to reflect on a stressful or critical event is absolutely crucial.
  • Why it’s important to factor in a student nurses’ life experience, such as prior trauma and mental health difficulties, when preparing them for rotations and clinical work.
  • How student nurses’ reactions to critical incidents were completely varied, and why it should be stressed to other students that this is completely normal.
  • Why staff and faculty should aim to build a trusting relationship with students, and how this benefits psychological coping in the event of a critical incident.
  • Why it’s important to consider a number of processes and factors in understanding student nurses’ experiences and later adjustment or not, to a critical event.
  • Some tools and strategies for helping better prepare student nurses, which Tiffany currently working on.

You can find the article we discussed here:Student Nurses’ Experiences of Critical Events in the Clinical Setting: A Grounded Theory”

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Transcription —

00:00

Welcome, everybody. It’s Nathan here, a clinical psychologist, and I’m the host of this podcast. So in today’s episode, continuing the spirit of interviews and conversations with quite inspiring colleagues, researchers, and people who are committing their working life to improve the well-being of nurses and midwives. I speak to Tiffany Hood, who is a researcher who’s done some really wonderful work looking at the experiences of nursing students when they experienced critical incidents whilst doing their training. So we’re going to dive into this conversation with Tiffany and she will tell us all about her research, but it really touches on something that I believe in. So it’s really important. And the kind of work that I’m doing is really looking at how we can better prepare nurses and midwives for the potentially traumatic and definitely very stressful experiences that many people encounter in their working life. Whilst Tiffany’s research that we’re going to talk about focuses on nursing students, really her findings, as far as I’m concerned, are applicable to qualified nurses and midwives as well. So she talks about how better preparation but also how better support is needed in the aftermath, days, weeks, and months, for people who’ve been exposed to traumatic and highly stressful incidents in the workplace. And of course, this is really important for students who are often very fresh, they may not have had much even life experience. But it’s also really important for anyone, right? Everyone deserves to have preparation for this kind of work, and everyone deserves better support after they’ve witnessed something in the workplace from their colleagues from their organization.

01:48

The timing of these episodes coincides nicely with some work that I’m doing over here in the UK, working with some local universities, that provide nursing and midwifery courses. And I’m providing some workshops and training to help those individuals who are undergoing that training to be better prepared from an emotional perspective. So talking about and reflecting on perhaps some of the realities of what they’re going to face, some of the positive experiences but the realities of some of the negative experiences, and equipping them with some tools to help them manage those emotional experiences, and discussing with faculty staff, and other nurse leaders about how they can better support their students. So this episode will appeal to a far-ranging audience. If you’re a nurse educator, this is definitely for you. If you’re a nursing or midwifery student, this is definitely for you. And this conversation will have relevance and hopefully resonance for anyone who works in an organization where there is exposure to traumatic or stressful incidents. Before I leave you to this conversation. A final thing to say is if you’re listening to this, and you would like to get more free resources, videos, and articles, and watch some live conversations that we have as part of nurse wellbeing, mission, live conversations with nurses and midwives about their own experience in the field, then come over to our free Facebook group, you can just type it into Facebook, search for nurse and midwife wellbeing mission, and come join the community there. So I now bring you, Tiffany Hood.

03:36

Welcome to the nurse wellbeing mission podcast hosted by me, Nathan Illman. This is the place where nurses’ and midwives’ well-being are the top of the agenda. Each episode aims to help nurses and midwives around the world flourish through informative, inspiring, and practical content and conversations.

04:03

So Tiffany, thank you so much for joining me on the podcast. If you could just start by telling us a little bit about who you are, where you work, and at what you do.

04:14

Certainly, my name is Tiffany Hood. I currently reside in Utah in the United States and I’ve been a nurse for 22 years. I am currently working as a nurse in the operating room at a level-one trauma center and I am an Assistant Professor of Nursing at Weaver State University in Ogden, Utah. And I also have a background in emergency nursing and pediatric nursing and cardiology and adult mental health. 

04:42

So you’ve got a really varied background. And when did your research career take off? When did you get interested in doing research?

