Hospital: When doctors and nurses need help themselves – Bavaria

During an emergency cesarean section, a baby is born lifeless. The mother is in the intensive care unit. She lost a lot of blood. She is in very bad physical and mental health. But not just you. Some of the gynecologists, midwives, nurses and resuscitation team members involved may have been tossing and turning in their beds, screaming at their children at home, being overly cautious at work and completely exhausted by lunchtime. Others break down crying months later. Andreas Igl, managing director of the Association for Psychosocial Support (PSU-Akut), hears stories like this all the time. “These are all normal reactions to an abnormal event,” he explains.

However, Igl doesn’t think it’s normal that most hospital employees are still alone with these problems. It has been standard practice for years in the fire department to offer the team emotional support after a difficult mission. In the healthcare sector, however, it is the exception. The people there stepped up to help others. “Everything is subordinated to the patient,” says Igl. But sometimes the helpers also need help. The PSU club has been fighting for this for years.

Supported by the German Medical Association and private foundations, they have set up an emergency number and a crisis team for clinics. More importantly, they taught doctors and nurses in workshops how they can help each other on the ward. In Upper Bavaria and Munich, where a few hospital doctors once started the non-profit project, the offer is now quite well known. But the breakthrough for Bavaria only came this year: the previous Health Minister Klaus Holetschek wanted to do something for the doctors, nurses and carers hit by the corona pandemic. He made it his mission to promote health for hospital employees. The association’s work should now be cast into a solid structure throughout Bavaria. The project will be financed until 2024, Holetschek announced at the beginning of October. They are now setting up a specialist and coordination center for psychosocial support; a contact point that is always there, even when there is no fire.

This is unique in Germany, says Igl. Many clinics have a psychologist. But who takes their problems seriously enough to knock there? The interview would have to be offered automatically after a difficult operation. He is convinced that it is best from a trusted colleague. At the PSU-Akut association they rely on this help from colleagues. It’s the real secret why PSU works so well, says Igl.

“I know, passes by.” A sentence like that, spoken by a colleague, could have a healing effect, explains emergency paramedic and social worker Peter Zehntner. He works as a trainer for the club. Last Wednesday, eleven people listened to him excitedly in a seminar room in Munich. He talks about how he had to revive a person for the first time. Afterwards he had a feeling of pressure in his hands that wouldn’t go away no matter how often he washed his hands, he says. “I know, it passes,” said a colleague – and with this one sentence he gave him the psychological support he needed. “You all have these conversations every day, and you’re doing it well,” says his assistant coach Barbara Zimatschek to those present. In the seminar they could now learn to bring a bit of structure to these conversations.

That’s exactly what they want here. One participant reports that she is a company doctor within the clinic. “Everyone has to come to me, something often breaks out.” She would like to have “a few tools of the trade” for this. The newly qualified senior doctor at a children’s clinic feels the same way. She is responsible for the simulation center there, so she practices with teams of doctors and nurses what to do in emergency situations, for example if a child suddenly convulses or needs to be resuscitated. This also triggers a lot of feelings. Recently, a participant ran out of the room crying because the situation was so similar to a previous experience, she says. An anesthesia nurse, on the other hand, reports on numerous disasters that she has experienced in 17 years of work, including car accidents with seriously injured children, the worst accidents at work or a violent attack in which a friend of all people was affected. “It would have been nice if we could have put the crap somewhere.”

They should now be responsible for this themselves. In a seminar lasting several days, the association trains participants to become contacts who are available long before anyone gets up the nerve to go to a clinical psychologist. But which words help when a colleague cannot cope with a situation? Sometimes all it takes is a small incident, a wrong remedy that you almost gave. A seriously ill child wearing the same socks as his own. Saying “I know” is good, advises the trainer. “It will pass” too. “The following happened to me recently,” not so much. You don’t want to burden your colleagues with more disaster stories.

With the right conversation, people can often quickly stabilize themselves and go back to work. They know this from research. In times of severe staff shortages, this is an important argument for supporting employees psychologically. If there is no contact person during the hectic night shift and in the days afterwards, the experiences can haunt the employees for weeks and months. Some people leave the profession altogether because of this.

If you allow the memory to happen, you clear your brain

But why do some events haunt us until we sleep? It’s up to our brains, explains PSU managing director Igl. In exceptional emotional situations, we store the memories in a different place than usual. They then lie dormant in the so-called amygdala, which the PSU managing director likes to describe as a disordered, smelly laundry basket. When the images come back in your head at night, it’s basically the brain’s request to tidy up, take what you’ve experienced out of the basket and put it away neatly. Allow feelings, share memories and seek comfort. This helps with tidying up.

Psychosocial support makes exactly that possible. The clinic with the dead baby has therefore invited a PSU team to come to it. There is already a trained employee there. However, the disturbing birth of a dead child affected many employees, from the delivery room to the resuscitation team and the intensive care unit. They were grateful for the help from outside. In such situations, the crisis team invites everyone to sit in a large circle. Anyone who can can go through the difficult shift again. If that’s too much for you, you’ll at least find out why you might be feeling bad and where you can find help later. But many people use such meetings to get everything off their chest or to mourn, reports Igl. Then they continue. They will be needed again.