Responding to trauma in the workplace

A traumatic event can be considered as any event which is outside of our usual experience and which causes a significant amount of distress. Depending on our history and personal life experiences, we will all react to these events differently and what may be considered as traumatic to one person, may not be the same for another. 

Some examples of traumatic events which may occur within health and social care settings include: 

• witnessing or experiencing an assault or verbal abuse 
• workplace bullying 
• or events which cause high patient mortality (for example due to the Covid-19 pandemic).  

Some staff, such as first responders and social workers may be more likely to experience trauma at work, although traumatic incidences can affect any team or profession.

Vicarious trauma (also referred to as secondary trauma) is where a person does not experience trauma first hand but is exposed to traumatic material indirectly through hearing, seeing or reading about another person’s experiences. Staff who are engaged in supporting people who have experienced trauma may experience secondary traumatic stress as a result.   

Though not everyone who experiences a traumatic event will go on to develop post-traumatic stress disorder (PTSD), recent research however has identified that healthcare workers experience PTSD at twice the rate to general population (Scott et al., 2022). It is therefore important that organisations are aware of how to support staff at work when trauma occurs.  

Preliminary research has begun to examine the impact of trauma-informed responses to support staff well-being during the COVID-19 pandemic:  

• A rapid response groups of clinicians and researchers created guidance in responding to stress experienced by hospital staff as a result of the COVID-19 pandemic
• The response to the COVID-19 pandemic has meant that more staff are working remotely. The British Psychological Society have composed advice for leaders of teams who engaged in trauma-related work from home
• The following NHS case study explores learning and advice from Northampton General Hospital following the development of staff support services as a result of the pandemic.

Following a traumatic event, a wide range of reactions can be expected. Some individuals may not experience any changes at all, whereas others may experience a variety of responses to the event. Some common reactions which can occur in the first few weeks after the traumatic event can include: 

• Strong emotional feelings (sadness, fear, angry, confused) 

• Repeated thoughts about the event or feeling that though you are reliving the situation  

• Difficulties with concentration and/or memory 

• Flashbacks or nightmares about the event  

• Strong and negative beliefs about oneself or the world around them (I'm bad, It's my fault, the world is unsafe etc)

Though these feelings may feel overwhelming and frightening, it’s important to be aware that they are a very normal response to a highly stressful situation. These reactions can be the brain’s way processing the traumatic situation and it is vital an individual is able to have the time to make sense of the event to enable them to recover.  

These feelings should reduce after a few weeks, however for some people they may last longer and they may start to notice these feelings are having a negative impact on their lives. This may suggest someone is experiencing Post-Traumatic Stress Disorder (PTSD). Not everyone who experiences a traumatic event however, will go on to developing PTSD.  

For more information about PTSD you can visit our webpage coping with traumatic experiences. 

The National Fund for Workforce Solutions suggest that identifying trauma and its impact within a workplace is not always simple. They propose that many employees may not want their employer to know they are struggling. When staff members are experiencing the negative impacts of trauma it may not be obvious and may present as absenteeism, presenteeism or high staff turnover within services. 

As managers tend to be the first point of contact in a crisis situation they should be aware of common signs that someone may be struggling with trauma at work and discuss providing the appropriate support. Some of these signs at work include: 

• Reduced work performance and difficulties concentration at work
• Employees being tearful, anxious or nervous
• Avoiding work tasks or areas in the workplace
• Frequent requests for time off or sickness absences
• Significant changes in an employee over a 6 week period or longer.

Managers should be aware of the service and/or local policies and procedures to follow in response to traumatic or risk related incidents. The Centre for Health Care Strategies advocate for the development of organisations which are both physically and psychologically safe for staff. Line Managers can support staff by facilitating access to psychological first aid and wellbeing conversations.  

Managers should also make staff aware of services which are available to them such as Keeping Well NWL, Employee Assistance Programmes and Occupational Health. 

Managers and leaders in health and social care settings can support staff who have been exposed to a traumatic event at work by implementing a series of processes and recommendations. Immediate action and reassurance to staff helps to foster a supportive work environment and allow staff members to make sense of the traumatic experience. 

Managers and leaders are advised to take the following steps to support staff: 

• Organise a debriefing session as soon as possible for staff members after the traumatic incident has occurred. A debriefing session is a confidential peer support session for staff members involved in, witnessed to or affected by the traumatic event to come together, with the focus on discussing the facts of the incident, acknowledging and validating staff members’ experiences of the incident, arranging care for certain staff members requiring further medical treatment/follow-up support, as well as outlining next steps of accessing further psychological support/resources. Practical support strategies and discussions around common reactions following traumatic experiences should also be incorporated into the debriefing session. The debriefing session is not a therapy intervention but rather a space for staff members to reflect on the impact of the traumatic event on themselves. NICE (2018) recommend that psychological debriefing is not offered as a preventative treatment for PTSD, however instead suggest that active monitoring of emerging trauma response symptoms is undertaken and if these persist after one month since the event, individuals should be referred for a mental health assessment. 

​​​​​​​There are many different models for debriefing sessions, including Mitchell’s CISD debriefing model, Dyregrov’s Psychological Debriefing Model (1989), Raphael’s Psychological Debriefing Model, Armstrong, O’Callaghan and Marmar (1991) and Trauma-Risk Management (TRiM, Jones et. al, 2003). Should you wish to find out more about a Critical Incident Stress Management debriefing session, please get in touch with us here.

• Check in on staff members’ wellbeing during supervision meetings and scheduled 1:1 meetings. Health Education and Improvement Wales have provided some advice on how to communicate with staff following a traumatic event.
• Provide materials relaying information on common stress reactions following a traumatic event to all team members, such as our coping with traumatic experiences webpage or this guidance for staff on coping after a traumatic event from Avon Partnership. 
• Inform team members of key sources of psychological support – Keeping Well hubs, Trust Employee Assistance Programme/psychology services, local IAPT services, GPs and Occupational Health. Monitor staff members for any emerging and concerning emotional or behavioural responses such as increased suicide/self-harm risk, emotional numbing, substance misuse and risk-taking behaviours. 
• Consider if practical changes can be implemented at work to allow staff members to feel safer or if any learning points from the traumatic incident can be executed. A discussion with HR or Occupational Health may be able to help facilitate these changes. ​​​​​​​

• Understanding the Impact of Trauma: explores trauma informed care in the behavioural and health sciences 

• Royal College of Psychiatrists: covers a wide range of traumatic events and the subject of post-traumatic stress disorder (PTSD), which may affect some staff after a traumatic incident. These resources also include a framework on how to support staff following the death of a patient by suicide. View the framework here (opens link)

• Crisis management guide for employers supporting staff affected by suicide

• The American Counselling Association have developed a factsheet on vicarious trauma in  counsellors.  

• ‘The University of Surrey have produced this postvention guidance on supporting NHS Staff following the death of a colleague by suicide