04:52

I didn’t go into research on purpose. I had always wanted to be a nursing instructor. I’ve always wanted to teach and was a little bit disheartened when I found out that in order to be a professor, you have to have a research degree. And so honestly, I hadn’t had any plans to be a researcher. But as I went into my graduate education and started taking research courses to prepare to be a professor, I fell in love with research. And I realized that it’s something that I really enjoy. So the topic that I’m discussing today, came to be clear back in 2013. That is a study idea that came about because I was teaching a clinical rotation at a hospital. And there was a student in our clinical rotation that I couldn’t find anywhere I had, I had gone to check on her, and I couldn’t find her. And when we eventually found her, she was back in a back corridor in a hallway, kind of by the storage rooms hiding, and she was backed up against a wall, she was very pale, she was having a hard time talking, and she looked very shaken. And she had just witnessed a big trauma in the emergency room. And you could visually see that it had affected her in a very significant way. And she wasn’t able to continue her clinical rotation that day, we had to send her home because she was so distressed that she wasn’t able to function. So that was kind of the initial point where I really thought wow, these types of situations that students see when they’re in the hospital can be traumatic for them. And it got my interest going in student mental health and the importance of better preparing them for critical patient events.

06:45

And if you don’t mind me asking, how about you? So when you initially did your training, Did you experience any suppose difficult, challenging, rare, highly stressful incidents? That I suppose may have paved the way for this kind of research as well. Or was it more of the experiences you had later on in your career, and with students that you were mentoring or educating?

07:07

It’s more of the stories that I heard later, I was, I don’t want to say lucky, I guess as a student, then, my experience, I kind of dodged a lot of those big traumas and patient deaths when I was a student. So I never experienced anything that to me was traumatic. But I did hear a lot of stories of colleagues who told me things that they saw when they were students that were shocking to me. And I realized that it’s much more common than I ever realized. But it didn’t occur to me until I started teaching. And I was in the hospital, with students and these types of stories just came out of the woodwork from other faculty members or from other students or from the students that I have.

07:48

It links in with something mentioned in the paper actually around the mixed picture students might get so sometimes being warned that you’re definitely going to see this thing and sometimes then maybe conflicting information. So someone saying, Oh, no, no, it’ll be fine. That’s not going to happen. And then obviously, for the unlucky few that it does happen that kind of conflicting messaging is not been particularly helpful.

08:13

Sure, of course, there, there was a student who talked about that in this study about how her faculty told her these types of things are rare, you probably won’t see any of this. We’ll talk about it in class, but you won’t see any of this. And then she did, she saw a major trauma. And it was extremely distressing to her. And she wasn’t mentally prepared to see it because she was told that it was something that was so rare, which I think years ago it was. But it seems like ever since the pandemic, there is more patient deaths than ever, and patients are more critical than ever. And we’re seeing more and more in the last few years, these extremely distressing critical events more than we’ve ever seen in the past. So it’s become more of an issue in the last few years, I think.

08:55

Yeah, certainly. In the article, in this sort of context, you discussed the difference between critical incidents and traumatic incidents. And I guess that’s quite an important distinction to make, isn’t it? So would you be able to just talk a little bit about that? 

09:13

Yeah. So a critical event is a word that’s used in the literature to describe a lot of different types of events. So anything that’s distressing, anything that causes a person to completely use up all of their coping skills, something that could lead to a psychological crisis, there’s a lot of different things that kind of are grouped into that, that category. A critical event could even be a medication error. There are a lot of things that are tied in, in the literature that people call critical events. In this article specifically that we wrote, we defined critical events as events that are a potential risk to life or limb or an actual perceive either perceived threat or an actual threat to one’s life. So things such as anywhere, anything from domestic violence to a mental health patient who becomes mentally unstable to codes and resuscitations and you know maternal hemorrhage, so anything that’s, that is a threat to one’s either mental or physical health.

10:32

Right? And in the paper that we’re going to talk about, well, actually, I mean, this is probably a good opportunity, should we just do want to just give a snapshot summary of what the article is about, and then we’ll go into a bit more detail.

