Critical Incident Stress Management CISM dissertation

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Stress Management: Nuclear Energy Institute

Nuclear energy has been heralded as one of man's greatest blessings. It has the ability to supply affordable energy to millions of citizens, solving some of the nation's most critical energy needs. Under normal circumstances, nuclear energy is safe and reliable. Plants have numerous protocols in place to assure that it remains that way. However, nuclear energy also has a dark side and the potential to cause great harm. In any incident that involves the release of radiation causes considerable stress for everyone involved.

Everyone is aware of the dangers of radiation and its effects on the body. Those who work in facilities are trained in all aspects of the dangers and in measures that they can take to protect themselves. Worker safety at a nuclear facility is a high priority and is a continual concern. This concern is magnified if an accident, or human act jeopardizes the safety of the facility. Workers at the facility are particularly vulnerable to stress is associated with critical incidents at the facility. They are closest to the source of radiation and have the greatest chance for high exposure levels.

The Nuclear Energy Institute (NEI) has developed a critical incident stress management (CISM) protocol to help identify and manage issues associated with stress involving a critical incident at a nuclear facility. Concern in the program is not only for the workers at the facility who maintain it on a regular basis, but also for first responders, as they are likely to be exposed to the compound and stress of the critical incident and of the potential for radiation exposure. Nuclear facilities are high risk for the development of stress related conditions among workers and among first responders. The development of a successful CISM program is essential for helping return to operations as normal in protecting the long-term health of those most likely in harm's way. The following examines the CISM plan of the NEI.

Elements of the Program

This program will have several elements that address critical incident stress management from prevention through the recovery phase. The formal elements of the program will include the following.

1. Engaging preventative measures to help prevent critical incident stress

2. Develop interventions aimed at preventing critical incident stress

3. Learning how to recognize the manifestations of critical incident stress

4. Developing appropriate interventions for plant workers and first responders who display these symptoms

5. Developing appropriate interventions to help develop resiliency in stressful situations

6. To understand the role of cultural constructs that may affect the design and implementation of these measures and to integrate ways to resolve them into the critical incident stress management plan.


Rationale for the critical incident stress management plan stems from research in the area of post traumatic stress disorder. Research in this area has largely focused on prevention and intervention featuring the negative effects of critical incident stress. This research will summarize research studies and how the findings can help in the development of the NEI Critical Stress Management Plan.

First responders and nuclear facility workers are considered to be a high-risk category in that they are at risk for a variety of health and mental health consequences, one of which is posttraumatic stress disorder developed as a result of traumatic critical incidents (Pietrantoni & Prati, 2008). The goal of the critical incident stress management program is to examine resilience factors that protect first responders' from consequences associated with stress.

Stress associated with critical incidents can cause symptoms including burnout, fatigue, diminished self-esteem and self-efficacy. These can lead to symptoms associated with other mental hall disorders such as depression and anxiety related symptoms. It is been found that the first responders' self-esteem and self-efficacy is predictive of resiliency after a critical incident (Pietrantoni & Prati, 2008). This research supports the development of preventative programs that focus on building self-esteem and that provide them tools that give them the confidence to handle the stress associated with critical incidents. Having the tools to cope is a key to the prevention of long-term problems. This research demonstrates that training aimed at prevention will help to reduce critical incident stress.

Critical incident stress debriefing is one of the methods that has been developed as an intervention to help first responders to cover from the stress created by the event into return to work as quickly as possible. Critical incident stress debriefing involves group counseling intended to normalize the shared event and to create resiliency among first responders and victims. The effectiveness of critical incident stress debriefing has demonstrated mixed results in the empirical setting (Jacobs, Horne-Meyer, & Jones, 2004).

According to these authors, the results were different among first responders and among victims, yet many of the studies included sample groups that contain both first responders and victims. Jacobs, Horne-Meyer, & Jones, attribute the reported results to skew in the sample populations, making the conclusions of the studies questionable. Their review suggests that critical incident stress debriefing is an effective method for reducing PTSD-related symptoms in first responders, but the same results are not obtained when the debriefing is conducted on victims. Studies indicate that for victims, the debriefing may actually have a detrimental effect on their mental health.

These research studies suggest that training aimed at increasing the first responders' ability to manage their stress will not only increase the resistance to the stress, but will also aid in resiliency after an incident. Critical incident debriefing after the event will further resilience in those that were prepared for the incident through training. The results of the studies lead to the rationale that training as a prevented measure and debriefing after the event are important parts of the Critical Incident Stress Management Plan. Research suggests that preparing for stress in the event of critical incidents begins long before the actual event takes place.


According to Bledsoe, (2002), providing critical incident stress management debriefing can create a legal liability. First responders may use this as evidence that they have incurred an injury through their work environment. However, it is the philosophy of the NEI and this management plan that the health and well being of first responders outweighs any legal liability that the program may create. Aside from the moral responsibility of helping those who help us, not treating the problems and allowing them to grow could also create also liability. The philosophy of this program takes a proactive approach to preventing and mitigating the effects of critical incident stress and in preventing host traumatic stress disorder.

Program Activities

One of the myths surrounding critical incident stress management is that first responders and those who work in potentially hazardous environments are tougher than the rest of the population. Recent research demonstrates that this is not true and that tragedies affect them as severely as the effect the rest of us (Brown, 2006). This program was developed in recognition of the need for mental health services for first responders and those who work closely with nuclear facilities. This program will entail several phases, with a focus on prevention and intervention to increase resiliency after a critical incident. The following activities will be included in the program.

1. Development of a critical incident stress management team to develop and oversee the program

2. Development of a critical incident stress management training program to help build a resiliency among fire department members

3. The development of a plan that will be enacted in the event of a critical incident to help members return to the daily routine with as little impact is possible

4. Conduct of a critical incident stress debriefing a soon after a critical incident as possible

5. Group counseling to help defuse the stress of the critical incident for those who were involved

6. Provision of individual…[continue]

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