10:45

Sure. This is a study that was done to evaluate and kind of analyze what students go through when they witness what we describe as critical events in the clinical setting, what causes psychological distress versus psychological trauma, and how students reach psychological recovery if they are able to reach psychological recovery. So we did this study, well, I should say, I interviewed 14, nursing students who had seen within the last 12 to 18 months a critical event in the clinical setting. They described what they witnessed, they described their coping mechanisms, their recovery, and some of the things that they had wished that they’d known before they witnessed the event. They described faculty interactions with them or lack of, they described interactions with the nurse they were assigned to that day or lack of, and just kind of their overall thoughts and feelings related to the event itself, how they felt in the moment how they felt right after and then in those weeks and months, and even up to a year afterward, how well they were coping, were they having flashbacks? Were they having nightmares? Was it affecting their personal life, or were they having anxiety and depression? So through this study, we were able to kind of put together the data, and Darcy helped me, as well, as we analyze data, we came up with this theory in this model of psychological distress and recovery. And since then, the research has continued, finishing right now with recommendations. But I’ve been able to travel to many, many conferences all over the country talking about this and learning even more from others. And it was a really powerful eye-opening experience to realize that we as faculty really don’t know what our students are going through, we really don’t know what their home lives are like, we don’t know if they have a support system at home, we don’t know if they have a mental health diagnosis that could affect their coping. And so because of all of the factors that we don’t know, we need to make sure that we’re preparing them ahead of time in our curriculum. And in our simulations and our skills labs, we need to be preparing them better, mentally, to be able to handle these types of events when they occur. And then we need a system in place where after they occur to support them for weeks, months, up to a year, however long it takes to make sure that they don’t experience psychological trauma, we want to prevent psychological trauma in our students.

13:23

I’m totally on board with the idea of psychological preparedness and teaching people some skills and setting expectations and that sort of thing. I think there’s just such a lack of that happens. It’s something that I was I couldn’t help thinking it was probably the psychologist and me. As I was reading through the article, I was thinking, gosh, these students, I expect they actually had quite a positive experience of having you interview them and provide a safe, comfortable space to talk about this. So obviously, it’s a piece of research you’re doing but it reminded me of when I was doing research 10 years ago when I was doing my research Ph.D., and I was working with people with epilepsy and it was all running experiments, assessing memory difficulties and that kind of thing. But I got a sense that it was therapeutic just being with me. Yours was obviously much more in-depth asking them questions about how they felt about things. So did you get a sense of that as you as you were doing the interviews and spending time with them?

14:29

Yes, definitely. And, part of the recommendations paper that we’re coming out with really emphasizes the importance of talk therapy and reflection and journaling, talking with peers, talking with other students talking with faculty talking about the event as much as you can, because of how therapeutic that can be. And many of the participants in this study after our interviews were over and the recording had stopped. They stayed for quite a while just to talk and thank me for taking the time to Let them talk and for how helpful it was for them to be able to process the event again. 

15:05

Yes, fantastic. Would you be able to just tell us about some of the questions you asked? And so that it was a semi-structured interview? Is that right? So what kind of questions did you ask what information were you trying to get from the students that you interviewed?

15:21

There was a list of questions that I had. But I found that I didn’t really have to use them very often, because people really wanted to just talk. So some of the questions that were prepared, just in case people needed them were things like, Well, I always started with just tell me a little bit about what you witnessed or what you experienced, and I just let them talk. But some other questions that we had prepared were things like, what do you wish you would have known before this event? We asked them about their faculties involved in the event, was your faculty member there? Or were you there? Without an instructor there? What was your interaction with the staff nurse that you were assigned to? What was your preparation in your nursing coursework that helped you prepare for this event? Or what nursing coursework? Do you wish you had had to prepare for this event? What were some of the things that you weren’t expecting? And a lot of things that came out of that were that students really based their ideas on critical events from television and movies, and really had this perception that a code or rapid response is what you see on TV, and that was distressing for them. Because in some of these events, the patient was never defibrillated. And that was distressing for them feeling like they were watching this event and feeling like the doctors weren’t doing everything that they could why weren’t they doing everything that they could why aren’t they defibrillating? Why aren’t they shocking them? And going home without the answers to those questions, and really not feeling prepared, not knowing that not every situation can be healed with a defibrillator? So some of those types of questions, and then we asked them, What did you do after the events? What were some of your coping mechanisms? What did the faculty do? What did the university do? Who did you talk to about those types of things, but really, for the most part, we didn’t need or I didn’t need to use very many of those pre-prepared questions because people talked, sometimes for an hour, or sometimes for an hour and a half? And they just wanted to tell me everything on their own. And so it was, it was wonderful, I enjoyed the experience of interviewing them so much because I felt honored that they trusted me with these sensitive issues and these unique experiences that they’ve had.

17:57

Hey, everyone, Nathan here, just a quick break away from our conversation today, just to say, if you’re a nurse educator, or you’re someone working in an organization with an interest in nurse well-being, and you want to find some ways to provide better preparation and support to nurses and midwives, then why don’t head over to our website and nursewellbeingmission.com to check out the work that we’re doing. And for some of the workshops and training that we provide, you can have a look on the website and you can find out ways to get in touch with me and start a conversation to see how we can start better preparing and supporting your team. Okay, let’s get straight back into this great conversation with Tiffany now.

18:38

I guess it’s quite diagnostic of the need to discuss things, isn’t it? The fact that you didn’t really have to ask much and they just wanted to pour it all out. And perhaps it represents the lack of that support or lack opportunity for that that they might have had? In a, you know, that kind of contained setting?

19:00

Absolutely.

19:01

Yeah. Something that I found really interesting that you wrote about was significant, a number of the students that you interviewed had a previous history of trauma or mental health difficulties. And we need to bear that in mind, don’t we, that many nurses? Well, I mean, many people in the population have experienced or witnessed traumatic or stressful things, but also mental health is very common mental health difficulties are very common. Could you just talk a little bit about some of the things that you drew from that in terms of recommendations or things to be aware of? With students?

19:40

Yes. And I want to define the numbers. So it’s right here. Yeah. Nine of the 14 participants had a prior history of trauma, either death of a family member death of a child during childbirth, the suicide of a fellow student nurse, the witness to abuse, or a prior mental health diagnosis. So some of the prior mental health diagnosis that they chose to share with me I didn’t ask, included depression, anxiety, post-traumatic stress disorder, social anxiety, and panic attacks. So nine of the 14 just in this one study had a prior history of something that in one way or another affected their experience. And that was eye-opening. And that is why I feel that we need to be more sensitive to a student’s background. And of course, we can’t ask them about a mental health diagnosis. We can’t ask them those types of questions. But what we can do is ask them to analyze themselves and ask themselves, do I have a mental health diagnosis? Do I have a home support system? Do I have any sort of negative coping mechanisms? What do I do when I’m stressed? Do I turn to alcohol? Do I turn to family? What do I do when I’m stressed, we can ask them these types of questions to analyze themselves and better prepare them before they enter the clinical setting. Just so that they can be aware that sometimes some of the things that we’ve experienced in our past may affect what happens in the clinical setting. So a good example of that was that one of the participants had lost a child during childbirth. And when she was at clinical, the events that she witnessed were an infant resuscitation a neonate, and newborn resuscitation. And she described how difficult it was to sit in the delivery room and to watch this Mother’s anguish as they were resuscitating her baby and doing chest compressions and the baby was blue. And how, in her mind, she was reliving her own trauma of watching that with her baby when her baby was born, and her baby didn’t survive. And in the clinical setting, the event that she witnessed this baby did survive, luckily, but she hadn’t thought until that moment, about this experience from her past and how it might affect her mentally in the future. So it might be a good idea to ask students not to ask them about their past experiences, but ask them to analyze their past experiences. And then if they feel comfortable sharing with faculty if they have something that they feel like maybe faculty should know, then to let faculty know, so that we’re aware, when we bring them on these clinical rotations, just in case, there’s a situation where one of their past experiences might be triggering to them.

22:34

I mean, it seems there’s a really quite nice structured activity that can be embedded within education, though, isn’t that it’s, it’s going to be beneficial for everyone to some extent because reflecting on how your past might affect the things that you’re about to experience is going to be useful. And then if it’s done in a standardized kind of way, it makes it easier, doesn’t it for the students and also for the staff who didn’t, it can be quite awkward or quite confronting sometimes having to talk about mental health if you’re not really trained in it. But if it’s standardized, it’s a bit easier to train people isn’t it too, for them to be able to pick that up?

23:14

Yes, so we’re working on a program at a university right now that we have just started discussing that we’re hoping to start in the fall, where we’re doing clinical self-risk assessments where the students assess their own risk, they’re given a worksheet to fill out. We are implementing some early intervention in our didactic courses, where we’re going to start talking really early about traumatic stress and burnout and secondary traumatic stress and all of those from the very first semester of nursing school rather than waiting until later. And working with our faculty to better train them on debriefing methods so that our faculty who are in a clinical setting can be prepared with resources on how to talk students through events and how to debrief them immediately after. So we’re going to start implementing this and hopefully, we’ll get to see some more positive outcomes. And then go from there and really see what else we need to do after that. And a lot of what we’re doing will be in this next paper that Darcy and I are working on, just about finished but we’ve written a lot about the same things that we’re going to be implementing at our university. My university Darcy works for a different university. Some of the things that we’re going to be implementing at Weber State University and a lot of the things that I recommend based on this study,

24:34

I should say actually, that when you’re referring to Darcy Darcy, as your co-author on this article, the way that we’ve been discussing,

24:40

Yes, Darcy is at the University of Northern Colorado so she works in Colorado, which is about six hours from me, and I met we were State University in Ogden. Darcy is the one who helped me through this study. She’s very knowledgeable in grounded theory, which is the method that I used, and she was wonderful going through the interviews with me, I would analyze them. And I would pull out the data. And I would try and find the major themes and try and build the model. And then I’d give it to her. And she would analyze it a second time, and give me feedback. And together, we were able to narrow it down to these 10 themes and really get a solid model. So I am forever indebted to her because of her knowledge and her expertise. In grounded theory, she was wonderful in this whole process. 

25:32

And the result is really great. I mean, there is such a sense of coherence. And that theory, the model that you’ve created, it’s a pleasure reading the paper and some of the quotes that you provide from the students, but I think I’ve got it in front of me. And the model that kind of ties it all together is really great. So I wonder if you could we’ve obviously kind of jumped around a little bit and talked about a few things. But would you be able to summarize the stages and I guess, your synthesis of that interview data, then?

26:07

Well, there are 10 major themes that I could go over. And then the relationship between those themes can really be best visualized with the model. Some of the themes affect other themes, some are all-encompassing. And so that’s where the model really comes into play. Because it shows really what affects what. And it’s drawn in a diagram form where things on the outside affect everything within. So lots of circles and arrows. But the 10 themes that came out of this study are a relationship of trust, preparation, coping and resilience, finding a role and role conflict, clinical instructor and nurse presents are an active presence in event stress response, post events, stress response, debrief isolation, invalidation, and the aftermath. So those are the main 10 themes, although you’ll see a little bit more than that in the model, those are the main 10 things that came out of this study. And if you want, I can just briefly describe each one, I could talk about it for hours, but I’ll do my best to summarize.

27:14

Yeah, we get we’re obviously gonna put a link to the paper and recommend that listeners go off and have a read of it because it is great. And like you said, with the actual visual in front of you, it makes more sense. Please go ahead. And just to summarize.

27:30

So the relationship of trust is the first theme. And that came about because a lot of the participants described a relationship of trust with their faculty member or with the nurse that they were assigned to that day, and how important it was that they have a relationship of trust with someone in the facility so that if this event occurred, they would have someone that they’re comfortable talking to and being vulnerable with during the event. So the relationship of trust, students described either having a relationship of trust and knowing that faculty member and having spoken to them and gotten to know them in class, and how comfortable they felt and how grateful they were that they were there. And then some other participants talked about how they didn’t have a relationship of trust with their faculty member, they didn’t feel comfortable with them, they didn’t feel like they could be open and vulnerable or debrief with them or share their feelings and emotions, and how that negatively affected their coping, because they didn’t feel like they had someone that they could talk to. 

28:22

Preparation is a pretty big theme. And that is a preparation that encompasses everything from birth to the event. So upbringing, religion, and prior careers. It also included nursing school. So the things that they did in nursing school to prepare them for the skills lab, the simulation lab, the things that they talked about in class pretty much everything in their past that prepared them for this one event. And students describe some ways that they felt they were prepared. But for the most part, they described how they were not prepared, they did not feel prepared. Some of them described how they would go to simulation and it didn’t seem real to them. They would describe how in simulation, there’s always a happy ending, we always save the patient, and everything’s okay. And in real life, most of the time that patient doesn’t survive one of these, especially codes. And so they weren’t prepared like they felt like they could have been a lot of people described how in nursing school some of these more critical events aren’t talked about during the entire first year. Sometimes they’re not talking about it until the second year or the end of the second year. But these events can happen on day one of clinical, you could go into a nursing home and a patient could suddenly stop breathing on day one. And so they described how a lot of the things that they felt they should have known they didn’t learn until later on even a year after the event.

29:52

Coping and resilience, was a theme that came about because of the talks that participants had with us all with me about how this event really built their resilience and really helped them gain coping skills. And a few students talked about how they felt like they did have some coping skills going into the event because of prior careers. One of them had worked in the operating room for years, and she had seen a million patient deaths, and she had seen amputations and she’d seen all these things. And she just felt like she was she had great coping skills, and then others didn’t. The next one, finding a role. That was an interesting theme that I wasn’t expecting. And a lot of participants described how, when this event started, the first thought that they had in their head was, What am I supposed to do? What do I do right now? Do I stand here? Do I watch it? Do I jump in? Do I care for the patient? Do I give medications do I do Truscott? What am I supposed to be doing right now? And this initial shock of I doesn’t know what my role is. And so the paper, describes how important it is to debrief if possible or if you have time have a conversation with the student and really come up with a role and let them know what they can expect ahead of time.

31:14

The next clinical instructor or nurse’s active presence is one of my favorites. This theme came from talks with participants about how even though you have someone in the room with you, that doesn’t necessarily mean that it’s beneficial. What you need is someone who is actively present someone who is supporting you who’s standing right next to you who’s giving you feedback, who’s telling you, your chest compressions are great, just go a little bit faster, or go a little bit slower. So a little bit deeper or standing right next to you and explaining they’re putting in a chest tube right now. And here’s why. And here’s what the patient’s vital signs look like. And here’s why. And they’re not defibrillating the patient right now. And here’s why. And here’s what they’re going to do next. So it’s someone who can be mental support, but also can educate during the event, and really give the rationales of what’s happening and why. And how important that was for their coping. They really needed that. They needed someone explaining almost a play-by-play so that when the event was over, they were better able to cope because they understood the rationales of what was happening.

32:22

The in-event stress response is a gathering of all of the testimony of what people felt and what people thought during the entire event. And that was really fun to listen to them. And to learn how different everybody is some people were excited, and some people were terrified. Some people wanted to run away and run out of the room post-event stress responses similar, that’s the feeling that they had right after the event. And the post-event stress response across the board was pretty similar. People were in shock. People needed time to process, they really needed time to walk around and to think and to have time to breathe,

33:01

Yeah sure.

33:03

right after the events. Three more, so debriefing was the next one. And in the paper, and especially the next paper that we have coming out, we talk about how important debriefing is and how you really need to debrief right after the event occurs. Even if it’s short, you need to sit down with them and let them talk and let them express their feelings, and answer the questions that they have. And how getting a really good debriefing after the event, how that impacted their coping, and really gave students the opportunity to process, and the people who didn’t receive a debrief were much more likely to experience the psychological trauma that we’re trying to avoid.

33:47

Isolation and validation are another theme. That’s a theme that was pretty universal, where after this event, students felt isolated, they felt alone, and they realized that they had experienced something that no one else had experienced, that no one else could relate to. That was this unique experience all their own. And it almost made them feel lonely because they can’t talk about it at home. You can’t talk about it with your family and friends, even if they’re in the medical field. They don’t exactly understand because they weren’t there. And it was another theme that I really wasn’t expecting. But that makes sense. It makes sense that after you experience something, this life-altering that you would have a period of really feeling isolations mental isolation, and validation. We tied into that because students just described how they just wanted to know that they were normal. They wanted to know that what they were feeling was normal. They wanted to know that any feeling that you’re feeling is okay. But there’s nothing wrong with you. If you’re super sad for a long time. There’s nothing wrong with you if you suddenly cry for no reason. There’s nothing wrong with you. If you’re feeling these emotions, it definitely doesn’t mean that you can’t be a nurse. It doesn’t mean that you’re not strong enough. It means that you’re human and that you care. And students really needed to hear that they were going to be okay that they could still be nurses and that they were still cut out for the medical field.

35:13

Failed. 

35:14

Yeah, there were, there was a student who talked about how I signed up for this. And I should be able to be tough enough to handle this.

35:23

Yeah.

35:24

And how impactful and almost sad and heartbreaking it was to hear that, no, I signed up for this. So I should be tough. And I should just be able to handle this. And, I should just get, I should be able to get through this. And I think a lot of students probably have that mindset, that, you know, I went into nursing, I should be able to handle all of these things. So that was a pretty big one. And then the aftermath just kind of talks about their experiences after the event, which sometimes people were okay after a week or so some people really weren’t okay, even a year after, they were still not okay. So the aftermath is, is pretty much everything that happened to them from the time they went home until they really felt like they had reached psychological recovery. 

36:06

It really sounds like for people listening to this for RNs, or student nurses listening is worse. something to bear in mind is that variation is the norm, right? Everyone has completely different reactions to things, there is a vast array of different emotions people can experience in the wake of these kinds of events. The way people cope with them is completely different from people’s needs afterward. Well, they are very different. Although there is that underlying theme that you just mentioned about wanting validation and normalization, I think that’s, that’s a deep sort of need that we all have. And just to know that we’re not, you know, weird or different from other people. But for people listening, I guess it’s just bear that in mind, you know, you’re okay. And your response might be different from your colleagues or other students. But that’s alright. Because you have a completely unique set of circumstances your preparation phase, right, like it’s from birth up until that point,

37:10

Yeah. And you really don’t know what others are going through. So we really need to encourage students not to judge one another, either, and just be supportive of one another.

37:19

Yeah. So talk to us a little bit about the wider implications of all of this. And I guess something that’s probably important to consider, as well as what are some of the barriers to some of the things that I suppose the practice points that lead on from this, in your own experience, perhaps where you work? And more generally, in the nursing profession? What are the barriers?

37:44

I think one of the biggest barriers is knowledge. I think we just really don’t know, the impact that these experiences have on students, even if we debrief with them in a post-conference or something after a clinical experience, they may not choose to share everything. So I think we just, need to be more aware, we need more knowledge to really understand that these students sometimes go home and they cry for weeks, and they have nightmares. And they have flashbacks, they are distracted in class, and they can’t concentrate. And these experiences can affect them far more than we think they do. Another barrier is that we as faculty are often the experts. And we’ve reached this level where these types of events don’t affect us anymore. And we have to be careful. And we have to go back. And we have to remember what it was like to be a student, we have to remember what it was like to have never seen a hospital before. And remember what it’s like to have never experienced these situations, and really put ourselves back in the place of the student to think if I had never been in a hospital before or if I had never heard of this before. What would I be thinking right now?

38:51

I would like to ask people really what their advice is to students to student nurses or people considering going into nursing. 

39:00

Oh, the students. My advice is that whatever you’re feeling is normal. Whatever you’re feeling is okay. And that’s not coming from me that’s coming from one of my participants in this study. And that’s, that’s almost word for word. She said, just know that whatever your feeling is, okay. Another participant really recommended it. This is from a student that they talked to the other students, they talk to their peers, and they gain a relationship with their peers so that they can talk about these experiences with others who really do kind of understand because they’re in a similar situation. And another recommendation for students would be that if you experience something that’s really hard for you to reach out to your faculty and let them know because most universities have resources. I don’t know about other countries or even other states, but here in Utah, most of the universities around here have mental health services within the university. They have a student health center that you can refer people to we have a list of resources that we are now giving our students with phone numbers and crisis hotlines. We have a whole list of places that they can go even after hours, even in the middle of the night phone numbers that they can call, if they really feel like they need help, and they need someone to talk to. So step one, though, is to reach out. And to not be afraid to make a phone call or to go up to a faculty member and say, I’m struggling and I need help. So I can understand that would be hard to do. A lot of students in this study talked about how they didn’t want to be judged by faculty, they didn’t want the faculty member to feel like they were weak, or that they weren’t cut out for this, or that there was something wrong with them. So I would say that your faculty members are empathetic and that you need to take the first step and really reach out and let people know when you need help. And that it’s okay to go get help. It’s okay to talk through these things. And that you’re not alone. You’re definitely not alone. There are a lot of other people who are probably feeling the same feelings that you are and going through similar things that you are.

41:07

They are all so fantastic and very tangible recommendations. And I think a lot of people listening to this will find that very helpful. very validating, and just informative, and hopefully that will lead to some people reaching out when this has happened. Thank you so much for talking with me today or this evening about me and its afternoon view. It’s been a real pleasure. And I think it’s it’s been really great to go through this particular article and talk about something that’s very close to my heart and something I believe strongly in is this preventative work but also really around the emotional curriculum and making changes to help prevent the later development of mental health illnesses. Thank you. That’s a good time too.

41:56

Thank you. Thank you so much for having me.

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